Today — the 10th of October — is World Mental Health Day. Take a moment to look through these photos from Niger, where Mahamadoul-kafi Djibrilla spoke at a community discussion of mental illness and treatment in Tahoua Region. Some might think that the least of rural Niger’s worries would be mental illness. But they’d be wrong. Mental disorders, whether treated by families and communities or by medical professionals are a part of life everywhere, even as most cultures are fearful of even acknowledging their extent.
The World Health Organization chose today to release its “Mental Health Atlas“, a statistical and policy survey on the mental health and mental healthcare systems of 184 nations. Their conclusion was that “countries all over the world spend very little on the treatment of mental illness.” The UN Secretary General noted that, while mental illness makes up 13% of the world ‘disease burden,’ “Resources allocated for mental health by governments and civil society are habitually too little, both in human and financial terms.”
Global spending on mental health, in rich and poor nations alike, is less than US$3 per capita per year. The report goes on to note that “up to 50 percent of people suffering from mental disorders in Europe and North America do not receive treatment, and up to 85 percent of people in developing countries do not receive treatment…” This coincides with other recent studies that show a United States population, facing increased pressure from unemployment and other crises, has dramatically cut back on its mental healthcare spending, deeming it an unaffordable luxury. Meanwhile, those same pressures have both increased the need for mental healthcare, and cut back funding for such services.
More Common Than You Think
The World Health Organization this year estimates 450 million people worldwide are suffering right now from mental illness, but estimates of the percent of people who will suffer some mental illness in their lifetime vary from between 5% and 25%.
In the European Union, one quarter of people will experience a mental health problem in their lifetimes, 9% will suffer depression in any one year, and 2.6% a year will suffer more severe disorders.
We’re Still Not Doing Much
In the United States at least 10% of the population is suffering depression right now.
Yet it would take almost 7000 new mental health professionals to meet the needed ratio of just one for every 10,000 people. And that number of needed professionals has increased by almost 2000 in the last three years.
In the developing world, the disparity is much greater. In Nigeria the ratio of psychologists and social workers is 0.02 to 100,000 population. In Niger, there were 0.2 psychiatric beds per 100,000 population, and no mental hospital based beds at all. There were 0.4 psychiatric nurses per 100,000, and the same percentage of other mental health professionals. And West Africa is not unusual in this. In Azerbaijan there were 5 psychiatrists and 7.1 psych beds per 100,000. In Ecuador these numbers were 2.1 and 1.69 per 10,000. In Afghanistan they are 0.036 and 0.055 per 10,000. In most of these, as most developing nations, there is no or minimal and unquantifiably small government support to aid those suffering from acute mental illness, let alone the huge percentage suffering less obvious forms.
It is no better in rapidly industrializing nations. In China there is only one mental health bed per 10,000 population and less than one mental health professional per 100,000. In India, where one in six health related disorders are mental, there are just 0.25 mental health beds per 10,000 population.
Real, Inescapable Illnesses
We should distinguish between lifetime — probably genetic — chronic and severe mental illness and situational mental disorders, both of which can disable those suffering. Mental illness is more prevalent in times of high unemployment, rapid social change, people struck by food insecurity and poverty, and times of population movement. Around 400 million people are suffering from these sorts of mental illnesses right now, but with so few resources to help them, the real numbers may be much higher
In the the United States, like much of the developed world, less chronic forms are mental illness are now recognized as equally severe problems for the society. Depression is the leading cause of disability in the United States among adults. Suicide rates for those currently suffering depression are well above the general population and are highest in rural areas with the least access to care.
Mental illness strikes those more statistically likely to suffer societal discrimination and poverty. The depression rate among African American women is 50% higher than that of Caucasian women in the US, just like the unemployment rate. In fact, African Americans make up almost a quarter of all suffering from mental illness in the US, far above their ratio to total population. In a world of increasing disparity, unemployment, poverty, food insecurity, and population movement, mental illness rises as well. The legal systems, even in the richest nations, contribute to the numbers of mental illness rather than help treat those who enter suffering from illness. In the UK, Only 1 in 10 prisoners DO NOT suffer a diagnosable mental disorder.
