(October 2006) Mental and neurological disorders affect more than 450 million people around the world. For people with a mental disorder, holding down a job or raising a family may be unattainable goals, whether they live in the wealthiest or poorest communities. Society suffers as well, from the loss of productive members, the burden of families caring for ill relatives, and the demand for medical services to treat other health problems associated with mental disorders.
Mental illness is considered expensive and difficult to treat, and it carries a negative stigma that discourages many people from seeking medical help. Most people receive no treatment for their mental disorders, especially in resource-strapped developing countries. An estimated 90 percent of people with epilepsy and 75 percent of people with major depressive disorder in developing countries are not adequately treated.
But some light is filtering into the dark world of mental illness, thanks to a growing recognition that “there is no health without mental health,” bolstered by the work of the global Disease Control Priorities Project (DCPP).* The DCPP health experts quantified the enormous health burden imposed by mental disorders for the first time, and they identify cost-effective treatments appropriate even in developing countries. This evidence may help convince policymakers to devote some of their scarce health resources to treating depression, schizophrenia, epilepsy, and other common mental and neurological disorders, and relieve some of the suffering.
Some governments and NGOs are tackling the mental health problem, even in remote and poor regions in less developed countries. In a recent article, Margot Cohen describes attempts to incorporate mental health services into community medical centers in rural Asia, with some surprising results. Mental disorders are difficult to diagnose, but volunteers in a rural Indian province are trained to query villagers with probing questions: “Does anyone feel very sad? Does anyone hear voices that might not be real? Has anyone withdrawn from daily work?” Whenever possible, visiting psychiatrists follow up with people who may need their help.
In another recent article inspired by the DCPP work on mental disorders, author Beryl Lieff Benderly addresses the widespread problem of post-traumatic stress disorder in places like Afghanistan, where people of all ages have endured seeing their homes and livelihoods destroyed, relatives murdered, and sometimes unimaginable violence. An estimated 70 percent of Afghan women and 60 percent of men suffer from depression, according to a 2002 survey. The psychological damage of such violence is severe and lasting, and it drags on countries’ ability to develop economically.
These stories show the possibilities for treating mental disorders even in developing countries, and the sometimes heroic efforts of some individuals and groups dedicated to treating mental disorders. However, the obstacles are daunting. In addition to severe shortage of resources for any health care—and the financial tug-of-war between major health issues like HIV/AIDS, cardiovascular disease, prenatal care, and malaria—many less developed countries are losing their health professionals to other countries. The international brain drain hits the medical professions especially hard. And efforts to address mental health are often stymied by the stigma and discrimination linked with these types of health problems. Still, the stories relayed by Cohen and Benderly, and the continuing efforts of the DCPP, offer a glimmer of hope that more people suffering from mental disorders can be helped.
* The Disease Control Priorities Project (DCPP) is an ongoing effort to assess disease control priorities and produce evidence-based analysis and resource materials to inform health policymaking in developing countries. DCPP has produced three volumes that provide technical resources to help developing countries improve their health systems and, ultimately, the health of their people. These volumes and a wealth of other material on mental and neurological disorders and other diseases is available on their website: www.dcp2.org.
Mary Kent is editor of the Population Bulletins at the Population Reference Bureau.