There are an estimated 450 million people worldwide with mental health disorders. Three quarters of them live in developing countries, and at least 85% of those are not receiving treatment. Even where treatment is provided, it often falls far below minimum acceptable standards, particularly when affected families are struggling with severe poverty. The impact of mental illness is magnified by inadequate food, clothing and shelter, and a complete denial of opportunities for change. The chronic trauma of untreated mental illness leads families to resort to human rights abuse such as shackling and chaining those affected so that they can get on with their everyday lives.
There is a silver lining. The global community is finally beginning to turn its attention towards mental health, recognising that it is a profound public health problem that affects productivity and therefore the wealth of nations. Mental health was prominent on the agenda at the World Economic Forum, Davos this year, prompting Tom Insel, Director of the National Institute for Mental Health in the US, to write in his blog that “the time is now”. Academics, researchers, practitioners and, increasingly, affected people themselves and governments are coming together to find answers to a problem about which very few questions have been asked.
Investments in mental health, by governments and others who have the resources, are grossly inadequate. This is beginning to change a little as some major funders such as NIMH, Grand Challenges Canada and DFID are funding large mental health research efforts and often investing funds to pool all the evidence.
Given the global magnitude of the problem and the desperation of the need of those affected, this is too little – not only in money terms but in scope, scale and pace. The scope of mental health research must expand from psychiatry and public health to cover in equal terms socio-economic factors that are in fact critical determinants of mental illness as well as of recovery. But, even more importantly, the pace of evidence creation through research must be matched, if not outpaced, by the effective, affordable and widespread delivery of services that address mental illness as well as the poverty of affected families.
Comprehensive delivery models already operating at scale, such as that of my own organization, the BasicNeeds Model for Mental Health and Development, can offer effective delivery solutions based on experience in developing countries. Through outreach clinics, mental health camps, regular checkups and medication, we help people to access community based mental health treatment. Once they have received medication and are stable, they are then supported in income generation activities such as agriculture that can either be undertaken individually or as part of a self-help group, or finding productive work such as gardening and household activities.
People with mental illness are also encouraged to join self-help groups where they are able to express themselves, share their experiences and develop ways and means to manage their mental health. Through the group they also learn to advocate for their needs.
Forty-one year old lady from Khamkeut district in Lao PDR married with five children and now engaged in farming says, “I used to work as a nurse at the clinic of a military camp and had to resign in the year 2008 due to my illness. I felt so disappointed being unemployed and considered as a useless person by my family and my neighbours. After having treatment since December 2010 with the BasicNeeds programme, I got better and my confidence has returned. I am able to help my family to earn a living. I can now work growing mushrooms and selling them at the market. I earn about 600,000 LAK (or £50) per week from selling mushrooms! My family’s financial situation is improved and I feel so proud of myself being again an asset to my family.”
Thus our work on mental health reduces people’s poverty and restores their sense of self-worth and dignity, enabling them to live and work successfully in their communities.
Speaking about the need for a “science of delivery” and the significance of their experience and insights, World Bank President Jim Yong Kim said that implementers “test solutions, observe the results, make corrections, test again … In most cases where countries and partners achieve good development outcomes, it’s actually this tacit implementer know-how that is driving the success.”
More investments are required for generating useable evidence and lessons from such solutions-driven approaches that not only go beyond treatment delivery, but also operate in the real world of families and communities.
Author: Chris Underhill, MBE, is the Founder Director of BasicNeeds, and a Schwab Foundation Social Entrepreneur of 2014.
Image: Plaster phrenological models of heads, showing different parts of the brain, are seen at an exhibition at the Wellcome Collection in London March 27, 2012.