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“The zero hour” for mental health

Tim Evans's picture



At times, many of us have felt a sense of loss or detachment from our families, friends and regular routines. We also have experienced nervousness and anxiety about changes in our personal and professional lives, as well as real or imagined fears and worries that have distracted, confused and agitated us.

While these episodes tend to be transitory for most of us, since they are a normal part of human life, for millions of people across the world, frequent and severe bouts of depression and anxiety are a debilitating daily burden that interfere with family, career, and social responsibilities. They can lead to alcohol or drug abuse or other self-destructive behaviors, which increase a sense of isolation and magnify feelings of sadness, loss, anger or frustration. Sometimes, death by suicide is an unfortunate outcome.
 
These mental disorders can also be triggered when massive social dislocations occur—driven by economic crises, such as the financial crisis of 2008; civil conflicts in places like Central America, Africa and Asia; epidemics, such as Ebola in Guinea, Liberia and Sierra Leone; or earthquakes, such as the recent one in Nepal.  Even after economic growth returns and unemployment drops, after peace settlements are reached, after we eventually reach zero Ebola cases, after the dead are mourned, and after the rebuilding of countries gets under way, there is long-term damage left behind in the social fabric of affected communities and mental well-being of individuals.
 
The social costs of mental and substance use disorders -- including depression, anxiety, schizophrenia, and drug and alcohol abuse--are enormous.  They are the fifth-leading cause of overall global disease burden, accounting for 7.4% of total years lost due to disability and early death.  And estimates from a World Economic Forum study show that the lost economic output due to the cumulative global impact of mental disorders will top $16 trillion, or more than 1% of the global GDP, over the next 20 years. 
 
Are countries prepared to deal with this often “invisible” and often-ignored malady? The simple answer is: no. 
 
In the second decade of the 21st century, not much has changed in many countries regarding how society views and deals with mental illness. Despite its enormous social burden, mental disorders continue to be driven into the shadows by the ever-present reality of stigma, prejudice, fear of disclosing an affliction because a job may be lost, social standing ruined, or simply because health and social support services at the community level are not available or are out of reach for the afflicted and their families.
 
And some countries are still using 17th century tactics to “protect society”: confining and abandoning the “mad” in asylums or psychiatric hospitals, often for life, which compound the negative impact of mental illnesses on these individuals and on society as a whole. 
 
In spite of these challenges, there is a growing impatience across the world to begin a new era in which mental health moves from the periphery to the center of the global health agenda and into the larger development context. Knowledge exists to guide this effort: As highlighted in WHO’s Mental Health Action Plan 2013-2020, approved by member states, there are evidence-based, intersectoral strategies and interventions to promote, protect and restore mental health, beyond the institutionalization approaches of the past.  Properly implemented, these interventions represent “best buys” for any society, with massive returns in terms of health and economic gains
 
If we are going to fully embrace and support the progressive realization of universal health coverage, we must work to ensure that prevention, treatment and care services for mental health disorders at the community level, along with psychosocial support mechanisms, are integral parts of accessible service delivery platforms and covered under financial protection arrangements. We must also advocate for and identify “entry points” across sectors to help tackle the social and economic factors that contribute to the onset and perpetuation of mental health disorders.
 
We, as part of an international, multi-institutional, working group, coordinated by the distinguished Harvard University professor, Arthur Kleinman, have begun to discuss ways to jump start society-wide efforts to address the mental health challenge.  To this end, World Bank Group President Jim Yong Kim and Margaret Chan, the Director-General of the World Health Organization, will co-host a major event on mental health in Spring 2016.
 
As we move forward with this task, we will be guided by the belief that the agonies of mental health problems that distort people’s lives, family bonds and communities, and that impose a heavy economic and social burden, can be dealt with effectively if there is political commitment, broad social engagement, and international support to make mental health an integral part of health and societal well-being across the globe.   
 
Roberto Iunes, Senior Health Economist, World Bank Group, and Melanie Mayhew, Communications Officer, World Bank Group, also contributed to this post.
 
