“When it comes to mental health, all countries are developing countries. A country that does not look after the treatment of more than 50 percent of people with depression living in that country, a country that allows a million people to stay in prisons when suffering from mental disorders, is it a country that can be called a developed country for mental disorders or mental health? You answer that.” –Shekhar Saxena, November 2016
This past August, Patricio V. Marquez and Shekhar Saxena wrote for Cerebrum on making mental health a global priority. This month, Saxena, a psychiatrist and director of the department of mental health and substance abuse at the World Health Organization, spelled out the challenges and opportunities during a discussion at the annual meeting of the Society for Neuroscience (SfN).
From the Cerebrum essay:
“Mental health is an essential part of human existence—but it tends to be transitory for millions of people throughout the world. Mental disorders can also be triggered by massive social dislocations—driven by economic crises, such as the financial crisis of 2008; civil conflicts, war, and violence in places like the Middle East, Central America, and Africa; epidemics like the recent Ebola outbreak in West Africa; or earthquakes, such as the recent one in Nepal. Even after economic growth returns and unemployment drops, peace settlements are made, or we reach zero Ebola cases; after the dead are mourned and the rebuilding of countries gets under way, there is long-term damage left behind in the social fabric of affected communities and the mental well-being of individuals.”
Marquez and Saxena describe costs to individuals, communities, and nations, including gigantic economic and lifespan losses:
“It has become increasingly clear that most countries in the world are ill prepared to deal with this often invisible and overlooked health and social burden. In the second decade of the 21st century, not much has changed in how many countries view and deal with mental illness. Some are still using 17th century tactics to “protect society”: confining and abandoning the “mad” in asylums or psychiatric hospitals, often for life, which grossly compounds the negative impact on these individuals and on society as a whole. Despite its enormous societal burden, mental disorders continue to be driven into the shadows by stigma, prejudice, and fear that disclosing affliction may mean jobs lost and social standing ruined, or simply because health and social support services are not available or are out of reach for the afflicted and their families.”
In both the essay and his talk (see video, below), there are many scary details and some hopeful signs. Someone in the world commits suicide every 40 seconds, more than people who die of malaria or breast cancer. Nearly half the people in the world live in countries that have less than one psychiatrist for 100,000 people. “There is a large gap between the [disease] burden and the budgets” of countries and world organizations, he said at SfN.
“We ignore them [the mentally ill] until the time their diseases become much larger, and it kills them much earlier than they should die,” Saxena said, “and this is a scandal. In the current society, we allow them to suffer because of their mental disorders but also to suffer because of their physical disorders [related to their mental troubles and arising from them], and they die much earlier.”
Specifically on neuroscience research, Saxena was equally withering: “More than 90 percent of scientific studies are from and about high-income countries. We are ignoring a very large number of people living in this world. Can we still say that we know the human brain” if we only study 10 percent of people?
Saxena described national and global initiatives to expand and improve health care, and gave examples of effective mental health strategies such as Japan’s approach after disasters such as earthquakes. He describes more in the essay, including a call for collaboration:
The physical, social, and economic burden and cost of mental illness are too large to ignore. Since the impact of mental health is pervasive and relevant to not only health but to other sectors, like education and labor, investing in mental health would significantly contribute to more general efforts to reduce poverty and share prosperity. Indeed, many non-health related global concerns have clear linkages to mental illness, such as enduring poverty, natural disasters, wars, and refugee crises. Also, such existing health priorities as non-communicable medical diseases, child health and HIV are inextricably related to mental health. They provide entry points to link priorities and collaboration with relevant actors in order to increase investment in mental health.
Saxena calls for all of us to do what we can to destigmatize mental illnesses and help people get the care they need. Not only is such action humane, but it is also good for economies, personal, national, and global. As he put it at SfN: “If there’s no health, there’s no wealth, either.”
In this video from SfN, Saxena’s talk starts at 7:30; a panel discussion starts at 44:00; the audience Q&A at 1:10:00.
The first lecture of each of SfN’s annual meetings is called Dialogues Between Neuroscience & Society; in other years, speakers included Senior US District Judge Jed S. Rakoff, artist Chuck Close, and “Top Chef” star Bryan Voltaggio.
– Nicky Penttila