"Mental Illness in Developing Countries: Moving Forward" by Kalina Kalyan
Approximately 450 million people worldwide currently suffer from some form of mental illness, including: depression, bipolar disorder, and schizophrenia, or brain condition. However, nearly half of the countries in the world have no explicit policy regarding mental health. Mental health is not often seen as a priority and has been severely neglected in the past despite it being a critical aspect to the wellbeing of society as a whole. The World Health Organization (WHO) launched a worldwide initiative called Project Atlas in the early 2000s in order to catalogue mental health resources around the world. In its initial survey, Project Atlas found that of the countries surveyed, 41% have no mental health policy, 28% have no separate budget for mental health, and 37% have no community health care facilities. While mental illness is often overlooked or placed on a lower level of importance in relation to symptom bearing diseases in the majority of countries worldwide, the stigmatization of mental health along with inadequate treatment is significantly more prevalent in developing countries.
Mental health is “an invisible problem in international development.” Many mental illnesses show no externally apparent symptoms and the issue of mental health is often overlooked due to focus on the “big three” communicable diseases in developing countries: HIV/AIDS, malaria, and TB. The prevalence of the “big three” overshadows a significant number of health conditions, detracting funds and attention from them. Mental illness is one of the most difficult health conditions to draw attention to, even without the focus on the “big three” due to its difficulty to understand from an outside perspective as well as the stigma that surrounds it. According to WHO, high-income nations, such as the United States, on average, spend 5 percent of their total health spending on mental health. In lower and middle-income countries, less than 2% of total health spending is spent on mental health. The lack of spending on mental health care further proves the idea that many countries fail to see mental health care as a priority, when it should be. Many low and middle income countries have made great strides in the goal towards eradication of the “big three” previously mentioned. Ideally, this would free up monetary funds for mental health programs and advancements in mental health policies. However, this has not been the case. Developing countries face a number of non-communicable diseases as well, which further use up funds that could be shared with mental health programs. These include respiratory diseases from smoking, cardiovascular disease due to increased prevalence of obesity, and the rapid growth of diabetes. With so many public threats and very limited health budgets, mental health care continues to be seen as a “first world luxury.”
The barriers around access to proper care in under-resourced countries are immense. One of the major problems is that developing nations have very few trained psychiatrists, and psychiatrists that are accessible tend to gravitate towards urban centers which results in a large populations of those with mental illness left unaddressed. The lack of psychiatrists in developing countries is just one of many issues in under-developed mental health systems. Trained professionals are the drive behind progress when it comes to advocating for mental health illnesses and without their leadership it is extremely difficult to construct an infrastructure for an ideal mental health system.
Mental illness has a large adverse effect on people’s ability to work, study, and care for their families. These effects create potential carer burden for the families of those affected by mental illness. This generally leads to greater poverty, thus having a significant economic impact in developing countries. Furthermore, the stigma surrounding many mental illnesses such as epilepsy, schizophrenia, and mental retardation prevents people in developing countries from seeking and receiving proper treatment. Poverty can be both a cause and a consequence of poor health and it has been found to contribute to brain disorders through lack of proper nutrition, unsanitary living conditions, and lack of access to health care. It has been found that poverty and cases of several psychiatric disorders, such as depression, correlate directly with each other.
There is emerging evidence that developing countries can, in fact, manage mental illness even with limited funding. In Rwanda and Haiti, Dr. Raviola, a Harvard professor, has organized programs in which a few psychiatrists train nurses and other health workers to diagnose and treat mental health conditions. His results have been promising. Likewise, Indonesia is developing a model in which primary care centers provide at least some screening for mental health with a referral system that will send urgent and extreme cases to available doctors. The emergence of these developments in mental health care and policy are huge steps in the right direction. However, these reforms must continue to be both funded and implemented.
Mental illness is a global health problem, and proper measures must be taken in order to ensure that treatment is accessible in both developing and developed countries worldwide. Health professionals should work to train others in developing countries to deliver basic mental health care, stigma of mental illnesses must be reduced, and the funding of mental health care must be increased in order to effectively treat mental illness. For change to occur, it is critical that the profile of mental health in international development is advocated and public perception of mental health illnesses are turned towards acceptance instead of stigmatization. Without these changes, mental health care in developing countries will not be able to advance.
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