The Rise of Global Mental Health

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. 

Psychiatric patients in Bucharest sleep two to bed with feet bound;
Image Credit: Bernard Bisson

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.

Global Mental Health: How Are We Doing? (WHO)

World Mental Health Day Forum by the Global Mental Health Advocacy Working Group: A Review

photo (2)Guest blogger: Socorro Lopez

Mental illness has proven to be one of society’s greatest invisible burdens, accounting for 4 of the 10 leading causes of disability worldwide. The Global Mental Health Advocacy Working Group recently honored World Mental Health Day by hosting a forum to discuss mental health needs amongst people in humanitarian crises, an extremely vulnerable group in terms of developing and dealing with mental illness.

The event’s panelists included Kelly Clements, the U.S. Department of State’s Deputy Assistant Secretary of the Bureau of Population, Refugees and Migration, Dr. Inka Weissbecker, the Global Mental Health Psychosocial Advisor for the International Medical Corp (IMC), and Dr. James Griffith, the Chairman in the Department of Psychiatry and Behavioral Sciences at the George Washington University School of Medicine and Health Sciences.

The discussion touched on three important themes in relation to mental health in emergency settings: the vulnerability of people suffering from mental illness, the critical gap in mental health services, and the detrimental social isolation that the mentally ill are frequently subjected to.

While approximately 10% of a population is traditionally at risk of developing a mental disorder under normal circumstances, this rate has the potential to double during a humanitarian crisis, meaning more people must deal with these disabilities in highly unstable environments. Furthermore, mentally ill individuals are more susceptible to stigma, discrimination, violence, abuse, and human rights violations in these circumstances.
Although there is a vast need for mental health services in emergency settings, there is a significant lack of access to quality care. The number of health professionals who can implement psychosocial interventions that effectively address mental illness is minimal during crises.

“There is a treatment gap between the people who need care and those who receive it,” said Dr. Weissbecker, who has monitored IMC’s mental health and psychosocial programs in countries such as South Sudan, Ethiopia, Sierra Leone, Syria, and Afghanistan.

A lack of healthcare professionals and mental health services often means that the burden of care for a mentally ill individual is placed on their families. Unfortunately, mental disorders are still fundamentally misunderstood around the world, causing many communities to be ill equipped to properly care for a portion of their citizens. In the absence of related health services, families resort to harmful traditional health practices that stem from local beliefs. These practices regularly call for extreme measures, such as chaining the mentally ill to trees or institutionalizing them in inept facilities, to isolate people dealing with mental disorders from the rest of the community.

By acting as natural buffers to instability and prejudice, Dr. James Griffith discussed the vital role that local caregivers, families and communities can play in treating mental illness. In accordance with this line of thought, IMC programs have integrated community involvement into their programs by hosting educational seminars that utilize local volunteers to raise awareness and social consideration for mental illness.

The panelists also addressed how this knowledge could be applied to two topics that have been making recent headlines: Ebola and the Islamic State in Iraq and Syria (ISIS). In terms of treating mental illness within extremist groups such as ISIS, the panelists were quick to correct the misconception that violence can commonly be associated with mental illness, a stereotype creating stigma and driving discrimination. According to the American Psychiatric Association, “the vast majority of people who are violent do not suffer from mental illness.”

In relation to Ebola, preventing and treating mental illness proved to be more applicable. In order to diminish emotional and psychological trauma, Weissbecker discussed the need to provide more education to people who contract the disease and their families, in order to decrease debilitating fear and prevent transmission. Reintegration services should also be offered to survivors who may be treated differently once they return to their communities. Finally, it is important to find ways to safely bury the dead, while ensuring that burials are still culturally significant.

Addressing mental health in emergencies is undoubtedly a multifaceted and complicated health challenge. Nevertheless, increased rates of mental disorders and the potential social ramifications of having such illnesses illustrate that mental illness in humanitarian crises is an urgent issue for global health. Reducing the current treatment gap and increasing communities’ understanding of mental disorders are two of the most promising tactics to improve the health status of the mentally ill in these situations. In doing so, devastating disability and demoralizing hardship can be prevented in populations that have already experienced immeasurable adversity in their lives.


Socorro Lopez is an undergraduate at the George Washington University, majoring in environmental studies and minoring in public health and geographic information systems. Her interests include environmental, reproductive, and global health. Prior to working at the American Public Health Association (APHA) as a Global Health Intern, she was part of the Collegiate Leaders in Environmental Health (CLEH) program at the Centers for Disease Control and Prevention (CDC). Socorro is originally from Roatan, Honduras and recently returned from Tanzania, where she was studying coastal ecology and doing research on water quality.

