Global mental health is "the area of study, research and practice that places a priority on improving mental health and achieving equity in mental health for all people worldwide." The field focuses on improving the prevention, care, and treatment of mental health disorders globally, along with improving the quality of life for those living with such disorders. This is often with an emphasis on those living in resource-limited settings with less access to mental health treatment.
Like with global health generally, there has been criticism of global mental health as a neo-colonial or "missionary" project.Movement for Global Mental Health Newsletter . May 2014. The medicalization of human experiences and treatments has also been criticized for ignoring local conceptualizations and methods for healing. Others have criticized pharmaceutical companies for moving into the global market just to get more clients.
While many in the global mental health field study psychosocial interventions developed by or in collaboration with locals, due to constraints in resources like personnel and time, prescribing medication is often seen as more cost-effective. In recent years, there has been an emphasis on creating community-based, scalable, and sustainable interventions.
The overall aim of the field of global mental health is to strengthen mental health all over the world by providing information about the mental health situation in all countries, as well as identifying mental health care needs in order to develop cost-effective interventions to meet those specific needs.
The global burden of disease
Mental, neurological, and substance use disorders make a substantial contribution to the global burden of disease (GBD).World Health Organization. Global burden of disease. Geneva, WHO Health statistics and health information systems. Accessed 15 March 2011. This is a global measure of so-called disability-adjusted life years (DALY's) assigned to a certain disease/disorder, which is a sum of the years lived with disability and years of life lost due to this disease within the total population. Neuropsychiatric conditions account for 14% of the global burden of disease. Among non-communicable diseases, they account for 28% of DALY's – more than cardiovascular disease or cancer. However, it is estimated that the real contribution of mental disorders to the global burden of disease is even higher, due to the complex interactions and co-morbidity of physical and mental illness.
Around the world, almost one million people die due to suicide every year, and it is the third leading cause of death among young people. The most important causes of disability due to health-related conditions worldwide include unipolar depression, alcoholism, schizophrenia, bipolar depression and dementia. In low- and middle-income countries, these conditions represent a total of 19.1% of all disability-related health conditions.World Health Organization: Mental Health and Development: Targeting People with Mental Health Conditions as Vulnerable Group. Accessed 15 March 2011.
According to Paul and Moser's meta-analysis, countries with high income inequality and poor unemployment protections have worse mental health outcomes among the unemployed. One article claimed 76%-85% of these said countries cannot provide care. Roughly 14% of adolescents have mental health challenges as well.
Mental health by region Africa
Mental illnesses and mental health disorders are widespread concerns among underdeveloped African countries, yet these issues are largely neglected, as mental health care in Africa is given statistically less attention than it is in other, westernized nations. Rising death tolls due to mental illness demonstrate the imperative need for improved mental health care policies and advances in treatment for Africans suffering from psychological disorders.
Underdeveloped African countries are so visibly troubled by physical illnesses, disease, malnutrition, and contamination that the dilemma of lacking mental health care has not been prioritized, makes it challenging to have a recognized impact on the African population. In 1988 and 1990, two original resolutions were implemented by the World Health Organization's Member States in Africa. AFR/RC39/R1 and AFR/RC40/R9 attempted to improve the status of mental health care in specific African regions to combat its growing effects on the African people. However, it was found that these new policies had little impact on the status of mental health in Africa, ultimately resulting in an incline in psychological disorders instead of the desired decline, and causing this to seem like an impossible problem to manage.
In Africa, many socio-cultural and biological factors have led to heightened psychological struggles, while also masking their immediate level of importance to the African eye. Increasing rates of unemployment, violence, crime, rape, and disease are often linked to substance abuse, which can cause mental illness rates to inflate. Additionally, physical disease like HIV/AIDS, the Ebola epidemic, and malaria often have lasting psychological effects on victims that go unrecognized in African communities because of their inherent cultural beliefs. Traditional African beliefs have led to the perception of mental illness as being caused by supernatural forces, preventing helpful or rational responses to abnormal behavior. For example, Ebola received loads of media attention when it became rampant in Africa and eventually spread to the US, however, researchers never really paid attention to its psychological effects on the African brain. Extreme anxiety, struggles with grief, feelings of rejection and incompetence, depression leading to suicide, PTSD, and much more are only some of the noted effects of diseases like Ebola. These epidemics come and go, but their lasting effects on mental health are remaining for years to come, and even ending lives because of the lack of action. There has been some effort to financially fund psychiatric support in countries like Liberia, due to its dramatic mental health crisis after warfare, but not much was benefited. Aside from financial reasons, it is so difficult to enforce mental health interventions and manage mental health in general in underdeveloped countries simply because the individuals living there do not necessarily believe in western psychiatry. It is also important to note that the socio-cultural model of psychology and abnormal behavior is dependent on factors surrounding cultural differences. This causes mental health abnormalities to remain more hidden due to the culture's natural behavior, compared to westernized behavior and cultural norms.
