On a global scale, the magnitude of undiagnosed and unaddressed mental health problems continues to be high. It is estimated that 120 million people globally suffer from depression, 50 million from epilepsy, 37 million from Alzheimer’s disease, and 24 million from schizophrenia. About 1 million people worldwide commit suicide every year, and approximately 20 million unsuccessfully attempt suicide. In the United States, suicide is the eighth leading cause of death—another life is taken this way every 17 minutes.
According to a World Bank study, mental health problems are a major cause of lost years of quality life. In spite of that, allocations to treat mental health problems in national health budgets are disproportionately small in relation to other diseases and the serious health consequences they pose.
Despite these efforts, the lack of effective mechanisms to deal with mental health issues remains pervasive and has been found in all countries surveyed in a WHO study. The most pressing need, however, is found in several developing countries. Out of the 191 countries surveyed, almost 25 percent do not have a national policy or legislation on mental health issues.
As indicated by the World Health Organization (WHO), the situation is worse among the poorest sectors of the population, whose “lack of access to affordable treatment makes the course of the illness more severe and debilitating, leading to a vicious circle of poverty and mental health disorders.”
Although treatments are available for many mental health problems, almost two-thirds of sufferers never seek help from a health professional. In many cases this is the result of a lack of economic means, and in others it is a reflection of the stigma frequently associated with mental illness. According to the WHO, stigma, discrimination, and neglect prevent care and treatment from reaching people affected with mental disorders.
Mental health disorders are among the main causes of disease and disability in the world. Depressive disorders are now the fourth leading cause of the global disease burden, and it is estimated that they will rank second by 2020, lagging behind only ischemic heart diseases.
In spite of this, on a global scale, approximately 70 percent of people have access to fewer than one psychiatrist per 100,000 people, 55 percent of people have access to fewer than one neurologist per million people, and 44 percent of people have access to fewer than one psychiatric nurse per 100,000 people. These are general figures that do not take into consideration significant regional, national, and local variations.
All in all, the services and resources available are one-tenth to one-hundredth of what is needed. Despite wide differences between mental health care in industrialized and in developing countries, both share a problem: Many people who could benefit from available psychiatric services do not use them. Even in countries that have adequate services, fewer than half of the people needing care make use of them.
The need to implement proper policies is urgent. Unless we do so, significant gains made over the last 40 years in reducing child and maternal mortality, increasing life expectancy, and lowering the burden of infectious diseases will be offset by the growth of mental and behavioral problems. Both international agencies and national governments must now invest in mental health services as a significant part of their development strategies.
Policymakers are often constrained by competing demands for financial assistance in dealing with mental health issues. They must take into account that some mental health disorders can be prevented; that most mental and behavioral disorders can be successfully treated; that not treating them will lead to high economic and social costs; and that much of this prevention, treatment, and cure is affordable. And, most importantly, it should be stressed that, through appropriate treatment, many of those who suffer from mental illness can resume normal, fulfilling, and productive lives.
César Chelala, M.D., Ph.D., is a public health consultant for several U.N. and other international agencies. He has carried out health-related missions in 50 countries worldwide.
