James Militzer

At Long Last: Is mental health poised to take its place on the global health agenda?

A survey of 2,000 people across Britain asked which of the following things they’d be most uncomfortable admitting publicly:

  • having a drinking problem
  • going bankrupt
  • being gay
  • having a mental illness

The biggest taboo by far? Mental illness.

It’s a stigma that’s present in all countries – and that’s often even stronger in the developing world. And it’s one reason that mental health has traditionally been an afterthought in global health discussions. But there’s a growing sense that this may be changing.

In what the American Public Health Association describes as “a historic first,” the American Journal of Public Health has devoted its May 2013 issue to covering the stigma against mental illness in the U.S. and internationally. And at the (packed) Global Mental Health sessions at Unite for Sight’s recent Global Health & Innovation Conference, every presenter commented on the sense of excitement and momentum in the field – as you can see in the videos below.

“Global mental health as a field has really escalated in the past couple of years,” says Dr. Gary Belkin, director of the Program in Global Mental Health at New York University School of Medicine (and one of the presenters at the conference). “There’s been a transformation in the visibility and attention of mental health in the global health agenda.”

This may be due in part to the fact that the problem has grown too large to ignore. Mental, neurological and substance-abuse disorders already constitute a larger share of the global disease burden than both cancer and heart disease, and depression alone is quickly becoming one of the largest causes of disease burden worldwide. Mental and psychosocial disabilities are associated with unemployment rates as high as 90 percent. Yet up to 85 percent of people in developing countries do not have access to any form of mental health treatment.

But Belkin also attributes the field’s emergence to the growing awareness of mental health’s impact on other health problems. “Mental health has really shifted in its relevance to overall health care,” he says. “Once we started looking at disease burden around disability, it really changed the sense within public health of the relevance of mental health conditions – and also their impact as an obstacle to other health care objectives. In terms of the cost effectiveness of overall health care, in terms of overall mortality, morbidity, being able to achieve other chronic disease goals – [there are] multiple dimensions in which you really can’t escape these issues.

“I now have conversations that go somewhere that never went anywhere, even a year or so ago, in really thinking innovatively about fully integrating mental health capacity within primary care … to be part of more upstream, early interventions and ongoing care management solutions. And these are ideas that I was first exposed to looking at low-income countries. So the global field is starting to get a problem list of issues that really are globalized… all those things are now global conversations and back-and-forth learning about best practices.”

Surprisingly, Belkin says that when it comes to integrating mental health into the broader health care system, developing countries may have an advantage. “Sometimes I feel there are more obstacles in the developed world, where there are really entrenched roles and turfs, and it’s sometimes harder to migrate care and embed it into one setting when it’s been in another for so long,” he says. “In the developing world, there’s sometimes, by necessity, this understanding of task sharing and task shifting. And I think one of the lessons from the Millenium Development Goals – and from the huge, aggressive, ambitious efforts around HIV, tuberculosis and malaria – was a realization that that siloed approach really missed opportunities for system strengthening, for building capacities that cut across disease categories.”

Mental health might be poised to receive the kind of sustained attention from major international players that has made such a difference in combating diseases like HIV, TB and malaria. At its upcoming World Health Assembly (May 20–28), the WHO is expected to endorse the Global Mental Health Action Plan 2013-2020, which proposes to address the global burden of mental disorders “by adopting a comprehensive and multi-sectoral approach involving coordinated services from the health and social sector, with an emphasis on promotion, prevention, treatment, care and recovery.” The plan would also set out clear roles for the WHO’s international, regional and national-level partners, while proposing key indicators and targets that could be used to evaluate levels of implementation and impact.

So perhaps in the coming years, we’ll look back at 2013 as the year global mental health finally came into its own. The videos below provide an overview of some of the challenges and opportunities in mental health today. You can learn more about the field’s recent evolution in the following interview with Belkin.

The Evolution of Global Mental Health – and interview with Gary Belkin

Let’s Close the Billion-Person Treatment Gap for Common Mental Illnesses – a presentation by Gary Belkin at the 2013 Global Health & Innovation Conference

Challenges and Strategies for Assessing Mental Health in Cross-Cultural Contexts – a presentation by Judith Bass at the 2013 Global Health & Innovation Conference

Global Mental Health and the Role of Academic Partnership – a presentation by Christina Borba at the 2013 Global Health & Innovation Conference

Assessing the Economic Impact of Psychological Distress on Employment and National Income in Ghana – a presentation by Maureen Canavan at the 2013 Global Health & Innovation Conference

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