Mental health is a worthwhile goal for United Nations Sustainable Development Agenda

 

no-health-without-mental-health

The post-2015 development goals will, as we know, set out the world’s development agenda for the foreseeable future—in the same way that the Millennium Development Goals provided a framework for global development over the past couple of decades. The United Nations is now preparing to choose its new set of sustainable development goals and the Global Mental Health community must work hard to ensure these goals include mental health.

Professors Vikram Patel and Graham Thornicroft have recently published an article in the British Medical Journal, which outlines why the case for including mental health in the UN’s new development agenda is a compelling one.

Indeed their case is compelling. When we think about it logically, it makes sense: poor mental health is a precursor to reduced resilience to conflict, they argue. In the midst of conflict, hope is a scarce resource and instead of teaching hope, “in the aftermath of war people with mental illness are often accorded the lowest priority”. If we think about the seemingly intractable global conflicts of today, from Syria and Iraq to the massacre in Gaza, the call to address mental health concerns as a priority development agenda, and as a result, rebrand mental illness and teach hope to thousands, is most pertinent.

Including mental health in the new global development agenda will also go a long way towards ending the paralyzing stigma associated with all kinds of mental illness. Not least, the most common mental disorders like depression and anxiety would be well on their way to receiving a more hopeful image globally, recognized as issues which affect us all personally and as communities, cities and countries.

Thornicroft and Patel in fact argue that if mental health is included in the new development agenda and mental health systems are globally improved, that would also “have a decisive role in making cities and human settlements inclusive, safe, resilient, and sustainable”. For addressing mental health concerns of an individual is not only beneficial to the person suffering, but when the problems associated with mental illness are given importance by society and a collective effort to address them is taken, it will inevitably create a sense of common belonging, hope, equality and indeed resilience among communities.

This would then also require addressing the income and economic inequalities faced by people who suffer from mental health problems. They have far lower rates of employment, but also, in times of economic recession, a population’s mental health is worse, argue the two professors. If we can thus promote a principle of ‘sustained, inclusive and sustainable economic growth, full and productive employment and decent work for all,” again this too would benefit wider society as a whole.

The narrative which is understood by these arguments is that mental health problems are a global issue that impacts not only those who suffer, but wider society and large populations of human settlements. It is thus, for our collective benefit that we make treatment available to people who are suffering and in turn spread the message of hope globally.

The reasons that we need to push for the inclusion of mental health in the global development agenda are of course many, and only a few have been mentioned here.  But what is important to remember is that the proliferation of mental health problems is the result of collective ignorance of these issues over a long period of time. When we can talk freely about depression, anxiety and other mental illnesses, we can find and develop ways to tackle these issues whether it’s through modern medicine, community-building or teaching hope to young people. What we do know is that the conversation can become truly global if we can secure mental health in the Post-2015 development agenda. The BMG editorial rightly highlights that mental health is a worthwhile goal for sustainable development.

A new article written by Bidushi Dhungel

Young and Vulnerable: The biggest tragedy regarding youth mental illness is collective inaction

This year, United Nations International Youth Day (IYD), on August 12, has been designated to celebrate the importance of youth mental health with the slogan ‘Mental Health Matters’. This is an opportunity, particularly for low and middle-income countries, to highlight a vitally important—but utterly neglected—aspect of youth life. The neglect has occurred on many levels by both state and society. In a statement, UN Secretary-General Ban Ki-moon rightly highlighted the global urgency to address the stigma and discrimination of youth with mental health conditions.

For the majority of youth who suffer from mental illness, they are forced to live a life of rejection from friends, society and relatives. They are denied the status of ‘citizen’, social membership and basic human needs, robbing them of a dignified life. Around the world, mental illnesses play a significantly negative role in the development of hundreds of millions of youth and their social and economic inclusion and empowerment. In poor countries like Nepal, the young population with mental illness is in a particularly vulnerable position because of the lack of a public health approach in dealing with mental illness, the absence of basic support for their recovery from the state and the deeply entrenched stigma of their illness.

More at risk

Coinciding with the IYD 2014, the United Nations Division for Social Policy and Development, the Department of Economic and Social Affairs has published an insightful report, ‘Social Inclusion of Youth with Mental Health Conditions,’ targeting global actors involved in the field of youth empowerment. I would recommend that youth activists and development workers in Nepal and abroad read this report seriously.

While the young years of life are usually considered to be the most physically active, healthy and energetic of one’s life, this phase is also one when people are most susceptible to mental health problems. However, in many low and middle-income settings, the latter risk is entirely ignored. I do hope that the exposure the issue is getting this year will be instrumental in changing the outlook of mental health, particularly of youth mental health, across the globe.

Nearly one fifth of the global population is comprised of youth aged 14 to 24 years. Almost 90 percent of these live in low and middle-income countries. In a study carried out by Professor Vikram Patel and his team, it is estimated that approximately 20 percent of youth experience a mental health condition each year around the world. Because the youth years are a phase of emotional transition and a time to nurture and pursue childhood dreams, the pressure to study well, find jobs and opportunities is also high.

