A Global Call for Mental Help

Mental illness takes many prisoners. Its jails hold not only the afflicted, but families, communities and even the economic health of countries.

Yet government and private funding for mental health is tragically inadequate, especially in many developing countries where mental illness carries tremendous stigma and shame. Recent news reports have described the mentally ill being restrained in cages and chains in Somalia and Indonesia. And psychiatric patients languish in prisons worldwide, in both developing and developed countries.

Mental and behavioral disorders affect more than 25 percent of all people at some point during their lives, according to the WHO. By 2020, WHO estimates that these illnesses will account for 15 percent of the total life-years lost due to all diseases and injuries.

Now, an international coalition of health experts and advocates says that it is time for the UN to highlight global mental health issues for officials at the highest levels by convening a General Assembly Special Session. The UN General Assembly has previously held only two health-related special sessions: one on HIV/AIDS in 2001 and a session on noncommunicable diseases last year.

"The call for a General Assembly Special Session is a call for the recognition of the importance of mental health," says Judith K. Bass, PhD '04, MPH, an assistant professor in Mental Health. Bass and colleagues made the case for the special session in a January PLoS Medicine essay. "Part of that agenda," says Bass, "is advocating for countries to actually have mental health policies, to have humane treatment of people with mental illness, to implement treatment, all the things we know are lacking."

While the essay's primary aim is to focus world attention on the plight of those affected by mental illness, its authors also highlight the economic costs. The article cites estimates that neuropsychiatric disorders will account for $16.1 trillion in losses over the next two decades. "If a large proportion of a population even has low levels of depression and is functionally impaired, they can't reach their potential and are literally depressing the ability of a population to economically develop," says Bass.

Three critical areas—access to evidence-based interventions, new research and human rights protections—need resources. Strengthening mental health research is an essential piece of improving care, says Bass, noting that more than 20 years have passed with no breakthroughs in the field. "Innovation is not focused on mental illness," she says.

Given the paucity of psychologists and psychiatrists in developing countries, evidence-based mental health services need to be integrated into primary care and community health systems, experts say. Health care professionals need training to screen for and treat basic psychiatric disorders, and research shows that community health workers can be educated to deliver mental health services as well.

"In most parts of the world, it is simply not feasible, or affordable, for a health system to achieve coverage of mental health care through mental health specialists alone," says Vikram Patel, MSc, PhD, a professor in International Mental Health at the London School of Hygiene and Tropical Medicine. "Use of alternative human resources [such as primary care doctors, community health workers], is not only a solution when there are no specialists, it can also, in fact, be effective in cutting costs and improving access in places that are relatively better resourced. It is important to note the key roles that mental health specialists need to play such as supervision, quality assurance and providing referral pathways."

Patel, one of the essay's coauthors, says that enhanced access to care, research advances and economic development won't be realized until the human rights of the mentally ill are recognized. "I don't think there's any community in the world today that has seen the systematic denial of basic human rights as [have] people with mental illness, and there are very few champions speaking out for these individuals," he says. "It's probably the most important issue in global mental health."