Mental health challenges remain unmet

by and

NEW YORK — One aspect not frequently considered of the Sept. 11 World Trade Center tragedy, the anthrax scare, and thousands of people fleeing in terror from Afghanistan is that these events may create or exacerbate mental health problems. Unless they are properly treated, many among those involved could be left with permanent psychological scars.

This situation gives special significance to a recent report from the World Health Organization titled “Mental Health: New Understanding, New Hope.” The report calls attention to one of the most serious public health problems on a global scale: the magnitude of mental health problems that are left undiagnosed and unaddressed, and which are the cause of unnecessary suffering and even death.

It is estimated that 120 million people globally suffer from depression, 50 million from epilepsy, 37 million from Alzheimer’s disease and 24 million from schizophrenia. About one million people worldwide commit suicide every year, and approximately 20 million unsuccessfully attempt suicide.

In the United States, suicide is the eighth leading cause of death — every 17 minutes another person ends their life. Following the World Trade Center tragedy, health officials in New York City have noted a significant increase in alcohol and drug abuse.

Both in industrialized and in developing countries mental illness and health-damaging behaviors cause tremendous suffering in those affected and in their families as well. In addition, they lead to high social and economic costs as a result of lost productivity and increased use of medical and social services.

According to a World Bank study, mental health problems are a major cause of lost years of quality life. In spite of that, allocations in national health budgets are disproportionately small in relation to the serious health consequences they pose.

To address the lack of resources and services for the mentally ill in the U.S., a growing number of independent groups are implementing actions to improve the situation. In addition, community health clinics across the country are providing free depression screening for the public.

Despite these efforts, the lack of effective mechanisms to deal with mental health issues remains pervasive and has been found in all countries surveyed in the WHO study. The most pressing need, however, is found in several developing countries. Out of the 191 surveyed, almost 25 percent do not have a national policy or legislation on mental health issues.

As indicated in the report, the situation is worse among the poorest sectors of the population, whose “lack of access to affordable treatment makes the course of the illness more severe and debilitating, leading to a vicious circle of poverty and mental health disorders.”

Although treatments are available for many mental health disorders, almost two-thirds of sufferers never seek help from a health professional. In many cases this is the result of a lack of economic means, and in others it is a reflection of the stigma frequently associated with mental illness. According to WHO, stigma, discrimination, and neglect prevent care and treatment from reaching people affected with mental disorders.

Mental health disorders are among the main causes of disease and disability in the world. Depressive disorders are now the fourth leading cause of the global disease burden, and it is estimated that they will rank second by 2020, lagging behind only ischemic heart diseases.

In spite of this, approximately 70 percent of people have access to less than one psychiatrist per 100,000 people, 55 percent of people have access to less than one neurologist per million people, and 44 percent of people have access to less than one psychiatric nurse per 100,000 people. These are general figures that do not take into consideration significant regional, national and local variations.

All in all, the services and resources available are one-tenth to one-hundredth of what is needed. Despite wide differences between mental health care in industrialized and in developing countries, both share a common problem: Many people who could benefit from them do not use available psychiatric services. Even in countries that have adequate services, less than half of the people needing care makes use of those services.

One of the recommendations posed by WHO is the need to implement policies that specifically address vulnerable groups. Among such groups are children, abused women, the elderly, and refugees and displaced people, particularly in countries experiencing civil wars or internal conflicts. Those now affected by the events in Afghanistan are in especial need of care and attention.

The need to implement proper policies is urgent. Unless we do so, significant gains made over the last 40 years in reducing child and maternal mortality, increasing life expectancy, and lowering the burden of infectious diseases will be offset by the growth of mental and behavioral problems.

Policy makers are often constrained by competing demands for financial assistance in dealing with mental health issues. Both international agencies and national governments must now invest in mental health services as a significant part of their development strategies. They must take into account that some mental health disorders can be prevented; that most mental and behavioral disorders can be successfully treated; that not treating them will lead to high economic and social costs; and that much of this prevention, cure, and treatment is affordable.

Through appropriate treatment many of those who suffer from mental illness can resume normal, fulfilling, and productive lives.