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World Mental Health Day 2011

A young boy in a wheelchair in Bolivia. His mother stands behind him and his father sits some way away.
José, from Bolivia, is a young boy with a slowly progressing physical disability. As well as the effect this has on him, it makes life more difficult for his whole family. His father has been diagnosed with severe depression and his mother is worried about her son, her husband and how she can cope. Community Based Rehabilitation workers from CBM-partner Yanapasiña are supporting the family in a variety of ways. Read more below.

CBM welcomes ‘The Great Push: Investing in Mental Health’. This is the theme of the 2011 World Mental Health Day, inviting a multisectoral approach in removing barriers to and highlighting highlights long term cost effectiveness of investing in mental health care.

‘The Great Push: Investing in Mental Health’

Each year, World Mental Health Day is celebrated on October 10. This day is significant in drawing attention to issues concerning not only mental illness, but mental well-being as well. Generally, activities would centre on public awareness, stigma reduction, education and advocacy.

This year’s theme is ‘The Great Push: Investing in Mental Health’. This theme invites a multisectoral approach in removing barriers to mental health care thereby reducing the burden of neuropsychiatric disorders. It also highlights long term cost effectiveness of investing in interventions for prevention of mental disorders and promotion of mental wellbeing.

CBM and mental health

CBM has developed a strong Community Mental Health (CMH) policy through working in this field, with its partners, for many years. In 2009, around 96,000 persons accessed CMH services supported by CBM.

CBM is involved in the international network Movement for Global Mental Health, which aims to improve services for people with psychosocial disabilities worldwide; CBM co-workers Dr Birgit Radtke and Dr Julian Eaton are members of its advisory group.

CBM is also proud to be an active participant in the WHO Mental Health Gap Action Programme (mhGAP), having reviewed mhGAP materials and currently being party to its implementation.

What is mental health?

According to the World Health Organization (WHO), "Mental health is not just the absence of mental disorder. It is defined as a state of well-being in which every individual realises his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to her or his community."

Mental health problems affect society as a whole and are therefore a major factor in global development. CBM’s mandate to reach out to the most marginalised groups is significant as the risk of developing mental health problems are higher among indigenous populations, victims of violence and disasters, migrants, refugees, children, abused women and neglected elderly.

Why is this an issue for the developing world?

*There is huge inequity in the distribution of skilled human resources for mental health across the world. Shortages of psychiatrists, psychiatric nurses, psychologists and social workers are among the main barriers to providing treatment and care in low- and middle-income countries. Low-income countries have 0.05 psychiatrists and 0.16 psychiatric nurses per 100 000 people, compared to 200 times more in high-income countries (*WHO).

There are several other barriers to appropriate mental health care:
  • In 40% of countries, primary health care providers do not receive any training in mental health. 
  • Stigma is a major barrier. In many parts of the world - including the ‘developed’ world - people with mental disorders are victimised because of their illness and become targets of unfair discrimination resulting in little or no access to housing, employment, social welfare or health insurance.
  • Another significant barrier to appropriate health care is the lack of psychotropic medication at the primary care level. While most countries have an essential drug list that includes basic psychotropic medications, 20% of countries do not have this essential package at the primary care level.
  • Almost half the countries in the world do not have significant mental health legislation, policy or a national level programme. This is a major barrier in ensuring the right to health care and accountability in human rights violations.
There is also a need to strengthen the voice of users of mental health services and their role in advocacy issues, to ensure that the rights of persons with psychosocial disabilities are fully represented.

Why is it a priority to support mental health resources in low income countries?

Psychosocial disabilities and neurological and behavioural disorders are common in all countries around the world, causing immense suffering and huge economic and social costs.

Closing the gap

The gap between the burden of mental illness and the resources used to address the problem is the widest in low income countries.  Closing this gap is not only the obligation of the respective governments but for International NGOs, foundations, communities, families, and mental health professionals.

