Mental Health Moves Up Global AgendaBy Katie Nguyen AlertNet April 19, 2013
LONDON (AlertNet) - Member states of the World Health Organisation<http://www.who.int/mental_health/en/> are expected to adopt an action plan to address mental health disorders, a leading - but often neglected - cause of suffering and disability around the globe. Mental disorders account for about 13 percent of the total global burden of disease and affect more than 450 million people. Not only do mental disorders cause increased mortality and a great deal of disability, but sufferers often face stigma, discrimination and abuse. Up to 85 percent of people with severe mental disorders in developing countries are unable to get treatment, compared with up to 50 percent in richer nations. But in a sign countries are taking mental health more seriously, WHO member states agreed a resolution last year requesting that the organisation draw up a plan to promote mental health. The Global Mental Health Action Plan 2013-2020<http://www.who.int/mental_health/mhgap/mental_health_action_plan_EN_27_08_12.pdf> is expected to be endorsed at the World Health Assembly in Geneva next month. Ahead of the meeting, AlertNet spoke to WHO's Dr Michelle Funk<http://cmhlp.org/faculty/michelle-funk>, who coordinates mental health policy, about the aims of the plan, the chances of mental health being included in the next set of development goals and why mentally ill people are being chained up<http://www.trust.org/alertnet/news/ghanas-mentally-ill-suffer-widespread-abuses--report/>.
Q: Why has mental health become important for countries? A: Over the last 10 years there's been much more awareness of the extent of the burden due to mental disorders (and) the inadequate response ... to addressing mental health problems. The approach (of addressing it) through developing mental institutions is not at all adequate, and in fact has led to a number of serious human rights violations for people with mental disabilities. Human rights violations towards people with mental disorders are some of the worst of any particular vulnerable group. These are violations that are not just happening in the community but also in the healthcare sector itself.
Q: What kinds of human rights violations are taking place? A: You'll find people chained to beds or secluded and isolated, locked in rooms ... where they stay for many months or years. The sanitation is appalling. People are given food in the same place where they urinate and defecate. There are many documented cases of physical and sexual abuse in facilities and outright neglect. In many institutions, the treatment provided if there is any, is extremely poor. People can be over-medicated or given medication that isn't suitable. [http://www.trust.org/dotAsset/404d3183-0c83-4b6f-a790-56e1272d6bfa.jpg] Q: What's the range of mental health disorders? A: When we're talking about mental disorders, we're looking at common conditions like depression, anxiety disorders, alcohol and substance abuse disorders as well as more disabling disorders such as schizophrenia and bipolar disorder. In terms of the action plan, we're also covering child and adolescent mental health problems, issues around suicide which is a common outcome for people with untreated mental disorders ... The action plan also covers neurological conditions such as epilepsy and dementia.
Q: What does the global action plan seek to do? A: The action plan is quite novel and unique in that it reflects a different way of thinking about mental health problems and a different way of dealing with mental health problems. There's a greater emphasis on protecting and promoting the human rights of people with mental health conditions, so moving away from coercive practices - forced treatment, forced admission - to trying to build services that people actually want to access, which better meet their needs, protecting them from the violations that they've experienced previously through mental health facilities. It's also introduced the notion of recovery - supporting people to live meaningful lives in the community despite having a serious mental illness. The action plan is talking a lot about improving access to income generation and education opportunities, housing and social services - that's the core to providing a comprehensive and effective response to the issue of mental health problems. [http://www.trust.org/dotAsset/8afb62ba-e9a8-4226-848c-e91f010305bf.jpg] Q: Many poor countries are struggling to even cope with malaria, TB and HIV/AIDS, so what hope is there that they will be able to address mental health disorders? A: There are huge challenges. The number one challenge is dealing with the poverty in the country. (Another) challenge is competing needs - addressing infectious diseases as well as addressing mental health problems. It's important to realise it's not just one against the other but it's a need to increase the overall budget for health and within that allocate sufficient funds for mental health knowing that the burden of mental health problems is extremely high. But in order to do that, it's really critical to overcome the stigma and discrimination associated with mental illness. That's really one of the most important reasons for the under-investment in mental health problems - in many countries there are false beliefs about people who have mental health problems, so a lot of the violations, a lot of the lack of interest in investing in mental health, is associated with these misconceptions.
Q: What kind of stigma is attached to mental illness? A: Mental health problems are associated with sorcery, with witchcraft ... In many middle and high income countries, and even in many low income countries, there are beliefs that people with mental health problems are unintelligent, that they're lazy, that they're dangerous, that they're weak or that they're not capable of making their own decisions. They're often blamed for their problems.
Q: Some campaigners hope mental health will be included in the next set of development goals - the Sustainable Development Goals (SDGs). What's your assessment of that? A: Obviously it's a dream that it would be included. There is a little bit of good news in that there was a report recently published - Health in the post-2015 UN development agenda<http://www.who.int/topics/millennium_development_goals/post2015/en/>. It was a global consultation on health, which is going to feed into the agenda of the SDGs. We were very happy that mental illness was actually recognised in that report. One of the recommendations was that the post-2015 agenda should address the growing burden of NCDs (non-communicable diseases like cancer, cardiovascular disease and diabetes) and mental illness, but of course we don't know what's going to happen in the end.