Commentary / World

Global needs on mental health remain unmet

by Cesar Chelala

On a global scale, the magnitude of undiagnosed and unaddressed mental health problems remains high. An estimated 330 million people suffer from depression, 50 million from epilepsy, 37 million from Alzheimer’s disease and 24 million from schizophrenia.

Depression is a major contributor to suicide deaths. About one million people worldwide commit suicide every year, and approximately 20 million attempt it. In the United States, suicide is the eighth leading cause of death — every 17 minutes another person ends their life.

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

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 a World Health Organization study. The most pressing need, however, is found in developing countries. Out of the 191 surveyed, almost 25 percent lack a national policy or legislation on mental health issues.

The WHO notes 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 problems, almost two-thirds of sufferers never seek help from a health professional. In many cases this is the result of financial issues, and in others it is a reflection of the stigma frequently associated with mental illness. According to the 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.

Yet about 70 percent of the world’s population have access to less than one psychiatrist per 100,000 people, 55 percent have access to less than one neurologist per million people and 44 percent have access to less than one psychiatric nurse per 100,000 people. These, however, are general figures that do not take into consideration significant regional, national and local variations.

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 make use of them.

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. Both international agencies and national governments must invest in mental health services as a significant part of their development strategies.

Policymakers are often constrained by competing demands for financial assistance in dealing with mental health issues. 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, treatment and cure is affordable. And, most importantly, it should be stressed that through appropriate treatment many of those who suffer from mental illness can resume normal, fulfilling and productive lives.

Cesar Chelala, M.D., is a public health consultant for several U.N. and other international agencies.