Investing in mental health can generate enormous returns in terms of reducing disability and preventing premature death. Besides increasing productivity of people with mental illness and their care givers, commitment in reducing the gap would also instil dignity in their lives and give voice to people with mental disorders who continue to suffer from human rights violations.

Economic burden

The economic burden of mental disorders is huge. The core costs in terms of treatment and service fees, and usually long periods of hospitalisation, are much more compared to other types of morbidity which are usually less chronic. In terms of indirect costs like that due to loss of productivity at work and job retention, the loss is staggering. Statistics are unavailable from developing countries but in developed countries like the United States of America, it has been estimated that 35-45% of absenteeism from work is due to mental health problems, namely depression and substance abuse.

Since mental disorders generate huge costs in terms of long term treatment and loss in productivity, logically they would also contribute to poverty. Conversely, insecurity, low income levels and malnutrition contribute to mental disorders.  Therefore, this results in a vicious cycle of poverty and mental disorders.

Therefore, timely and appropriate investment in mental health intervention can break this vicious cycle and result in decreased overall economic burden of mental disorders.

Investments in primary care services can prove to be very cost effective in treating burdensome psychiatric conditions like chronic Schizophrenia. Such investments in service provision are not only required but worthwhile. Commitment to prevention of mental disorders can also pay rich dividends in the long term. Detection and suitable intervention for depression, delinquent behaviour, suicide and substance abuse in childhood and adolescence will result in mental well being of the potentially productive adult population.

The great push in investing in mental health is a timely call, recognising the human misery, disability and economic cost caused by poor commitment to mental health service provision

Key facts on mental health - burden of disease

  • Psychosocial disabilities are common. About one out of eight to half (12–48%) of all people will suffer from psychosocial disabilities at some point during their life.
  • 450 million people worldwide have mental or behavioural disorders.
  • There are more than 75 million people with alcohol use disorders and more than 15 million people with other substance use disorders in the world.
  • Epilepsy affects 50 million people worldwide, 80% of whom live in resource poor countries.
  • Unipolar Depression is the second leading contributor to the global burden of disease after cardiovascular diseases. More than 350 million people suffer from depression at any one time.
  • Nearly one million people commit suicide every year.
  • Physical restraint- this inhuman and degrading treatment of people with chronic mental illness like schizophrenia continues to be widely practised in the developing world.
  • Based on a 2004 world survey, 35–50% of people with serious psychosocial disabilities in high income countries had received no treatment in the previous year. For low and middle income countries, more than three-quarters of those with serious psychosocial disabilities (76–85%) had not received any treatment during the same period.
  • There are effective treatments for most psychosocial disabilities. Most of them can be delivered in primary care settings.
  • Treatment does not always mean medication. Many psychosocial disabilities can be treated using psychosocial methods.

Personal story - "My name is Francis..."

A young man chopping coconuts ©CBM
My name is Francis.  I’m from this village. 
I did my school here in primary, then at secondary level I went to Dom Bosco school, and from there I did my training centre studies.

But in form 2, I started feeling the problem beginning. I couldn’t really concentrate and after that, during my three or four years I started to get sick.

Read more on http://www.endthecycle.org.au ('End of Cycle' is a CBM Australia Advocacy initiative)

From WHO Headquarters, Geneva, Switzerland

Delegates at the third mhGAP forum, held in Switzerland in October 2011 ©CBM
Delegates at the third mhGAP forum, held in Switzerland in October 2011
On 10th October 2011 - World Mental Health Day - the third mhGAP Forum was held at WHO Headquarters in Geneva, Switzerland.

A wide variety of organisations working in mental health discussed progress and challenges in the fight to reduce the gap between needs and services in the field of mental health. Read more here.

External reading

Read more about José

Families need support too

José has a physical disability. This makes life difficult for his whole family, and his father has been diagnosed with severe depression.


A timely call

Dr Andrew Mohanraj


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