IH News Global Health Weekly News Round-Up

Politics and Policies:

  • The government of Australia is preparing to soon offer a 20-minute HIV test in Melbourne. It has yet to decide which clinics will offer the test.
  • The National Population Commission has announced that China has planned to improve county-level family planning services.
  • Regulations have been issued by the government of Indonesia to bear graphic photographic warnings on the cigarette packets.
  • The United Nations has allowed Bolivia to return to the United Nations main anti-narcotics treaty and has given its approval on chewing the coca leaf.
  • Twelve nations have signed a new United Nations treaty which aims to counter the illegal tobacco trade.
  • New York City (U.S.) hospitals will adopt new guidelines that will forbid emergency room doctors to give out more than three days’ worth opioid painkillers to the patients.

Programs:

  • Pfizer Inc. has included its pneumococcal conjugate vaccine to expand its pediatric immunization program in Tanzania.
  • UNICEF calls for cessation of child recruitment in the Central African Republic. More than 300,000 children have been affected by the violence which has led to their limited access to education and health facilities.
  • US$176 million announced by IMF and World Bank for debt relief for the Union of the Comoros. It will help the country to fight poverty and improve health and education facilities.
  • European Union gives EUR 16million support to Ghana. This money will support the implementation of the Millennium Development Goal (MDG) Accelerated Framework and Country Action Plan developed to combat maternal mortality.
  • $25 million has been awarded by Abt Associates for a three-year malaria prevention project in Kenya.
  • The FCC has launched $400 million heath care development fund with an aim to create and expand telemedicine networks.

Research:

  • According to a study published in the British Journal of Psychiatry there is a relationship between mental health and spirituality.
  • According to the Journal of Infectious Diseases, nosocomial transmission responsible for XDR-TB outbreak in South Africa.
  • A study identifies the chances of infection (co-infection) with another disease when a person is infected with a disease.
  • A study published in the Journal of Neurosurgery Pediatrics, climate can be the reason for a neurological condition, hydrocephalus in children in Uganda.
  • Number of new annual cases of HIV/AIDS cases in India has dropped by 57 percent in the last decade.
  • A study published in J Neurol Neurosurg Psychiatry links loneliness with higher chances of dementia or memory loss.
  • Researchers have identified role in obesity and diabetes. They have found that blocking the expression of gene TRIP-B2r  in mice protects them against obesity and insulin resistance.
  • A report published by Natural News states that children who are vaccinated according to the CDC recommended schedule are five times more likely to develop diseases as compared those who are not.
  • According to the findings of a report, among all rich countries, people of U.S.  live unhealthy and shorter lives.

Diseases and Disasters:

  • The Flu has surpassed an ‘epidemic’ threshold in the United States. It is widespread in all except the three states of US.
  • According to The New Times survey, there is a severe drug shortage in Kigali hospitals (in Rwanda).
  • The World Health Organization (WHO) yellow fever has killed about 171 people in Darfur (Sudan).
  • Top U.N. Aid officials warn food crisis in two isolated southern states of Sudan. People of South Kordofan and Blue Nile have been feared dying of malnutrition and disease.
  • According to the officials, about 80 people have died in Bangladesh due to cold-related diseases like respiratory problems, pneumonia and cough.
  • People in Beijing have been warned of extremely hazardous air quality. The density of PM2.5 particulates has reached 700 micrograms per cubic meter in many parts of city.
  • Sri Lanka’s Ministry of Health has warned the public of possible outbreak of Leptospirosis (rat fever) in flood affected areas.
  • According to the health authorities, Barbados has recorded an increase in dengue cases since the last year.
  • Paraguay has confirmed reports of outbreaks of dengue in the north and east of the country. It has declared a national epidemics alert.

WHO Videos: Depression and World Mental Health Day

This post was written by Sarah M. Simpson.

Do you or someone you know have a big black dog following them? The World Health Organization recently collaborated with illustrator Matthew Johnstone, author of “I Had a Black Dog”, to mark the 20th anniversary of World Mental Health Day as designated by the World Federation for Mental Health (WFMH). Initiated in 1992, World Mental Health Day signifies a day to encourage public discussion of mental disorders and to bring awareness to investments in mental disorder prevention, promotion and treatment services. This year’s theme is “Depression: A Global Health Crisis”. In the book “I Had a Black Dog”, Johnstone chronicles his struggle with depression through narrative and illustrations. Interestingly, the “black dog” reference was popularized by Winston Churchill, a long-time sufferer of depression and mental illness. Using Johnstone’s illustrations, WHO has come up with the series of videos, featured below that highlight symptoms of this illness along with ways to prevent and treat it.

Depression is one of the world’s most widespread illnesses, often co-existing with other serious illnesses. It also doesn’t discriminate and anyone from men to women, adults to children, the rich to the poor can be affected. According to the World Health Organization (WHO), depression is a common mental disorder with more than 350 million people suffering from this “hidden burden” world-wide.

As these videos show, depression is different from one’s usual mood fluctuations. Depression not only makes you feel sadness for long periods of time, but it also interferes with your ability to function and perform everyday activities at work, school or home. Effective treatments include psychosocial treatment and medication. The active involvement of depressed people and those who are close to them in addressing depression is key. The first step in treating this illness is to recognize the depression and seek support. The earlier the treatment begins, the more effective it is in treating this illness that affects so many people.

