E-Kantipur

The Sept 19-20 United Nations General Assembly meeting on Non-Communicable Diseases was the highest level meeting dedicated to NCDs in  UN’s history. Prior to the meet, there was much excitement that the General Assembly would give high priority to address the leading causes of NCDs. But, sadly, mental health problems, a leading component of NCDs—comprising 14 per cent of the global burden of all diseases and 20-45 percent of the burden of all disabilities—were entirely excluded from UN agenda.

The exclusion of mental health from UN agenda is a perfect example of how the high level of stigma against mental health affects the required action at the top. Thus, in order to prevent the UN form being guided by wrong social stereotypes in dealing with mental health, “World Mental Health Day-October 10” is being celebrated around the world with the slogan “The Great Push: Investing in Mental Health”.

Most recently, the Movement for Global Mental Health and the World Federation for Mental Health have intensified efforts to ensure mental health needs of populations are addressed on time. As highlighted in the first Lancet (Medical Journal) Series on Global Mental Health-2007, huge increases in resources to address mental health problems is called for worldwide. Scarcity of resources for mental health, inequity to access, and inefficiencies in their use have serious consequences, the most direct of which is that people who need care get none.

Mental health problems are largely neglected and stigmatised in low and middle income countries where government spending on mental health is far lower than the needed amount. This neglect at the government level is often reflected at the international level including the UN. Almost a third of the countries worldwide do not have a specific budget for mental health and one-fifth of those that have, spend less than a per cent of their budget on mental health. For instance, Nepal spends less than 0.8 per cent of its healthcare budget on mental health, which is a national shame.

Professor Eliot Sorel of George Washington University School of Medicine and School of Public Health terms UN’s exclusion of mental health from its NCDs agenda as unfortunate. Professor Sorel argues that “mental disorders are a highly prevalent group of NCDS affecting the lives of one out of 4-5 people each year. Factors related to mental illness can interfere with the treatment of other illnesses and frequently co-occur with cardiovascular disorders, diabetes, cancer and other non-communicable diseases.”

As stated in the Lancet series on global mental health, every year up to 30 per cent of the population worldwide suffer from some form of mental disorder; at least two-thirds of those receive inadequate or no treatment, even in countries with the best resources. The treatment ‘gap’ approaches 90 per cent in many developing countries and the cases of severe rights violations of people with mental health problems are rampant.

According to the Lancet series, the cost of providing an optimal level of mental health services is estimated at US $2 per person in the low-income countries and US $3-4 per person in middle-income countries, which are modest figures compared to the costs of scaling up services for other major contributors to the global disease burden like cancer and diabetes. In fact, the truth is that if not addressed on time, mental health problems increase the risk for many physical illnesses—cancer and diabetes included.

In addition to the scarcity of resources and the lack of political commitment to address mental health needs and people’s rights, stigma and discrimination play a vital role in dehumanising mental health sufferers and prevents individual and families from seeking help. The good news is that mental health problems are diagnosable and treatable. According to Professor Sorel, people can return to productive lives and positive relationships in the majority of cases. “The main barriers to successful treatment,” says Sorel, “are stigma and discrimination that still prevent individuals in all countries from seeking treatment on a timely basis. The major problem is the lack of access to basic mental health services.”

Despite the evidence of increasing mental health problems in developing countries, progress in mental health service delivery has been slow. The political will to create accessible and humane mental health care is almost non-existent in developing countries. There are multiple barriers that push mental health into the margins. The biggest of these barriers are associated with resources (human and financial), leadership and public attitude.

It is with the commitment to overcome these barriers that World Federation for Mental Health in partnership with the Movement for Global Mental Health has launched an initiative called the Great Push for Mental Health. The Great Push has four elements: Unity, Visibility, Rights and Recovery. This initiative advocates the need to address mental health in a broader framework, including human rights and development perspectives in the course of treatment of mental disorders. Thus World Mental Health Day is an important opportunity for us to enthuse new energy into achieving the goals of The Great Push. 

Given the high prevalence of mental disorders, widespread rights violations of people with mental health problems, and the great burden of psycho-social disabilities related to these illnesses both on individuals as well as the society, it is imperative that mental health is included in the UN agenda in the very near future.

Let’s join our hands to celebrate this World Mental Health Day in order to build up the pressure for the achievement of The Great Push goals. This will help us build up an environment where mental health is a top priority of any society and is recognised as part of the fundamental human rights.

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