• Mental health

Mental health

Mental health services are under-resourced and neglected in many developing countries, according to a recent issue of the id21 Insights health bulletin. This is at a time when the demand for such services is growing rapidly.

Of the 450 million people worldwide with mental health problems, most live in developing countries. Although treatment is not expensive, most people do not receive the treatments they need and governments on average allocate less than one per cent of their health expenditure to mental health. The articles in this bulletin assess the current state of mental health services in developing countries and outline what policy changes are required.

Findings include the following:

• There is a common myth that depression is a disease of affluence. In fact, there is a strong link between marginalisation and mental health problems, and those living in poverty are more likely to suffer from depression.
• Families bear the main burden of caring for people with mental health problems. When people do seek treatment it is usually from primary medical care where their underlying mental health problems often go undetected. There is very little provision of treatment dealing with the psychological or social aspects of health.
• People with severe mental health problems such as psychotic disorders are often still incarcerated in old-style mental hospitals built during the colonial era. This type of treatment stigmatises mental health problems, violates human rights and institutionalises people.
• There is a strong link between HIV/AIDS and mental health problems. Those affected by AIDS can suffer from depression, cognitive impairment and dementia. In the later stages of AIDS, a condition known as “AIDS mania”, a mood disorder characterised by inappropriate excitement, occurs in 1.4 per cent of cases.
• There is also a strong link between maternal mental health and infant health. In South Asia, depression during pregnancy and after childbirth is strongly associated with low birth weight, poor growth and development and a higher risk of physical health problems in babies.
• Mental health problems have a knock-on affect on other areas of healthcare. Depression can lead to increased likelihood of strokes and heart attacks, and alcohol and substance misuse can lead to a range of health problems and to violence.
• The rapid social change caused by the processes of globalisation has led to increased levels of mental health problems. Migration on a massive scale has disrupted family and community ties and increased unemployment among small-scale farmers and entrepreneurs. This has led to rising rates of suicide and premature death due to alcoholism and substance misuse.

The bulletin argues that mental health issues must be included in programmes directed at promoting poor people's health and improving economic conditions in developing countries. Recommendations include the following:

• Treatments which originated in developed countries can also be used effectively in developing countries. For instance, group therapy has been used successfully in rural Uganda where it was delivered at low-cost by health workers with no previous mental health training.
• Depression, schizophrenia and substance misuse can be treated successfully and cost-effectively at local level. Community and primary treatment programmes are not costly to implement and should be supported by donor agencies.
• Local communities usually have mechanisms for promoting resilience and healing; social policies on healthcare and health promotion should incorporate culturally appropriate strategies.
• There should be more collaboration between health professionals working in mental health and those working in other areas of healthcare and health promotion.

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