Where is Mental Health?

By Adam Joseph
Global Mental Health Columnist

This first segment of a two-part series focuses on the absence of mental health as a significant priority on the global health stage.

Unlike the more visible problems of HIV, malnutrition, or maternal and child health, mental health has not attained a heightened sense of urgency on the global health stage. The World Health Organization (WHO) recently released a media report that highlights the underinvestment in mental health care in developing nations. The findings are disturbing: in low income countries, the average spending for mental health care can be as little as $0.25 per person per year.[1]

Image courtesy of the WHO.

Why has global mental health been unable to leverage substantial foreign aid movements, when it is clearly a problem that is destructive to developing nations?  Perhaps the most important reason that explains the lack of support is the ubiquitous stigma of mental illness, as well as the absence of a unifying advocate for mental health.

National Public Radio recently released a story highlighting the stigma associated with mental illness in India. Women in India are often afraid of pursuing treatment in mental health because of the “dishonor” it would bring to their families, which would greatly reduce their chances of getting married.Therefore, elements of India’s social structure have contributed to the taboo of mental health in the nation, resulting in inadequate psychiatric care.[2]

Given that treatment of mental health is so highly stigmatized in communities worldwide, the major funders to global health initiatives do not group mental health with other significant priorities.  The UN chose to exclude mental health from the Millennium Development Goals, a fact that has been hotly contested by advocates.[3],[4] In low to middle income countries, over three-quarters of the mentally ill receive no care at all. Despite this, the Bill and Melinda Gates Foundation choose not to focus its efforts on research in mental health because of “other efforts” already being made in the field.[5] Perhaps this stems from the inability to present mental illness in the same way that a malnourished child from Sudan or a balding young mother with breast cancer can be presented. Mental illness is simply not “photogenic” enough.

Even in fully developed countries, there exists a particular repulsion from mental illness. When a person develops cancer in the U.S., there is a strong public support structure that encourages them to obtain care. However, when someone has bipolar disorder or an anxiety disorder, seeing a psychiatrist becomes largely a private matter that, if made public, marginalizes and alienates the person from others. Simply put, stigma cannot be eliminated from the third world when developed nations cannot provide a model for other nations to follow.

In addition to such marginalization, the current dearth of celebrities advocating global mental health compounds the neglect of this issue.  Other global health initiatives, such as HIV and cancer, have celebrities who actively advocate for awareness of such illnesses. For example, NBA star Earvin “Magic” Johnson, who announced being HIV-positive in 1991, was essential to raising awareness for HIV. Similarly, Lance Armstrong was diagnosed with testicular cancer and started the Livestrong campaign, which has raised over $400 million for cancer to date.[6] Countless Americans proudly display the popular “Susan G. Komen For the Cure” pink ribbon on their car bumpers.

Images Courtesy of Wikimedia Commons

Mental illness lacks this unifying figure. When a celebrity comes out as having issues with their mental health, perhaps with alcoholism, they are immediately type-casted as another celebrity who let fame and money get to their head.

There exists a legend that, in the late 18^th century, French physician Philippe Pinel entered a lunatic asylum in Paris and majestically freed the insane from the chains that bound them. Now, more than ever, we need a “Pinel” to unchain the shackles of stigma from those with mental illnesses. Only then will we be able to initiate a truly meaningful global mental health finance effort that can confront the tragedies of mental illness.

Tags: celebrities, gates foundation, india, mental health, stigma, who

Category: Global Mental Health, Online Columns