Mental illness is moving up the global agenda — but there is still much to do.
Nominally, 2016 should be a good year for mental health. On 13 and 14 April, the World Health Organization (WHO) and the World Bank will hold an unprecedented joint conference in Washington DC to discuss mental health as both a global disease and an economic problem.
It is a welcome gesture after many snubs. Mental illness was left out of the United Nations’ influential high-level meeting on noncommunicable diseases (NCDs) in 2011. Almost begrudgingly, the UN gave mental health a brief mention in the entry for NCDs in its 2015 Sustainable Development Goals. As well as reducing deaths from NCDs such as heart disease by one-third, it said, the world should also “promote mental health and well-being”.
The UN failed to recognize that in terms of impact, mental disorders are at least as harmful as those better-recognized and better-funded diseases. Mental-health conditions account for 37% of the healthy life years lost to NCDs. This reflects shortened lifespans and a loss of ability to work effectively, and it translated to a global loss of US$2.5 trillion in 2010; that figure is projected to rise to $6 trillion by 2030. Simply ‘promoting’ mental health is not enough.
Many developed countries scarcely give mental illness more than lip service. In the United States, for instance, the topic is brought up only when a mass shooting launches a ‘conversation’ about the poor state of mental-health treatment — and then only as a distraction from the gun-control debate. Such attention rarely leads to new funding for mental-health research.
Underlying much of this neglect is the persistent bias, conscious or not, towards believing that many mental-health conditions are a moral failing rather than the result of complex biology, despite overwhelming evidence for the latter. For poor countries wracked by infectious and childhood diseases, it can be easier to confine people with psychosis than to try to treat them. And treatment is hard to find the world over: globally, there are only nine mental-health providers for every 100,000 people, and some countries have only one or two providers. A Comment this week calls for a global strategy to combat care deficiencies in both developing and developed countries.
Even in developed countries, people find it difficult to consider depression as a condition to be combated with the same clarity of purpose as heart disease. This is exacerbated by the failure to develop drugs for depression that are as clear-cut and effective as statins. This is unlikely to change soon: if anything, neuroscience is painting a bleaker picture by showing how complex these diseases are. More than 100 genetic regions have been associated with schizophrenia — and autism and depression are probably even more complex. Addressing all of these will require entirely new approaches. A News Feature this week looks at the latest developments on one emerging, but still unproven, front: phone apps intended to assist people with mental-health disorders.
The annual Mental Illness Awareness Week in October promotes mental health, as do many organizations devoted to erasing the stigma and bias that harm patients and inhibit politicians. But so much more is needed in terms of improved treatments and access to care.
Finance ministers at the meeting next week should recognize the positive economic returns of investing in this direction. The UN, the WHO, the World Bank and governments should be expected to contribute something tangible to this pressing issue. The summit’s attendees should come away with plans for creating specific development targets, and mechanisms for funding research, ensuring that treatment is available in low-income countries, and holding nations responsible for giving mental illnesses as prominent a place in health care as other NCDs.
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Mind matters. Nature 532, 6 (2016). https://doi.org/10.1038/532006a
BMC Medicine (2017)