Global Mental Health

In most low and middle income countries, at least 75% of individuals identified with a mental illness receive no care.*

Today’s lecture in Social Medicine given by Dr. Anne Becker and Dr. Bepi Raviola revealed that 3 of the top 10 leading causes of years lived with disability in low and middle income countries are mental illnesses, with unipolar depressive disorders being the number 1 cause of disability. In fact, by 2030 unipolar depressive disorders will be only second to HIV/AIDS as the overall leading cause of burden of disease, or DALYs. In the aftermath of disasters, such as in Haiti, the situation is even worse.

But there’s no need to look elsewhere to see the poor state of care for the mentally ill. In the United States, the largest providers of mental health services are in prisons. It was also only a little over half a century ago when it was the norm to lock people in asylums or perform psychosurgery by inserting an ice pick through the eye socket, into the brain, and cutting away at the frontal lobe.

We’d like to think that we’ve moved away from such inhumane and grotesque treatment of people. But who knows if 50 years from now we’ll look back and ask ourselves why we were medicating people.

There is, however, a case for optimism. During my time at The Coalition of Behavioral Health Agencies in New York, I worked with some of the most passionate individuals on the front lines of mental health care and advocacy, pushing for a recovery-oriented and person-centered approach. Unlike the old model of either controlling or stabilizing a person, this new approach sees the person behind the disorder and tries to get people back on their feet again. Many of these programs use creative and innovative ways to help people find jobs, live self-sufficiently, and develop community and deep relationships with others. And it’s been working.

Dr. Courtenay Harding, in a 32-year long study of serious schizophrenia patients in Vermont, showed that 62%-68% of the people significantly improved or recovered. These individuals exhibited no more enduring symptoms, no longer behaved oddly, did not require any more medications, were living in the community, and were working and relating well to others.

Curious, I asked Dr. Harding what it takes to help people recover. Her answer was simple but profound.

She replied, “You can start by asking them, ‘what do you need to get better?'”

*Patel V. Alcohol use and mental health in developing countries Annals of Epidemiology 2007; 17:S87-92.

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