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This is a major step in the fight to recognize mental health and mental illness as global issues: a comprehensive report from the Lancet Commission on Global Mental Health, published At three years old, published last week at a summit in London with royals Prince William and Kate Middleton, the Duchess of Cambridge, presents to show her support for the cause.
But it was not a festive event. Over the 45 pages of the report, we deplore the fact that the world ignores the millions of people who suffer.
This neglect translates into "pitifully weak" financial support from governments and research and patient care groups, according to 28 researchers, clinicians and mental health advocates, the authors of the report. The report points out that untreated patients are often unable to support themselves and that their caregivers can not work as well.
The situation is particularly serious in low-income countries, where mental health care is often unavailable. According to the report, only one in 27 people with depression in developing countries receive adequate treatment. Developed countries get a little better: one in five people with depression is treated. But on the whole, the richest countries are poor enough to provide adequate services. The report states that "all countries can be considered developing countries in the context of mental health".
It is not as if the magnitude of the problem is unknown. In the mid-1990s, the first global burden of disease study indicated that of the top ten causes of disability in the world, five were mental illnesses. Mental health researchers had little to offer at the time in terms of inexpensive and proven treatments. But since then, researchers have shown that agents such as speech therapy can often accurately identify and treat diseases such as depression and addiction. With the help of a mental health specialist, these community health workers can even help some people with schizophrenia to learn to live with their illness.
The report calls for greater reliance on community health workers, greater attention to stigma, a broader definition of mental illness, including mental health, a search for ways to create resilience in the community. currently healthy people and the use of therapy tools.
The big problem is the money. The Commission notes that the funds available are "extremely alarming", citing a comparison between spending on other diseases in 2013 and spending on mental illnesses. It turns out that for every year of healthy life lost due to mental illness, health donors around the world provided 85 cents of assistance. But for HIV / AIDS, there was 144 dollars for every year of healthy life lost and 48 dollars for tuberculosis and malaria.
So why the lack of investment?
Julian Eaton, psychiatrist and co-director of the Global Division of Mental Health at the London School of Hygiene and Tropical Medicine, explains at least in part the slow pace of acceptance of the high incidence of mental illness and people with disabilities. Cultural sensitivity can also hinder investments. "In the academic world, there has been a sometimes rather annoying debate about the opportunity to export Western ideas about mental health in other countries," Eaton said.
Meanwhile, what Commissioners call "multiple transitions" creates an increased need for prevention and treatment programs. Pandemics, wars, poverty, economic and political uncertainties, the rising incidence of natural disasters, and shifts in climate change in the environment create enormous psychological tensions that can affect mental health.
Stigma is another major obstacle to funding. It's pretty much on every commissioner's list. Janice Cooper, who runs the Carter Center Mental Health Center in Liberia, says it's a problem in both developed and developing countries – and at many levels. "There is ignorance, there is the perception of contagion, there is the notion that in some circles it is not important," she says.
For Commissioner Pamela Collins, who heads the global mental health program at the University of Washington, there is also an information problem. "Many people think that this is troubles in high-income countries and do not see them as problems for low- and middle-income countries," she said. And she fears people are forgetting that some of these conditions are deadly. There are 800,000 deaths a year in the world due to suicide, most often as a result of depression.
A group of 15 young leaders from around the world, many of whom have personal experience of mental illness, has been recruited by the Commission to spread its messages on social media and get young people to talk about mental health issues. Grace Catera, 25, is one of 15 members. The conflict in his home country, Rwanda, left Catera with PTSD that led to two suicide attempts. Catera says that governments may be blinded by other problems: "It's like we're going to solve this crisis and the crisis that would follow and maybe when we have time, we'll talk about mental health."
Other commissioners said that politicians felt no pressure from people with mental illness or their advocates, and that there was no strong lobby for people with mental illness.
Vikram Patel, co-chair of the commission and head of Harvard's Global Mental Health Program, says it's high time for the foundations to get going. "We know how to promote mental health, we know how to prevent mental health problems, and we know how to enable recovery," he says. The help could not arrive soon enough for the commissioners. They predict that between 2010 and 2030, mental illnesses will cost the global economy billions of dollars in health spending, lost wages and productivity.
But the nature of mental illness can scare the foundations, says Eaton. "People probably rightly think that mental health problems are more complex than infectious diseases or fractures." With vaccines, one shot costs a fixed amount and one person is protected for life. Not so bad with mental illnesses. "Speaking of big funds, the Gates Foundation is a classic example, investors want to know how much it costs," he said. Although inexpensive treatments have been developed, the question of how long it will take for people to use them
The Gates Foundation (a supporter of NPR and this blog) does not fund research on mental illnesses, although it funds studies on cognitive development of children. In a statement to NPR, Trevor Mundel, Head of Global Health, said: "There is no doubt that mental disorders are a major cause of death and disability, and that we need to invest more . " because there is still a huge disparity between the burden of infectious diseases in developing and rich countries, and we believe that our support can play a catalytic role in addressing major gaps in global health equity. "
With all the reasons given by the commissioners, however, there was some optimism in the room. After all, several international and British governmental organizations as well as private organizations had supported their summit. Commissioner Julian Eaton was comforted by the growing number of people willing to talk about mental illness, and just about everyone at the meeting was thrilled when the royal family arrived.
"But people still have to sign the checks," he says.
Joanne Silberner, former NPR correspondent for health policy, is a freelance journalist based in London.
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