By: Dr. Heather F. McClintock PhD MSPH MSW, Elena Schatell MPH (c) MMS (c), and Hannah Stewart
This is the first part of a IH Blog series, Global Mental Health: Burden, Initiatives and Special Topics.
Part I: An Overview of Global Mental Health
According to the World Health Organization (WHO) mental health is more than the absence of mental disorders. It is “a state of well-being in which the individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her community.” The Global Burden of Disease Study has reported that for nearly three decades more than 14% of Years Lived with Disability (YLDs) were due to mental health concerns, such as depressive disorders and substance abuse. Over one in three people will experience a mental health problem in their lifetime. Depression, the most prevalent psychiatric diagnosis, affects an estimated 264 million people globally. Bipolar disorder and schizophrenia affect 45 million and 22 million people worldwide, respectively. One out of five of the world’s children and adolescents have a mental disorder, and about half of mental health concerns begin before the age of 14. The burden of mental health concerns has serious human repercussions. Every year, approximately 800,000 people die by suicide, this is nearly 1 person every 40 seconds.
The burden of mental disorders varies significantly by country. In order to track this variation, WHO created a Mental Health Atlas. The Atlas contains profiles for nearly all member states presenting information on each country’s burden of mental health concerns, system governance, resources, and service availability and uptake. The Atlas also contains many other important indicators of mental illness including suicide mortality rates and the number of treated cases of severe mental disorders.
According to the most recent 2017 Atlas, the United States reported that 4,128.45 disability adjusted life years (DALYs) per 100,000 people were lost due to mental health concerns. This is higher than some of the USA’s high-income counterparts: Denmark (3,819.99 DALYs per 100,000), France, (3,700.67 DALY’s per 100,000), Australia (2,972.99 DALY’s per 100,000), and Japan (2,240.63 DALY’s per 100,000). And while reported rates of mental health concerns tend to be higher in high-income countries, more than 80% of people living with mental health concerns live in low- and middle income countries (LMIC’s). In these settings, access to culturally appropriate and effective mental health services remains low with treatment rates often as low as 35-50%. The outlook isn’t improving. By 2030, major depression alone is projected to be the largest contributor to global disease burden.
Determinants of mental health concerns include biological, psychological, social, economic, environmental, and cultural factors. Biologically, genetic factors increase risk for the onset of mental disorders. Psychologically, personality factors are associated with poor mental health. Contextual factors such as violence, unsafe neighborhoods, war, unemployment, minimal social cohesion, discrimination, and human rights violations all increase the likelihood of mental disorders. Humanitarian crises, due to their widespread impact globally, have been a recent focus for the assessment and evaluation of mental health issues. In conflict settings the prevalence of depression and anxiety is more than double. Roughly one in five people who have experienced conflict or war in the past 10 years will have depression, anxiety, post-traumatic stress disorder, bipolar disorder, or schizophrenia.
In comparison with the general population, persons with psychiatric diagnoses die 10 to 20 years younger than those without such disorders, a prognosis worse than heavy smoking. The morbidity and mortality of mental health concerns translate into devastating global economic costs. We lose about $1 trillion U.S. dollars globally per year in productivity due to depression and anxiety. It is projected that the burden of poor mental health will cost the global economy $16.3 trillion between 2011 and 2030, more than chronic heart disease. The economic costs of mental disorders go beyond the direct healthcare costs and extend to hidden indirect economic costs such as loss of productivity according to the 2011 World Economic Forum report.
But the true cost of the burden of mental health concerns comes at the price of human suffering. Living with mental health concerns not only affects the human psyche, it has social and human rights consequences. Unmanaged and untreated mental illness not only impacts the individual lives of those affected; it impacts family, friends, their social and work-related environments, and society as a whole. Individuals experiencing mental illness are often maltreated and marginalized on a global level. They are subjected to human rights violations, including denial of employment, denial of education, malnutrition, negligence, and physical abuse. It’s critical that the world radically change the way we deliver mental health services to create new systems that are rights-oriented, user-centered, and achieve true parity.
References (in order of appearance)
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GBD 2017 Disease and Injury Incidence and Prevalence Collaborators. (2018). Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017. The Lancet. DOI:https://doi.org/10.1016/S0140-6736(18)32279-7 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6227754/
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Wang et al., (2007). Use of mental health services for anxiety, mood, and substance disorders in 17 countries in the WHO world mental health surveys. The Lancet.
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About the Authors:
Dr. Heather F. McClintock PhD MSPH MSW
Dr. McClintock is an IH Section Member and Assistant Professor in the Department of Public Health, College of Health Sciences at Arcadia University. She earned her Master of Science in Public Health from the Department of Global Health and Population at the Harvard School of Public Health. Dr. McClintock received her PhD in Epidemiology from the University of Pennsylvania with a focus on health behavior and promotion. Her research broadly focuses on the prevention, treatment, and management of chronic disease and disability globally. Recent research aims to understand and reduce the burden of intimate partner violence in Sub-Saharan Africa. Prior to completing her doctorate she served as a Program Officer at the United States Committee for Refugees and Immigrants and a Senior Project Manager in the Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania. At the University of Pennsylvania she led several research initiatives that involved improving patient compliance and access to quality healthcare services including the Spectrum of Depression in Later Life Study and Integrating Management for Depression and Type 2 Diabetes Mellitus Study.
Elena Schatell MPH (c) MMS (c)
Elena Schatell is a current student at Arcadia University enrolled in the Dual Master of Public Health/Master of Medical Science in Physician Assistant Program. She aims to promote public health in underserved communities as a future physician assistant. Her current public health interests include access to mental health services, stigma surrounding mental illness, and the relationship between faith and mental health. She has interned at the National Alliance for Mental Illness (NAMI) national office in Arlington, Virginia, working closely with the Advocacy and Public Policy team on conducting research on service barriers and state mental health policy. During her time at NAMI, she also authored articles for the Advocate magazine and blog.
Hannah Stewart
Hannah Stewart is a global mental health researcher and advocate that uses the power of research methodology to elevate mental health as a human rights issue. She earned her Bachelor of Science in Psychology from Baylor University and her Master of Public Health in Global Health Leadership at the University of Southern California. Her research interests include the psychological impact of traumatic experience, culturally appropriate psychosocial interventions, and the intersection of mental health and climate change. She is currently a research scholar at the Global Environmental Health Lab where she focuses on building research capacity at universities in Myanmar. Hannah is also one of two delegates from the United States to the Executive Committee of the Global Mental Health Peer Network, a lived-experience organization that advocates for individuals living with mental health concerns by engaging diverse stakeholders in mental health.
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