The invisible problem in global development

The world is facing a "global human rights emergency in mental health," says the World Health Organization (WHO) via the Guardian. It's a quiet crisis keeping millions out of the global marketplace.

Mental health problems (including autism, substance abuse, schizophrenia, depression, dementia) account for an estimated 14 percent of all global health conditions, yet receive less than 1 percent of most countries' health-care budget, according to the Guardian. Overall, the WHO estimates a 75 percent coverage gap in many countries with low and lower-middle incomes. One-third of all countries lack a mental health program, and only one of 10,000 UK charities listed on GuideStar is dedicated to international mental health.

Saudi Ali Mufreh exemplifies the problem, having lived in chains for 35 years since developing mental problems at age 15. Ali spends his days alone, hearing little more than the sound of “his clanking iron restraints,” says Al-Riyadh. Ali's brother Omar explained:

I was forced to chain my brother in this small room to protect him and protect others from him. I am searching for a cure to his condition, but I have had no luck yet. If I let my brother go, then he will place the whole family in danger. On two occasions, he tried to burn down the house. Both times we escaped, but the whole house was severely damaged.

Ali is not alone. Dr. Irmansyah, Indonesia's director of mental health services, estimates that 30,000 mentally ill people are restrained in cages, stocks or chains. Some suffering from mental illness are deposited at camps like Indonesia's Yayasan Galuh, where patients live on a hard tile surface surrounded by open sewers, according to PBS NewsHour.

In addition to violating basic human rights, the isolation of those with mental illness also creates an economic burden on developing countries, says the Guardian.

Mental illness adversely affects people's ability to work, creates a potential career burden on their families and generally leads to greater poverty.

But, there's hope.

In 2008, the WHO launched the Mental Health Gap Action Program to improve conditions for the mentally ill, primarily in developing countries. The WHO asserts that “with proper care, psychosocial assistance and medication, tens of millions could be treated for depression, schizophrenia, and epilepsy, prevented from suicide and begin to lead normal lives&emdash;even where resources are scarce.”

Four critical areas for emphasis going forward include:

• Reaching people in the countryside: Many of the developing world's mentally ill live in the countryside, and what few treatment services that exist are likely far away in the capital cities. Large numbers of non-specialist field health workers could be trained in basic mental health care and drug distribution, serving as a first line for treatment and as a conduit for passing more serious cases onto city hospitals.
• Changing Public Awareness and Perceptions: The mentally ill are often hidden from society due to the social stigma and marginalized, so it is little surprise they receive minimal help. The U.N.'s Millennium Development Goals make no mention of mental disabilities, and discussion of mental health is often considered "something of a luxury" among policymakers and the media. Making the topic visible and less stigmatized encourages donations, research and advocacy.
• Preventing illness before it develops: Aiding malnourished or overworked mothers and their newborns is a critical step to preventing mental illness in the first place. According to one WHO report,“improving nutrition and development in disadvantaged children can lead to healthy cognitive development, improved educational outcomes, and reduced risk for mental ill health."
• Seeing the mentally ill as potential workers: In one study from India, the onset of mental illness reduced working hours by 64 percent (from 28 to 10) — not including increased family care — suggesting major economic benefits accruing to countries who get the mentally ill treated and back to work. In other words, there may be only one aid program a family like Ali’s needs: treatment for Ali himself.

Developing countries and NGO's will eventually realize the advantages of treating the mentally ill. However, changing the way the general population perceives the mentally ill may be just as difficult as treating the mentally ill themselves.