Photo: © John Stephen Oluoch
When I finished my medical degree, I wrote a final dissertation on the prevention of suicide among adolescents. The subject was not popular at all, comparing with my colleagues' works on cancer, heart disease and other pathologies, but the dissertation could make a difference. If we look from a global health perspective, we quickly realize the absence of attention given to mental health issues. So the question is: is there place for mental health in global health initiatives?
The situation in middle- and low-income countries is not comparable to the reality in developed countries, even knowing all the stigma about mental disease in our society. When one thinks about developing countries, the attention is usually focused on HIV, poverty, malnutrition and child health. Mental health is forgotten and so are mental patients in those countries: there are no psychiatrists, there are no clinics, there is no support and no respect for the patients.
The Global Mental Health Series published by The Lancet last month (see link below) is a remarkable contribution to bring mental health to people's attention. The main aim is to set new priorities for development and make mental health part of them. According to the World Health Organization, the average spending for mental health care in low income countries can be only 0.25 USD per person per year. Again, we have to maximize the stigma associated with mental disease we see in our daily lives to imagine the huge discrimination psychiatric patients suffer in developing countries. Being mental health so highly stigmatized worldwide, those who fund global health initiatives don't see mental health as being a priority. Apparently, this is also the case of the UN which has excluded mental health from the Millennium Development Goals. Mental Health is an issue marginalized even among us, who live in developed countries, but things must change if we want to solve the problems instead of pretending they don't exist.
In order to scale up mental health care it's important to have a good picture of the problem. There is a tremendous shortage of mental health workers, and the situation can be as desperate as in Eritrea or Liberia, where there is only one psychiatrist for the entire population! But training is only a part of the problem. There is a need to establish new partnerships through which governments should work with NGOs and other agencies to find solutions for those who have no voice: the psychiatric patients. Planning is a good start, but let's not forget about the funding: inadequate funding constrains the few public institutions’ ability to maintain and upgrade their facilities for mental patients. For example, in Ghana a 2003 government report showed that there were only three psychiatric hospitals available to the over 24 million people in the country, all of which are under-funded, overcrowded and located in the urban and better-developed South of the country.
In conclusion, there are no psychiatrists, no institutions and no drugs to support mental patients in most developing countries. They are stigmatized by their communities, sometimes tied-up, and are usually homeless and jobless, walking around their villages or towns. Social stigma is a delicate problem that helps to establish a direct link between poverty and mental illness. There is an urgent need to break this cycle. To do so, it's crucial to sale up mental health. Mental health has an important place to take in public health and basic human rights issues but specially a valuable role to play as development priority.
In order to scale up mental health care it's important to have a good picture of the problem. There is a tremendous shortage of mental health workers, and the situation can be as desperate as in Eritrea or Liberia, where there is only one psychiatrist for the entire population! But training is only a part of the problem. There is a need to establish new partnerships through which governments should work with NGOs and other agencies to find solutions for those who have no voice: the psychiatric patients. Planning is a good start, but let's not forget about the funding: inadequate funding constrains the few public institutions’ ability to maintain and upgrade their facilities for mental patients. For example, in Ghana a 2003 government report showed that there were only three psychiatric hospitals available to the over 24 million people in the country, all of which are under-funded, overcrowded and located in the urban and better-developed South of the country.
In conclusion, there are no psychiatrists, no institutions and no drugs to support mental patients in most developing countries. They are stigmatized by their communities, sometimes tied-up, and are usually homeless and jobless, walking around their villages or towns. Social stigma is a delicate problem that helps to establish a direct link between poverty and mental illness. There is an urgent need to break this cycle. To do so, it's crucial to sale up mental health. Mental health has an important place to take in public health and basic human rights issues but specially a valuable role to play as development priority.
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