mental health

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October 10, 2011 | 8:59 AM | By

It’s World Most-Neglected-Health-Problem Day

Flickr, by Dierk Schaefer

Neon Brain

It’s actually World Mental Health Day, and also Columbus Day.

Neither of these calendrical milestones are likely to get much public attention, unless perhaps someone can combine them for a story suggesting that Christopher Columbus only discovered the New World in 1492 thanks to his megalomania and narcissistic, obsessive-compulsive disorder.

I am not doing much this year for Columbus Day (the state of Hawaii officially refuses to celebrate it, by the way) and would like to focus most on World Mental Health Day.

Not much to celebrate really. Overall, I think it’s fair to say we’re doing a lousy job on mental health.

As I’ve reported before, mental illness is one of the leading causes of death and disability worldwide, yet it remains a very low priority on the global health agenda. Leading mental health researcher Vikram Patel has noted that mental illness kills more women than maternal mortality.

My friend and colleague Joanne Silberner recently reported on this disparity — between the global burden of this disease and the low attention it gets — on PRI’s The World, after a visit she paid to a clinic in Uganda. Said Silberner:

The World Health Organization estimates that more than 450 million people suffer from mental disorders, and a new report by the World Economic Forum figures the annual global costs of mental and neurological illnesses at $2.5 trillion. That is three times the economic cost of heart disease.

Here are some of the stories today about World Mental Health Day:

The Independent World Mental Health Day: Time to Invest

Voice of America Treatment for Mental Health Underfunded, Inadequate

Huffington Post World Mental Health Day — A revolution needed

UN News Centre UN Secretary General Ban Ki-moon urges more resources for mental health

Actualitie news Afrique WHO highlights global under-investment in mental health

The gist of most of the news stories is that we aren’t spending enough on mental health and so many experts and leaders are calling for more money.

Talk is cheap, of course, and these are tough economic times. Donations are down for the global AIDS response. I recently attended a UN meeting focused on chronic diseases where advocates called for expanding the global health agenda to better respond to problems like diabetes, heart disease and cancer. There’s a push to expand the number of slices despite a shrinking pie.

Many argue we need to increase the size of the pie, that investment in global health provides many times more in return. In lieu of that happening, perhaps the best chance for mental health issues — as well as other neglected diseases — of receiving more attention and resources is if the experts can finally agree on how best to set priorities in the global health agenda.

One would think it should be based largely on the burden of disease as well as the socioeconomic and health benefits of reducing that burden. We’re not there yet, partly because some problems are easier to solve than others, despite the disease burden, and partly because achieving that cost-benefit analysis I mentioned is also easier said than done.

Still, many say the gross neglect of mental health is perhaps the strongest evidence of our misplaced priorities.

FILED UNDER: Health, Joanne Silberner, mental health, UN Week, Vikram Patel, World Health Organization
May 16, 2011 | 7:30 AM | By

PRI’s Joanne Silberner on Mental illness in Uganda

Joanne Silberner

Uganda works to improve mental health care

Health journalist Joanne Silberner, former health policy correspondent based at NPR’s flagship in DC and now (lucky for us) based here in Seattle at the University of Washington, has done an excellent report on the lack of mental illness care in Uganda for PRI’s The World.

I’ve done a few stories here about the mental health in the global health context, noting it is both a massive contributor to the burden of disease yet gets almost no attention when it comes to the global health agenda.

As Silberner reports, the first in a PRI series she’s doing on mental health in the developing world, improved acess to work training for the mentally ill is perhaps just as important as improving and expanding access to treatment: Continue reading →

FILED UNDER: Health, employment, Howard Frumkin, Joanne Silberner, mental health, millennium development goals, PRI, UW
March 25, 2011 | 12:09 PM | By

Why is mental illness so low on the global health agenda?

Flickr, by Dierk Schaefer

Seattle recently hosted a big international meeting in which many of the world’s leaders in the fight to improve health met to parse data, debate statistical methods and struggle toward consensus aimed at informing the global health agenda.

Given this focus on data, are the biggest contributors to the global burden of disease also getting the most attention and resources?

Consider two major causes of death and disability worldwide — maternal mortality and mental illness.

