February 2005, id21 insights health #6
No health without mental health
The enormous gap between mental health needs and available services in developing countries has been well documented, culminating in the 2001 World Health Report. Of the 450 million people worldwide with mental health problems most live in developing countries. Mental and behavioural disorders affect one out of four people during their lives. Although treatment is not expensive, most people do not receive the treatments they need and governments on average allocate less than one percent of their health expenditure to mental health.
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Other articles in this issue:
HIV/AIDS sufferers and children whose families are infected with the virus may suffer mental health problems arising directly or indirectly from living with the virus. HIV infected people have to deal with the stigma attached in some communities to being HIV positive. Partners, family and friends, may experience psychological stress from having to nurse sick relatives and deal with multiple deaths.
Globalisation affects the way people live and work. It is hardly surprising, then, that globalisation and its related social and economic changes affect the mental health of individuals and countries. Economic and social change has left many people without incomes and has led to a breakdown in traditional family and community structures as the most able travel miles to live in crowded, polluted slums in search of work.
The World Health Organisation's theme for World Health Day 2005 is 'healthy mothers and children'. While the physical health of women and children is emphasised, the mental and social dimensions of their health are often ignored in developing countries. However, recent evidence suggests that the mental and physical health of mothers and children are linked, and that one cannot be possible without the other.
In 1990, 58 percent of the world's population aged 60 years and over lived in developing countries. By 2020 this will rise to 67 percent. In developing countries the number of people over 60 will increase by 200 percent compared to 68 percent in the developed world. This will be accompanied by unprecedented economic growth and changes in social structures and the pattern of family life. How will these changes affect the care and support of older people with mental health conditions?
Are people living with mental illness guaranteed the best available mental health care? Evidence suggests that they do not enjoy the same rights, in terms of self-determination and protection from exploitation and discrimination, as do people who do not suffer from mental illness. Some ethical codes do relate specifically to mental health - yet the transition from rhetoric to reality has so far been limited.
Armed conflict has affected over a billion people worldwide in the last 50 years, with most survivors living in low income countries. Mental distress is common during and after periods of mass conflict, but the number of people who require clinical treatment needs closer scrutiny, especially in relation to post-traumatic stress disorder (PTSD). In particular, the needs of those with severe mental disorder demands further attention.
In the past 50 years there has been a rapid growth in the development and application of effective treatments for many child and adult psychiatric disorders in developed countries. However, the real challenge is to find how these treatments can best be adopted by developing countries with limited resources. Evidence from Uganda, Chile and India shows how low cost community-based mental health treatments can be successful and sustainable.
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Forthcoming issues
# 54: What hope does Corporate Social
Responsibility hold for development?
# 55: Mobility and access
for people with disabilities
# 56: Understanding childhood poverty
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