Drug use, emotional and learning difficulties and disappointment are common. In countries like Nepal, socio-economic disparities and practices of early marriage and strenuous labour can make the situation worse, leaving young people more at risk of experiencing mental health problems than anyone else. Many studies suggest that over 70 percent of mental disorders start before the age of 16. One in nine children attempt suicide before high school graduation and 40 percent of those are in grade school.This is clear evidence that mental health services must be developed to target young age groups.

Educating and collective action

OPRF School Planting, 2013

The prevention and promotion of mental health issues is the way to deal with the growth in mental health problems amongst the youth. Integrating mental health issues into school education is the most effective approach to prevent and promote mental well-being. With an ambition to institutionalise mental health education at the school level and teach hope from an early age, US-based entrepreneur Kathryn Goetzke and her team have just started a pioneering programme, Schools for Hope. This team strongly believes that we can teach our kids how to find pathways to hope, no matter what they experience and that ultimately, we can prevent suicide in youth and adulthood. If this programme is successful, it will be a revolutionary step forward in promoting and institutionalising emotional health and mental well-being.

The biggest tragedy regarding mental illness is collective inaction, which has perpetuated tremendous fear, uncertainty, helplessness, segregation, and hopelessness in the lives of those who suffer. Rather than the illness itself, a fear of social rejection and segregation leads almost a million people to commit suicide every year, with the majority of them young people. By promoting greater social inclusion and empowerment of youth living with mental illness in society, we can change this reality.

It is also vitally important to spread the message that effective services (both social and clinical) exist to manage all kinds of mental health problems. We need to build capacity and a knowledge base to address them. Now, we have to start demanding equitable investment for the mental well-being of the population by asking that the state make holistic mental health services available and accessible for all.

 A new article written by Jagannath Lamichhane

Lamichhane is global coordinator of the Movement for Global Mental Health

Hidden Pictures and the World Health Organization: A Journey to Uncover Global Stories of Mental Health

Hidden Pictures Film

Here is a video we are all about right now at iFred. It’s a summary of the film Hidden Pictures by filmmaker and physician Delaney Ruston. Ruston’s work highlights both the serious need for global mental health resources and the power our personal stories can have

iFred joined global leaders to support the World Health Organization in crafting the Mental Health Global Action Plan by in 2012, that was then adopted by the United Nations in 2013.  Countries around the world convened to discuss implementation of the action plan for Global Mental Health Day in October, 2013, and, with policy highlighted in Ruston’s film. Have you browsed the document yet? You can read an mhGAP summery here or the entire document here. on creating social change.

Watch the WHO and Ruston’s video here and tell us what you think:

Hidden Pictures

In order to address the suffering of those with mental health problems, there needs to be a radical shift in the understanding of mental illness

-Jagannath Lamichanne

I have always believed that the challenge of dealing with mental health problems is their invisibility. Anyone who suffers from mental illness repeatedly questions: Does it exist? Do other people also suffer the same problem? Do people believe that my mental suffering is real? Does it make me different? It is to provide answers to such complex questions, to promote the visibility of mental health, promote their acceptance and find ways to address the problems related to them that I have been working.

I learned early on that mental health problems were of serious concern to many people around the world. For example, depression, — the most common of mental illnesses — if left untreated, can lead to disastrous personal, social and even economic costs. Further, the lack of treatment and right to live with integrity as an

"...our big challenge is the legitimacy of civil society voices who have been struggling for years demanding the recognition of human rights and the social condition of people with mental health problems."

“…our big challenge is the legitimacy of civil society voices who have been struggling for years demanding the recognition of human rights and the social condition of people with mental health problems.”

equal member of society for those who suffer is an infringement on their human rights. This is especially true in under developed and developing countries where resources are scarce and access to any kind of treatment is bogged down with stigma alongside financial burdens.

In 2010, the World Health Organization (WHO) released a report titled “Mental Health and Development”. It focused on the civil, economic, human, and health rights of people with mental health conditions. According to the report, “the majority of development and poverty alleviation programmes do not reach persons with mental or psychosocial disabilities.” It goes on to say that between 75 percent and 85 percent of people who suffer from a variety of mental health problems do not have access to any form of mental health treatment.

But what is most crucial is the impact that such problems can have on society and on personal well-being of those who suffer. The report suggests that those with “mental and psychosocial disabilities are associated with rates of unemployment as high as 90 percent” and that they are “not provided with educational and vocational opportunities to meet their full potential”.

The lack of treatment and the stigma associated with mental illness has pushed those who suffer to the extreme margins. However, the relevance of mental health as a global issue is further established when one examines the link between chronic physical illness and mental illness, for mental illness is not an isolated occurrence.

