World in men­tal health cri­sis of 'mon­u­men­tal suf­fer­ing', say ex­perts

The Guardian Australia - - World News - Sarah Bose­ley Health ed­i­tor

Ev­ery coun­try in the world is fac­ing and fail­ing to tackle a men­tal health cri­sis, from epi­demics of anx­i­ety and de­pres­sion to con­di­tions caused by vi­o­lence and trauma, ac­cord­ing to a re­view by ex­perts that es­ti­mates the ris­ing cost will hit $16tn (£12tn) by 2030.

A team of 28 global ex­perts as­sem­bled by the Lancet med­i­cal jour­nal says there is a “col­lec­tive fail­ure to re­spond to this global health cri­sis” which “re­sults in mon­u­men­tal loss of hu­man ca­pa­bil­i­ties and avoid­able suf­fer­ing.”

The bur­den of men­tal ill-health is ris­ing ev­ery­where, says the Lancet Com­mis­sion, in spite of ad­vances in the un­der­stand­ing of the causes and op­tions for treat­ment. “The qual­ity of men­tal health ser­vices is rou­tinely worse than the qual­ity of those for phys­i­cal health,” says their re­port, launched at a global min­is­te­rial men­tal health sum­mit in Lon­don.

When it comes to men­tal health, says the com­mis­sion, ev­ery coun­try is a de­vel­op­ing coun­try. “Govern­ment in­vest­ment and de­vel­op­ment as­sis­tance for men­tal health re­main piti­fully small,” says the re­port. The high cost of $16tn by 2030 is es­ti­mated from pre­vi­ous World Bank data on the loss to the global econ­omy of peo­ple of work­ing age with men­tal health prob­lems.

In some coun­tries, peo­ple with men­tal dis­or­ders are abused and in­car­cer­ated, it says. “Hu­man rights vi­o­la­tions and abuses per­sist in many coun­tries, with large num­bers of peo­ple locked away in men­tal in­sti­tu­tions or pris­ons, or liv­ing on the streets, of­ten with­out le­gal pro­tec­tion,” it says.

Prof Vikram Pa­tel of the Har­vard Med­i­cal School, joint lead ed­i­tor, said men­tal ill-health caused “colos­sal hu­man suf­fer­ing” and was re­spon­si­ble for sub­stan­tial num­bers of deaths that are at­trib­uted to other causes. “Men­tal health prob­lems kill more young peo­ple than any other cause around the world,” he said.

Sui­cides are at­trib­uted to deaths from in­juries. Opi­oid deaths are con­sid­ered to be drug mis­use. “We are treat­ing men­tal ill­ness as a risk fac­tor,” said Pa­tel. “A lot of global health pri­or­ity set­ting has his­tor­i­cally been around dis­eases that kill.” The com­mis­sion es­ti­mates that 13.5 mil­lion deaths ev­ery year could be averted if the un­der­ly­ing men­tal ill-health prob­lems were ad­dressed.

In many coun­tries there is no ex­pec­ta­tion of help. Sur­veys in In­dia and China, which have a third of the global pop­u­la­tion, sug­gest that more than 80% of peo­ple with any men­tal health or sub­stance use dis­or­der did not seek treat­ment. And when they do seek help, the qual­ity is poor.

Hu­man rights vi­o­la­tions oc­cur most of­ten against peo­ple with men­tal health dis­or­ders such as schizophre­nia and learn­ing dis­abil­i­ties. “Tens of thou­sands of peo­ple with men­tal dis­or­ders are chained in their own homes, or in prayer camps and tra­di­tional heal­ing fa­cil­i­ties,” says the re­port.

When peo­ple are freed, it may be with­out warn­ing or proper prepa­ra­tion for their care, lead­ing some­times to ar­rest, im­pris­on­ment and early death. “In 2016, a tragic case oc­curred in South Africa when the Gaut­eng De­part­ment of Health stopped fund­ing a large 2,000 bed fa­cil­ity and al­lowed the dis­charge of vul­ner­a­ble peo­ple with psy­choso­cial dis­abil­ity into im­prop­erly li­censed com­mu­nity res­i­den­tial fa­cil­i­ties, lead­ing to the death of more than 140 peo­ple,” says the re­port.

The com­mis­sion rec­om­mends a much higher pri­or­ity for men­tal health and par­ity with phys­i­cal health­care, as well as the in­te­gra­tion of men­tal health care into rou­tine pri­mary care.

• In the UK, Sa­mar­i­tans can be con­tacted on 116 123 or emailjo@sa­mar­i­tans.org. In the US, the Na­tional Sui­cide Preven­tion Life­line is 1-800-273-8255. In Aus­tralia, the cri­sis sup­port ser­vice Life­line is 13 11 14. Other in­ter­na­tional sui­cide helplines can be found at www.be­frien­ders.org.

Tens of thou­sands of peo­ple with men­tal dis­or­ders are chained in their own homes

Prof Vikram Pa­tel,

Har­vard Med­i­cal School

Pho­to­graph: China Pho­tos/Getty

A men­tal health pa­tient in China, which, with In­dia, con­tains a third of the world pop­u­la­tion but where 80% of men­tally ill peo­ple do not seektreat­ment.

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