While being happy and content is what most people strive for, we often don’t know what we have until it’s gone. This year’s Mental Health Gap Programme (MhGAP) meeting at WHO in Geneva began with a personal story. A man told of his daughter, a recent college graduate, who throughout adolescence and young adulthood experienced severe depression. Family support and access to treatment helped her move forward, and today she is gainfully employed and happy. The man asked the several hundred attendees to raise their hands if anyone in their own families had ever suffered mental illness. Almost every person raised his/her hands, illustrating the pervasiveness of mental health problems.
In the United States, one in five adults experiences mental illness each year. Globally, the WHO estimates that one in four people will be affected by mental or neurological disorders. Currently, 450 million people suffer from such conditions, placing mental disorders among the leading causes of ill-health and disability worldwide. Depression carries the heaviest burden, accounting for 2.54 percent of all global disability-adjusted life years.
Today is World Mental Health Day, a day to acknowledge our duty to include mental health in our efforts to improve public health. As we know, designated funding does not match the mental health burden worldwide; according to WHO, mental health receives an average of one-half of one percent (0.5%) of health spending in low-income countries. The majority of those funds are spent on psychiatric hospitals (73%), rather than on community care. A 2016 article in the Lancet made a plea for the international public health community to realize and respond to the fact that the effect of serious mental illness in many countries is similar to that of the many infectious and chronic physical illnesses that receive much more funding for treatment and research. The reality is that funding for mental health is limited, so public health professionals must:
- Integrate high-impact mental health services in all health and community care services. Mental health is a common co-morbidity with other infectious/communicable diseases and non-communicable diseases. Think critically about the populations who are most affected, such as pregnant and postpartum women, and integrate services for them first.
- Advocate. Raise mental health awareness among donors, Ministries of Health, and other policy makers and urge them to increase funding and programming.
- Expand services. Mental health services remain limited in most low-and-middle-income countries.We can expand services by training all health and community care workers in evidenced-based mental health actions. One example is stepped care-or SBIRT, which provides screening, brief intervention, and referral pathways for treatment into standard services that health and community care workers provide.
A number of evidence-based materials from WHO/MhGAP can be adapted to fit local contexts and needs and are being used in more than 100 countries. If we act as unified public health professionals, we can reduce the number of people who raise their hands when asked if they have been touched by mental illness.