Follow the World Bank health team on Twitter: @WBG_Health

Related
Global Burden of Disease: Generating Evidence, Guiding Policy
WHO Mental Health Action Plan 2013-2020
The Global Economic Burden of Non-communicable Diseases
Ebola: World Bank and Liberia to Work with Japan to Launch a Psychological Support Project
Blog: Mental Health: Time for a Broader Agenda
Blog:  Is Violence a Public Health Problem?
Blog:  Is Unemployment Bad for Your Health?
Blog: Healthier Workplaces = Healthy Profits

 

Comments

Submitted by Freddy on

This is really great idea. Addressing anxiety, depresion is a really good think. Having workshops, sessions like Guylaine Dion is doing is excellent iniative. Sleep problems, also, should be consider to address. Thanks

Submitted by Mary De Silva on

Fantastic to have the announcement of a World Bank/WHO meeting on depression in Spring 2015, co-hosted by Margaret Chan and Jim Yong Kim. I am extremely excited and privileged to be part of the scientific working group for this meeting, and hope that as a result we can push mental health up the global agenda, and through doing so create much needed investments to improve the lives of the many millions affected by depression and anxiety disorders.

Submitted by Simon R on

"If we are going to fully embrace and support the progressive realization of universal health coverage, we must work to ensure that prevention, treatment and care services for mental health disorders at the community level, along with psychosocial support mechanisms are integral parts of accessible service delivery platforms and covered under financial protection arrangements,..." Where are you locating action on prevention? Is this meaning prevention of further mental distress, or mental disorders (your term)and/or working more on sustaining resilience and the factors for mental wellbeing in communities of place etc?
Our recent report with The Health Foundation (UK)discusses health assets and asset based approaches that perhaps need incorporating into a woder health promotion agenda. link: http://www.health.org.uk/publications/head-hands-and-heart-asset-based-approaches-in-health-care/
Thanks for this important work.

Submitted by Judith Klein on

In the work that we do to develop community-based mental health services, we must remember to include the voices of people who use those services so that they have a say in shaping the services and supports that will meet their actual needs, and not just the needs of the system.

Submitted by Diana C on

This is terrific that the issue of mental health will receive such high-level attention by World Bank and WHO in Spring 2016. As a clinical psychologist transplanted into the global health arena, I am struck by how psychological factors are often minimized or ignored in efforts at improving health outcomes. The momentum for mental health has been percolating over the last several years and now it's time to put the political commitment and funding behind the awareness that a person's health and well-being are driven by multiple determinants.

Submitted by Papalo on

The momentum for mental health has been percolating over the last several years and now it's time to put the political commitment and funding behind the awareness that a person's health and well-being are driven by multiple determinants.

Submitted by Anne DiNoto on

Fantastic post! It's so important to remind people these episodes are a "normal part of human life." I support these efforts as someone who has a family history of suicide and mental health disorders. I also understand these issues as my family and home town, The Town of Union dealt with economic crisis when large corporations left the area and flooding devastated the area. It is a small town in upstate New York that does not make the world headlines. Let us know how we can help move this agenda forward!
http://www.townofunion.com

Submitted by Christopher Dowrick on

This is a very welcome initiative. It will be important to include primary health care perspectives, as this is a crucial setting for successful implementation of positive mental health activity, especially in low and middle income countries.

Submitted by Nasima Selim on

Social Determinants of Mental Health, citizen initiatives and internet portals available in the vernacular. What is crucial in this statement is to shift the focus back to the social (and cultural) determinants of mental health globally. It has been a while since in 2001 WHO launched a systematic effort to make mental health a global issue. After 15 years, it is time to revitalise the efforts to thoroughly mainstream mental health, and reflect upon the enormous body of knowledge and know-how there is, so as to mobilise that knowledge with personal and political commitments and fiscal allocations. What I would like to add to this is the utmost importance of getting citizen initiatives on board, specially in societies where the state often fails to take up the challenge. Moreover, in the age of social media, online portals of information and best practices of interventions (available in vernacular) should give rise to a global repository to use, share and distribute across the world.I applaud this initiative personally as well as on behalf of the Bangladesh Mental Health Network, a recently formed citizen initiative with collaboration between psychiatrists, psychologists, caregivers, public health professionals, mental health lawyers and activists to mainstream mental health in the region.

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