This relationship between mental and physical illness is an ongoing cycle that has yet to be broken. While many organizations are attempting to solve problems about physical health in Africa, as these problems are clearly visible and recognizable, there is little action taken to confront the underlying mental effects that are left on the victims. It is recognized that many of the mentally ill in Africa search for help from spiritual or religious leaders, however this is widely because many African countries are significantly lacking in mental health professionals in comparison to the rest of the world. In Ethiopia alone, there are "only 10 psychiatrists for the population of 61 million people," studies have shown. While numbers have definitely changed since this research was done, the lack of psychological professionals throughout African continues with a current average of 1.4 mental health workers per 100,000 people compared to the global statistic of 9.0 professionals per 100,000 people. Additionally, statistics show that the "global annual rate of visits to mental health outpatient facilities is 1,051 per 100,000 population," while "in Africa the rate is 14 per 100,000" visits. About half of Africa's countries have some sort of mental health policy, however, these policies are highly disregarded, as Africa's government spends "less than 1% of the total health budget on mental health". Specifically in Sierra Leone, about 98.8% of people suffering from mental disorders remain untreated, even after the building of a well below average psychiatric hospital, further demonstrating the need for intervention.
Not only has there been little hands-on action taken to combat mental health issues in Africa, but there has also been little research done on the topic to spread its awareness and prevent deaths. The Lancet Global Health acknowledges that there are well over 1,000 published articles covering physical health in Africa, but there are still less than 50 discussing mental health. And this pressing dilemma of prioritizing physical health vs. mental health is only worsening as the continent's population is substantially growing with research showing that "Between 2000 and 2015 the continent's population grew by 49%, yet the number of years lost to disability as a result of mental and substance use disorders increased by 52%". The number of deaths caused by mental instability is truly competing with those caused by physical diseases: "In 2015, 17.9 million years were lost to disability as a consequence of mental health problems. Such disorders were almost as important a cause of years lost to disability as were infectious and parasitic diseases, which accounted for 18.5 million years lost to disability,". Mental health and physical health care, while they may seem separate, are very much connected, as these two factors determine life or death for humans. As new challenges surface and old challenges still haven't been prioritized, Africa's mental health care policies need significant improvement in order to provide its people with the appropriate health care they deserve, hopefully preventing this problem from expanding.
Western Pacific The World Health Organization (WHO) Western Pacific Region comprises 38 countries and approximately 2.2 billion people– nearly a fourth of the global population. Nearly 10 percent of this population (~215 million individuals) struggles with poor mental health. Vast variation in the mental health infrastructures throughout the Western Pacific poses a challenge for consistent, reliable mental health care across the region. Regional mental health leadership and initiatives remain largely fragmented, inhibiting the potential to address growing concerns relating to rapid urbanisation, proliferation of drug supplies and abuse, climate change vulnerability, and economic deprivation, among other issues. The Western Pacific Region accounted for a quarter of suicide mortality in 2019.
In the region's low- and middle-income countries (LMICs) (Cambodia, China, Fiji, Kiribati, Laos, Malaysia, the Marshall Islands, Mongolia, Papua New Guinea, the Philippines, the Solomon Islands, Tonga, Tuvalu, Vanuatu, and Viet Nam), child and adolescent mental health is particularly at risk, with this population accounting for nearly 18 percent of DALYs attributed to mental illness and substance abuse. Despite this, most of the region's LMICs allocated ≤1% of their total mental health spending on Child and Adolescent Mental Health (CAMH). This presents a particularly problematic situation, given that over 30% of these countries' populations are composed of individuals between 0 and 24 years of age and given that approximately three-quarters of lifetime cases of mental disorders develop in this age range. This signals the necessity of developing early-intervention mental health initiatives in the region.
Latin America and the Caribbean