On top of those suffering transitory illness there are millions suffering genetic predispositions to chronic — and incurable — severe mental illnesses such as schizophrenia. While treatment is making it more an more possible to live a fuller, normal life even with severe mental illness, fewer people have access to even basic mental health care. While schizophrenia affects only around 0.3% to 0.7% of the population worldwide, that’s still 24 million people.
Fear Compounds Suffering
I know these things because I work for a charity that provides housing, among other services, to people in my community who suffer chronic mental illnesses. Where I live, we have under 1000 chronic mental illness care beds to a population of 250,000, enough to meet the needs of much less than %1 of population.
But it is next to impossible to build new homes for long term care of those suffering mental illness: neighbors, community groups, and the press react with vilification and hatred when new housing is planned.
People suffering from mental illness, according to long-term studies in Europe, New Zealand, and the United States have all concluded that “that the risks of violence by someone with mental health problems are no greater than those for the general population as a whole.”
People suffering from mental illnesses are no more to harm strangers in any fashion than any other population, but are 2.5 times more likely to be the victim of crime than others. Where the severely mentally ill are more likely to be involved in violence is within their home, as a symptom of lack of treatment. The likelihood of committing any form of armed violence once in their lifetime among people with serious mental illness was 16%, as compared with 7% among people without mental illness. This does not include most sufferers of less severe mental illness, nor those who are receiving appropriate treatment. In fact, the vast majority of those suffering from mental illness are not included in these statistics, as they suffer from depression or other disorders that present no danger to others. The severely mentally ill are more a danger to themselves than anyone else, yet they are feared as violent and dangerous far outside their actual danger. People with no mental disorder who abuse alcohol or drugs are seven times as likely as those without substance abuse to commit violence. And since the rates of substance abuse among the untreated severely mentally ill are very high, much of the statistical relevance may be down to this. In fact, among those severely mentally ill who did not have a history of substance abuse, having been a victim of violence themselves, or homelessness, the likelihood of them engaging in any violence over their lifetime was in line with the general population.
Despite this, the perception of the severely mentally ill as violent — at least in the United States — has doubled since the 1950s while more and more severely mentally ill have found treatment that allows them to function normally. Recent studies reveal a majority of respondents falsely believe people suffering from Schizophrenia were inherently dangerous.
What You Can Do
Where do we go with this? First, educate yourself and others. Learn more about what these illnesses are and how you can avoid them in your life or help those in your family or community. From Tahoua to communities around the world, we need to speak, learn, and demystify mental illness. I often tell people that I pass my agency’s clients regularly as I walk down to my neighborhood shops to buy a cup of coffee or a newspaper. No one looking at them would ever know these were people with severe and persistent mental illnesses. They look like — because they are — regular members of our community. Now imagine how hard it is to identify those who’ve suffered from episodic mental disorders due to depression or trauma. Look around you and realize one in every five people you pass is in that group.
But like so many things in this world, a large part of the problem must be tackled with funding. We actually know what we need to do. This year, the WHO published a survey of shortages in mental health care in 144 developing and poorer developed nations. They found these countries would need 1.18 million mental health professionals, almost half of whom would be psychosocial care providers, to care for those suffering and educate others about mental illness. The yearly cost to provide this workforce was estimated at about US$ 4.4 billion.
For comparison that would be less than 0.5% of the United States annual defense budget. So we’re actively choosing to spend money we have on other things. It does not have to be this way.
Look After Yourself and Help Look After Your Community
So for this World Mental Health day I’d hope you not only see to your own mental health, but think of the others suffering, whether they be on your street or across the world. They are your brother and sisters and, but for a bit of luck, could be you.
- World Mental Health Day: Treatment Remains a Challenge Around the World (psychcentral.com)
- It’s World Mental Health Day (drvitelli.typepad.com)
- It’s World Mental Health Day, so stop stigmatising my pills. (thefword.org.uk)
- Blog Party: World Mental Health Day, October 10 (psychcentral.com)
- Health System Hide and Seek: “Mental Health” Never Gets Found (gph2110.wordpress.com)
- 50 Signs of Mental Illness: A Guide to Understanding Mental Health (Yale University Press Health & Wellness) (untreatableonline.com)
- Patients suffer when reimbursements for mental health care are reduced (skwillms.wordpress.com)
- Useful WHO First-Aid Guide for Mental Health in a Disaster (sociolingo.com)