The constitution of the World Health Organization (WHO) opens with a definition of health that underscores the importance of “mental…well-being.” Even still, mental health has struggled to achieve parity in global health. For much of its history, the field of mental health developed parallel to public health. Mental health, and the lack of it, was nebulous and eluded the gold standards of clinical measurement like bioassays and microscopy. As a result, psychology and psychiatry (components of the larger field of mental health) were shunned by other disciplines for a perceived lack of scientific basis and over-emphasis of sociological factors. Those with mental disorders, cognitive and developmental impairments were thusly cared for largely by religious institutions and, eventually, asylums rampant with inhumane treatment and neglect.
By the 1970’s the United States was moving toward deinstitutionalization and curiosity about how to effectively study and treat mental illness in the context of culture. Mental health research worldwide began engaging with patients as active participants with “lived experience.” The sharing of epidemiological data around mental health indicators became more fluid. The push for data-driven and evidence based decision making in global mental health produced big payoffs. The 1990’s saw both the WHO’s first World Mental Health Report and the first iteration of The Global Burden of Disease study.
These publications highlighted the sheer burden of poor mental health. Of the ten leading causes of disability, five were mental illnesses, including the leading cause of disability in the world: unipolar major depression. Self-inflicted injury was among the top ten leading causes of premature death in developed countries. While the psychiatric epidemiological data continued to underscore the need for new interventions and novel funding mechanisms for global mental health, not much has changed. Last year, the Lancet Commision on global mental health and sustainable development released a 45-page report outlining a global health crisis that is severely underfunded relative to its burden on society. Even in developed countries, only 20% of individuals living with depression will receive adequate treatment. In developing countries, the number is a dismal 4%. But only 1% of global health development funds are allocated to mental health programs. That comes out to just $0.85 per year of healthy life lost to mental illness, compared to $144 for HIV/AIDS programming and $48 for malaria and tuberculosis.
Even if the funding existed, global health education has yet to produce a reliable pipeline of mental health professionals with the skills necessary to address the crisis. Educators at schools of public health in the United States have identified that mental health is still not adequately integrated into public health curriculum. Johns Hopkins remains the only school of public health in the country with a dedicated mental health department. While the majority of other public health programs offer coursework that have mental health as a component of its curriculum, few programs offer tracks or courses that have mental health as its primary focus, leaving students interested in the field to piecemeal their education together through independent study and practicum/thesis work.
(Read the study on mental health in schools of public health here)
The evidence is clear that global mental health should be recognized as a global health and global development priority. Despite the lack of full acceptance by the global health donor community and larger public health community, the field of global mental health has continued to grow. Organizations like the Movement for Global Mental Health serve as collaboration spaces for mental health researchers and advocates. The Lancet Commission on Global Mental Health continues to produce calls for action that elicit drastic, even if short-lived, spikes in mental health earmarked development assistance. And just this year, the field’s superstar, the Peter Piot or Paul Farmer of global mental health, Dr. Vikram Patel was awarded the prestigious John Dirks Canada Gairdner Global Health Award.
“...All countries can be thought of as developing countries in the context of mental health“Patel et al.
We are living in the age of a changing climate, protracted humanitarian crises, and a global population that is increasingly forcibly displaced from their homes. The burden of mental health problems will continue to pose a threat to health that will require the unique skill set of the field of global mental health. Leaders like Dr. Patel continue to advance the global mental health agenda in an effort to realize the complete definition of health that lies at the core of global health. For those of us for whom global mental health is our calling and passion, we must continue to push for our place at the table when the global health agenda is being set.
Note: One of the photographs used in this blog appears elsewhere on the internet in an unredacted form. However, to protect the privacy and dignity of those who appear in the photograph, I’ve elected to hide their faces.