Cesar Chelala
Cesar Chelala
A physician and writer

Global needs on mental health are still unmet

On a global scale, the magnitude of undiagnosed and unaddressed mental health problems continues to be unacceptably high. It is estimated that 330 million people globally suffer from depression, 50 million from epilepsy, 37 million from Alzheimer’s disease and 24 million from schizophrenia.

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. Depression is a major contributor of suicide. About one 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 — every 17 minutes another person ends their life.

According to a World Bank study, mental health disorders are among the main causes of disease and disability in the world. 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.

The lack of effective mechanisms to deal with mental health issues remains pervasive. The most pressing need, however, is found in several developing countries. Out of the 191 surveyed, almost 25 percent do not have a national policy or legislation on mental health issues. As indicated by the 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 afflictions. Stigma, discrimination, and neglect prevent care and treatment from reaching people affected with mental disorders.

In spite of the need for support, on a global scale approximately 70 percent of people have access to less than one psychiatrist per 100,000 people, 55 percent of people have access to less than one neurologist per million people, and 44 percent of people have access to less 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 common problem: Many people who could benefit from them do not use available psychiatric services. Even in countries that have adequate services less than half of the people needing care make use of them.

There is a dire need to implement proper policies. Unless we do so, significant public  health 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.

Policy makers are often hindered by competing demands for financial assistance in dealing with mental health issues. Some basic tenets are: mental health disorders can be prevented; most mental and behavioral disorders can be successfully treated; not treating them will lead to high economic and social costs; much of their prevention, treatment and cure is affordable. And, most importantly, through appropriate treatment many of those who suffer from a mental disorder can resume normal, fulfilling, and productive lives.

About the Author
César Chelala is a physician and writer born in Argentina and living in the U.S. He wrote for leading newspapers all over the world and for the main medical journals, among them The New York Times, The Washington Post, The Wall Street Journal, The Japan Times, The China Daily, The Moscow Times, The International Herald Tribune, Le Monde Diplomatique, Harvard International Review, The Journal of the American Medical Association, The Lancet, Annals of Internal Medicine, and The British Medical Journal. He is a co-winner of an Overseas Press Club of America award and two national journalism awards from Argentina.
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