The Hidden Elephant of Global Mental Health
By Iris Guo, Lily Sul, Nathan Liu
This post is part of a series of opinion pieces in diverse mediums focusing on the theme “What makes you mad about global health?” These submissions are by McGill students who were part of the course PPHS 511 Fundamentals of Global Health in Fall 2021.
Global mental health aims to “alleviate mental suffering through the prevention, care, and treatment of mental and substance use disorders,” which supports the sustained mental wellbeing of communities globally [1]. However, although equity is one of the central tenets of global mental health, disparities in many aspects are apparent and must be addressed to foster mental wellness throughout society [1, 3].
Mental health issues have enormous socioeconomic implications. As such, barriers in access to services or treatment often exist in the context of geographical location, gender identity, socioeconomic status, racial and/or ethnic background, sexual orientation, and much more [3]. For example, poverty not only increases the likelihood of developing psychiatric disorders, being inflicted with mental health disorders often exacerbates poverty through reduced functionality and ability to acquire long-term employment [3]. Moreover, people with mental health conditions are often faced with discrimination and stigma, perpetuating a cycle in which they are more reluctant to seek treatment [3]. This is especially the case in low- and middle-income countries, where health inequities are already prevalent; combined with the lack of mental health awareness, shortage of professionals in the field, and neglect of mental health as a public health burden, these countries are hit the hardest [2].
Thus, global mental health should be addressed in a global manner; this issue will not truly be resolved if the focus is mainly on high-income countries (HICs), as is being done now. The narrow-minded, negligent approaches have led to more than 70% of people who need mental health services lacking access to resources, even though we currently have evidence-based therapies to treat mental health disorders [5]. In this article, we will be discussing two global inequities that may contribute to this dichotomy.
I. Ineffective mental health resource integration despite clear evidence of effectiveness in LMICs
This is not to say that no efforts in bringing mental health resources to LMICs have been attempted. However, there are inefficiencies in how this is carried out. To expand the coverage of mental health services from centralized care centres, countries around the world have implemented community-based mental health care [5]. However, a problem of this implementation is that many mental health services in the community are not prepared to face the resulting mental health needs. This is further exacerbated by the limited infrastructure, shortage of human resources, high rates of comorbidity with physical health problems, and high levels of stigma and discrimination of people with mental health conditions that influence the acceptance and uptake of services [5].
Focusing on schizophrenia, nearly 90% of individuals requiring treatment for the disease in low-income countries do not receive treatment [5]. Untreated schizophrenia puts an immense burden on families and caregivers that could ultimately lead to severe human rights violations against individuals with schizophrenia. As this issue is ultimately due to the ineffective integration of mental health services, improving the quality of care as well as thoughtful distribution of resources to communities affected by severe and persistent mental illnesses may be potential solutions in overcoming these issues.
II. Lack of mental health promotion and prevention in LMICs
Furthermore, our focus should not only be on treatment but also on the prevention of mental health disorders through the promotion of mental well-being. This way, we take a more holistic approach to try to close the mental health gap in LMICs. Unfortunately, this outreach is currently absent in most LMIC health systems.
One population that we should focus on for mental health outreach is children. Children constitute roughly 50% of the population in many LMICs, yet most research on mental health interventions for children comes from HICs and may not have translational value to children in LMICs [5].
In addition, according to the United Nations Children’s Fund (UNICEF), almost 1 billion children worldwide experience regular physical punishment, and about seven in ten children experience psychological aggression [5]. The effects of child maltreatment can have serious consequences that often manifest as psychiatric disorders in adulthood. As such, there is a serious need for programs aimed at mitigating childhood trauma and reducing violence against children, and this integration should be a high priority in global mental health.
As argued by Srinivasan, anger is apt in situations where there is a moral violation [4]. Indeed, here we are faced with a situation that violates fundamental human rights and serves as an offence against social justice worldwide [3]. If we do not get angry and take action to combat the inequities surrounding global mental health, we are internalizing the mindset that “the moral violation is not so bad, just a practical problem to be solved, rather than a wrongdoing to which its victim must bear witness” [4]. We must work to ensure global advocacy and ethical care of all those who live with mental illnesses, especially focusing on those in marginalized communities [3].
Taking into consideration all of the inequities in the field of global mental health, a more holistic, intersectional approach should be implemented that will then lead to a better understanding of the underlying processes behind mental health issues, and eventually to interventions that ensure mental wellbeing for all.
References:
Collins PY. What is global mental health?. World Psychiatry. 2020;19(3):265-266.
Kirmayer LJ, Pedersen D. Toward a new architecture for global mental health. Transcult Psychiatry. 2014;51(6):759-776.
Ngui EM, Khasakhala L, Ndetei D, et al. Mental disorders, health inequalities and ethics: A global perspective. Int Rev Psychiatry. 2011;22(3):235-244.
Srinivasan A. The Aptness of Anger. J Polit Philos. 2018;26(2):123-144.
Wainberg ML, Scorza P, Shultz JM, et al. Challenges and Opportunities in Global Mental Health: A Research-to-Practice Perspective. Curr Psychiatry Rep. 2017;19(28).
Acknowledgments:
We would like to thank Professor Madhukar Pai for setting and sharing this assignment results with us and the teaching assistants Alexandra Jaye Zimmer, Lavanya Huria and Angie Sassi for their support in coordinating the results.