According to WHO, four chronic illnesses—cardiovascular, diabetes, cancer and respiratory illnesses— are responsible for 60 percent of the world’s deaths. Further, The Lancet series on Global Mental Health suggests that persons with these chronic illnesses have much higher rates of depression and anxiety than the general population. Major depression among persons experiencing chronic medical conditions increases the burden of their physical illness and somatic symptoms. More importantly, it increases medical costs and mortality.

The bottom line is that mental illnesses occur with chronic physical illnesses in many patients, causing significant role impairment, loss of productive hours and disability. They also worsen prognosis for heart disease, stroke, diabetes, HIV/AIDS, cancer and other chronic illnesses. But the majority of factors responsible for mental illnesses — like depression among those suffering from chronic illnesses — are not being adequately addressed.

It has been a hard job for us to educate people that mental illnesses are a result of both social and medical conditions. While improving the quality of mental health services in coordination with physical health services, we also need social attention, care and support to ensure the recovery of people with mental health problems.

For this, the WHO report suggests two development paradigms: the need to improve aid effectiveness in poor countries; and the use of a human rights approach (universally) that ensures there are sufficient resources to provide quality services for people with mental health problems as well as their inclusion in development programmes.

Still our big challenge is the legitimacy of civil society voices who have been struggling for years demanding the recognition of human rights and the social condition of people with mental health problems. There is a need to create a strong social force for radical changes in the mental health area.

(With support from Bidushi Dhungel)

 

The Past, Present, and Future for Depression; A Perspective of Hope from Geneva

 

As I sit here at a crowded Starbucks in sunny Geneva Switzerland, preparing for the meeting tomorrow at the headquarters of the World Health Organization, I marvel at how far we have come in the field of mental health since my father’s suicide over 20 years ago.  In those days, we looked upon suicide as a poor choice a person made and simply did not talk about it.  Today, while we still have a long way to go, we are starting to understand that it is more than a choice; it is a complicated combination of life circumstances, chemical processes of the brain, genetics, and childhood trauma.

Last year I had the privilege of attending the discussion of the ground breaking resolution for the UN to make global mental health a priority throughout the world with a proposed Global Mental Health Action Plan.  On May 27th, 2013 the World Health Assembly adopted the “Comprehensive Mental Health Action Plan 2013-2020“, putting the world on notice that mental health must be a priority.   I have the honor of attending the WHO follow-up conference tomorrow October 7th, during Global Mental Health week, to hear across the globe how member states and affiliated organizations are going to put the plan into action.

In 2004 when I began my work to end the stigma of depression through rebranding, less than 25% were receiving treatment leaving a full 75% of the world population untreated.  Last year, the World Health Organization statistics reported that the number untreated is now 50%, so while progress might not be evident it is improving.  These statistics bring me joy and gratitude that the tireless work of the people in the field of mental health, creating awareness and bringing services to the 350 million with depression, is not happening in vain.

That being said, there is much left to do.  Depression is now the leading cause of disability worldwide, yet it is treatable.  It is significantly underfunded and still highly stigmatized and there is much more to do to bring treatment numbers to 100%.

I encourage you to join us October 10th, Global Mental Health Day, to learn more about depression.  Join us in watching the free, live Global Web Screening of Hidden Pictures, the first feature documentary on global mental health.  Read and share information on mental health from organizations like Psyhcentral and Webmd with perspectives from both the medical profession and patients.  Or take the pledge to plant a virtual sunflower, showing your solidarity in our movement to bring dignity and respect to those living with depression.

Follow us on Twitter and join our Facebook community for posts throughout Global Mental Health week.  There is Hope.  Depression is treatable.  Share the word and help save a life today.

 

 

World Health Organization Adopts Mental Health Action Plan

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We recently learned that the 66th World Health Assembly has adopted the World Health Organization’s comprehensive mental health action plan (2013-2020). The action plan is the outcome of extensive global and regional consultations over the last year with a broad array of stakeholders including: 135 Member States; 60 WHO CCs and other academic centers; 76 NGOs and 17 other stakeholders and experts.

As one of the 76 contributing nonprofit organizations at the forum, we are proud to have played a role in the development of this Action Plan as we feel it is a critical step in the right direction of eradicating the stigma of depression and meeting the needs of the 350 million worldwide living with the disease.

As part of our ongoing efforts to be leaders and advocates for the disease, we plan to have International Foundation for Research and Education on Depression (iFred) representatives once again at the mhGAP Forum in October to discuss the launch of the plan and its implementation.

The four major objectives of the action plan are to:

  • Strengthen effective leadership and governance for mental health.
  • Provide comprehensive, integrated and responsive mental health and social care services in community-based settings.
  • Implement strategies for promotion and prevention in mental health.
  • Strengthen information systems, evidence and research for mental health.

We look forward to continuing collaboration with WHO representatives and working towards solutions that will give hope to millions living with depression.

For more information about the Action Plan click here.