A recent article in the Lancet claimed that global mental health needs attention. It’s not hard to imagine – if 40% of the world lives in extreme poverty on less than $2 per day, with limited access to basic health services, mental illness then sits at the bottom of the stack of future priorities. As this article states, “the lives of individuals with mental illness exist under the worst of moral conditions.” The author, who has been involved in global mental health for four decades describes depressing scenarios …”appalling, dreadful, inhumane – the worst of words pile on each other to name the horror of being shunned, isolated and deprived of the most basic human rights…hidden by families, stoned by neighborhood children, treated without dignity, respect or protection by medical personnel.”
One of the major issues in dealing with mental health (in any part of the world) is the stigma associated with most psychiatric disorders. In fact, mental health professionals and family members often promote these stigmas making it even more difficult to break the cycle. Addressing the issue of global mental health, the article argues, will require a moral transformation – giving social legitimacy to people suffering from a mental illness.
The article goes on to claim the state’s responsibility for protection of its citizens (under international law) which arguably should protect against this human tragedy.
Regardless of who we want to blame, addressing this global and tragic situation will require both civil and state response. Those of us who are physicians, nurses or global health experts should advocate to bring more attention to mental health issues.
For example, we can advocate for a more robust, creative and effective curriculum to train health professionals. In my medical training, I remember finding it particularly boring, tedious and difficult to memorize the DSM IV criteria for the many psychiatric condition that ultimately I could barely tell apart. In fact, I have subsequently found that the most effective way to teach the real impact of psychiatric disease is through narrative medicine – poetry, stories, or movies – that depict the mentally ill and bring the human spirit into the experience of these diseases.
We don’t need to tolerate the apparent apathy toward global mental health. For those unfortunate enough to live in poverty with a mental disorder, we can give them a voice by advocating to improve their moral conditions. Improving medical education is just one small step we can take towards improving the global mental health crisis.