Global Health Weekly News Round-Up

Politics and Policies:

  • House rejects bill to ban sex-selective abortions. It was a measure that sought to impose fines and prison terms on doctors who perform abortions on women who are trying to select the gender of their offspring.
  • The Agriculture department (US) has announced that it would expand testing for E.coli in raw beef trimmings.
  • California announces intent to award four medi-cal contracts to health net of California subsidiary.
  • Wolk’s flu bill passes Senate moves to assembly. This bill would require hospitals and clinics to reach a 90% vaccination rate among their health-care workers by 2015 or adopt masking requirement for those who decline flu shots.
  • Federal disability law does not cover medical marijuana patients. A panel of the appeals court threw out the patient’s lawsuit, which had charged that some California cities were violating the ADA by shuttering medical marijuana dispensaries.
  • Medical marijuana is legal in Connecticut. A law has been signed by Gov. Dannel P. Malloy approving its use, a measure that includes strict regulations in an attempt to any avoid problems. Qualifying patients and their primary caregivers would be able to possess a combined one-month supply of marijuana.
  • A ban that would impose a 16 ounce limit on any sugary bottled or fountain drinks that contain more than 25 calories per 8 ounces in New city restaurants, delis and movie theaters was proposed by Mayor Michael Bloomberg.

Programs:

  • World Health Organization (WHO) award for reproductive health was given out at the 65th World Health Assembly in Geneva.  It was awarded to four countries- Rwanda, Nepal, Malawi, Ethiopia and Yemen.
  • Norway will provide up to NOK 500 million over a five year period for health in developing countries, which will be used to help women and babies through childbirth and the critical first 24 hours after delivery.
  • The first pilot waste water treatment plant with integrated wood production opened in Mongolia. It is funded by the German Ministry of Education and Research (BMBF): Model region Mongolia (MoMo) project.

 Research

  • According to a recent study, people suffering from pneumonia with high blood sugar level are at a greater risk of death. The team found that those with diabetes had highest risk (14%) followed by those with hyperglycemia not diabetes (10%) and those without diabetes and normal glucose levels had lowest rates (3%).
  • In a recent study, researchers found that taking common painkillers might reduce chances of getting skin cancer.
  • Consumption of oil rich Mediterranean foods such as fish and sea food helps to improve physical and mental well-being.
  • Global research team yields new health insights into different types of trans fats. The findings strengthen the evidence that unlike industrial Trans fats, natural trans fats produced by ruminant animals are not harmful and have an health enhancing potential.
  • Soon a breath test will help to detect deadly tuberculosis bacteria in 6 minutes. However the doctors say that it cannot replace the sputum test which will remain the gold standard.
  • Researchers from Melbourne’s Burnet Institute said that reducing the prevalence of the disease among the drug users could also lead to a drop in infections across the wider populations.
  • Breakthrough drug may extend life of women suffering from deadly breast cancer. According to the daily mail newspaper it could be available in Britain within a year if it passes regulatory checks.
  • According to a research released last week, a drug already approved for prostate cancer has been shown to slow the spread of advance forms of this disease. In the patients treated with drug, the cancer did not worsen for 16 months as compared to 8.3 months in the group that did not receive this drug.
  • Premature babies are 4.5 times more likely to suffer from severe mental health problems. The study reveals that those born after just seven months in the womb or earlier are at highest risk compared with full-term babies.
  • According to a recent study a link between poor asthma control and eczema was seen among Brazilian urban children.
  • A study indicates that allergies (specifically allergies to plants, grass and trees) are linked to higher cancer risk. The researchers say that these allergies cause inflammation which may lead to an overactive immune system- and that over activity can in turn lead to blood cancer.

Diseases & Disasters

  • 6.6 magnitude earthquake strikes Panama’s pacific coast. There are no reports of injuries or deaths and no tsunami is expected.
  • A strong earth tremor of 5.1 magnitude hit northern Italy on Sunday. This area was struck by the deadly quakes in the last two weeks.
  • Measles outbreak in west Cork concerns Irish health officials. The Health Service Executive (HSE) is advising patients to vaccinate their children against viral disease.
  • Tuberculosis infected beef sold in Edo (Benin). On inspection it was seen that it has nodular lesions which enveloped on the surface of the various organs of the slaughtered cow.
  • A new strain of flu is likely to spread through Australia. It is likely to replace swine flu that emerged in 2009. Flu shots are available for people aged 65 and older, pregnant women, people with chronic disease as well as Aboriginal and Torres Strait Islander people.
  • Bird flu found in 21 poultry farms out of 85 in Bangladesh this year.
  • Hong Kong officials have confirmed H5N1 strain of avian influenza. They have confirmed it being the first human case of bird flu since November 2010 in Hong Kong.
  • Greek crisis spurs epidemic of suicides and mental illness.
  • New Mexico man is the first human plague case in the U.S. this year. The department of health press release has confirmed that the man is infected with Yersinia pestis.