Today, the international community, or at least the global health community, has made reducing the number of maternal deaths and complications in childbirth worldwide a top priority. The Gates Foundation has made this a primary mission of its global health program. This priority, which really targets both mothers and children, represents two of the UN’s eight Millennium Development Goals.

Maternal health is wisely regarded as a critical, high-value goal for global health because of the important (and not always measurable) magnified benefits to a family and community that come from focusing on women’s reproductive health and the health of newborns.

Yet, surprisingly, mental illness actually kills and maims more young mothers worldwide.

Continue reading →

FILED UNDER: Health, Science, Alan Lopez, Chris Murray, Debra Kaysen, health metrics, Jane Simoni, maternal health, mental health, mental illness, Shannon Dorsey, suicide, Theo Vos, Vikram Patel
December 14, 2010 | 9:07 AM | By

NPR: Using lay therapists to deal with mental illness in India

Flickr, by Dierk Schaefer

Neon Brain

In the global health arena, mental health care is typically considered — or not considered at all, more accurately — as infeasible for poor communities compared to the more pressing disease burdens of physical illness like AIDS, tuberculosis, malaria, pneumonia, malnutrition and the like.

But as I’ve written here before, the burden of mental illness in the developing world is massive and many experts are exploring innovative ways to bring mental health care to poor communities.

For example, NPR’s Joanne Silberner reports on the use of lay people doing mental health therapy in India. Silberner’s report is based on a new study in the Lancet that found people suffering from anxiety or depression can be assisted by therapists with minimal training. Says Silberner:

In India, there is only one psychiatrist for every 400,000 people, according to the Indian government. The Lancet study involved about 2,600 people in the state of Goa with common mental illnesses such as anxiety or depression. About half were assigned case managers who had taken a two-month training course in mental health counseling.

For another example, take a look at my post “The most neglected disease in global health” about a pair of local experts training locals to treat PTSD in Iraq, Congo and Cambodia for another example.

FILED UNDER: Health, mental health, neglected diseases
September 9, 2010 | 11:20 AM | By

Mental Illness Disease Burden a Surprise To Everyone, Researcher Recalls

Albert Einstein said the key to solving a problem is in how you define the problem. If critical problems in global health are poorly defined, or left out of the equation, it’s going to be hard to solve them.

On Tuesday, I wrote that mental illness is often neglected when we talk about global health. I mentioned how Paul Bolton, a tropical medicine doctor working in Thailand, was converted in the 1990s from a focus on treating physical disease to expanding mental health therapies in the developing world.

Flickr, by Dierk Schaefer

Neon Brain

In short, Bolton read the 1990 Global Burden of Disease report, which was really the first comprehensive, quantitative assessment of the primary causes of death and disability worldwide. Mental illness, it turned out, was a much bigger problem than had been thought.

“Globally, neuro-psychiatric conditions are estimated to account for almost 30 per cent of all YLDs (years of life lost to disability), far in excess of any other specific category,” 1990 Global Burden of Disease report.

Yesterday, I talked to one of the author’s of Bolton’s conversion — Alan Lopez, head of population health at the University of Queensland in Australia and a professor of global health at the UW. Continue reading →

FILED UNDER: Health, Science, Alan Lopez, Chris Murray, Global Burden of Disease, health metrics, mental health
September 7, 2010 | 6:00 AM | By

The Most Neglected Disease in Global Health

Flickr, by Dierk Schaefer

Neon Brain

Is it Kala-azar black fever? Elephantiasis? African sleeping sickness? Guinea worm?

How about mental illness?

“Mental health is the Rodney Dangerfield of international health,” says Paul Bolton, an expert in evaluating treatments at Johns Hopkins University, paraphrasing the comedian’s signature line: “It gets no respect.”

But it should, Bolton says, if our goal is to improve lives rather than simply cure or prevent disease.

Hundreds of millions of people in the developing world suffer from emotional, neurological or behavioral disorders, according to the World Health Organization.

Okay, but we also have loads of people in poor countries dying from AIDS, malaria and TB — to name just a few — and you want to talk about depression? Continue reading →

FILED UNDER: Health, Science, mental health, neglected diseases, PTSD, UW