History of Mental Health Series: Mental Health in an Unequal World

Foreword

History of Mental Health Series is a set of articles that reviews the history of mental health from a sociological perspective: from the ancient to the modern understanding of the concept. Nowadays, mental health is one of the most widely discussed topics; however, it had a hard, alluring history of development through the centuries. The following six articles explore the history of mental health and some of the most fascinating and sometimes unbelievable facts about the topic, aiming to raise awareness about mental health and its importance of one’s wellbeing.

1. History of Mental Health Series: Mental Illnesses and Demons

2. History of Mental Health Series: Is there a Healthy Mind in a Healthy Body?

3. History of Mental Health Series: The First Asylums

4. History of Mental Health Series: Chlorpromazine and the Drug Revolution

5. History of Mental Health Series Deinstitutionalization and Community Care

6. History of Mental Health Series: Stigmatization of Mental Health

7. History of Mental Health Series: Mental Health in an Unequal World

Mental Health in an Unequal World

Mental health has come a long way, from the ignorant and deadly approaches in ancient times, to the modern world with scientifically and medically proven knowledge of the field, and vastly improved therapies. Nowadays, treatments are not only knowledge-based and effective, but also, they are believed to be more morally performed.

Despite the well-developed and developing mental health interventions, the majority of the population in low or medium-income countries (LMIC) still do not have access to proper care to treat their mental health problems. (Kohn et al., 2004). In addition to this, various studies have shown the correlation between costs and treatment, arguing that in most cases, price is an impediment to an effective and timely treatment of mental health problems (Chisholm et al., 2016; Petersen et al., 2016).

Hence, inequality in mental health treatments creates a huge gap in how mental health treatment is regarded globally. In response to this issue, the World Health Organization (WHO) developed the Mental Health Gap Program Intervention Guide (mhGAP-IG), designed to be easily used by non-professionals (WHO, 2016); however, implementing scientific knowledge and findings into practice has been problematic in low and middle-income countries. The main reasons for this, are the lack of recognition and understanding of the issue in society - in addition to stigma, shortages of mental health professionals and workers, separation and differentiation of mental health treatments from other health treatments, all result in poor quality care for those who need help (Thornicroft, 2012).

Figure 1: Scene from One Flew Over the Cuckoo’s Nest by Miloš Forman. (1975).

In LMICs, mental health conditions are not properly explored; therefore, further research is required to delve into the issue and create solutions that will be fashioned for each one of them based on their culture and conditions. For that reason, the following priorities have been identified to maximize the result with limited finances:

Capacity Building - Scaling up the number of trained personnel for mental health assistance. The lack of a professional staff that is skilled in evidence-based practices is the number one reason for the program’s failure. Unfortunately, 90% of mental health patients with severe illnesses such as schizophrenia do not receive proper or any kind of treatment in low-income countries due to a lack of professional treatment institutions or skilled staff, which, it must be said, is a human rights violation against mentally ill people (Lora, 2012).

Challenging mental health stigma - Eliminating mental health stigma remains an obstacle for mentally ill individuals. The stigma prevents people from seeking help and promotes silent suffering. Additionally, it causes discrimination against them. In addition to economic problems and inadequate mental health care facilities and services, discrimination and prejudice against people with mental illnesses can prevent or delay mental illness treatments (Henderson et al., 2013).

In 1979-1993, researchers conducted two identical surveys in the UK within 10 years. The findings were similar, which, unfortunately, were mostly negative: “Over 80% endorsed the statement that “most people are embarrassed by mentally ill people”, and about 30% agreed “I am embarrassed by mentally ill persons” (Huxley, 1993).

Preventing Mental Disorders - This approach puts attention not only on a cure for recurring mental disorders but also attempts to prevent them before they are fully developed. Researchers talk about the importance of prevention and argue that it is the key to sustainable aftermath (Cuijpers, et al., 2012). In addition to this, sustainability and quality must remain as a core part of the process, which can only be assured by research and observation of processes; that is, existing mental health care practices.

Mental illnesses - deadly illnesses?

Figure 2: Manet, E. Le Suicide (1877)

“Despite progress, one person still dies every 40 seconds from suicide,” said WHO Director-General, Dr. Tedros Adhanom Ghebreyesus. Unfortunately, suicide is the second most common cause of death in young people from 15 to 29 - the first being traffic accidents (WHO, 2018). Every year more countries are joining the WHO initiative against suicide; however, more effort is needed, as so far only 38 countries have measures for suicide prevention (WHO, 2018).

Suicide rates are higher in high-income countries, which can be explained by the culture and lifestyle within these societies. Individuals are lost in their quest for success, almost all alone, wearing multiple masks, proving Durkheim’s theory. He argues that suicide is not only a consequence of various psychological factors, but also social factors, and named social integration as one of the main causes, as a higher level of integration means stronger ties to society, or contributes to a general sense of belonging and feeling of “not being alone”. When an individual is less integrated within society, the feeling of being lost and being lonely increases, and one is more likely to commit suicide (Durkheim, 1966).

World Mental health day and modern mental health movements

Figure 3: World Mental Health day 2021, WHO

Since 1992, the world has been celebrating Mental Health Day on the 10th of October. The ultimate goal of this date is to raise awareness of mental health problems in the world - fighting prejudices and supporting people with mental health issues (WHO, 2021). Thus, people join around the same issue and celebrate life in every form and condition, and each year the occasion has a specific topic and theme. In 2021, WHO decided to use the motto "Mental Health in an Unequal World: together we can make a difference" to demonstrate the goal of the organization and all the others who joined around the issue of mental health (WHO, 2021). Apart from official days, millions of users of social media are actively engaged in various mental health campaigns, promising a better future with better mental health.

In conclusion, mental health is one of the most stigmatized health issues, among other illnesses. It has a long history - from skull trephine methods as a cure for mental illness to modern therapies involving medicine-based treatments. Ancient people had enough proficiency to treat various diseases; nevertheless, they could not figure out the extraordinary behavior of those who were physically ill. Throughout our history, Mentally ill people have often been victims of discrimination and stigma. In the modern world, humankind has science-based knowledge about the issue which must be the precondition for better and more adequate treatments. Moreover, various movements are advocating for the rights of people with mental illness; however, patients are still struggling in every aspect of life, from receiving proper treatment, to the complete integration into society.

References:

• Byrne, P. (2000). The stigma of mental illness and ways of diminishing it. Advances in Psychiatric Treatment, 6, 65–72.

• Chisholm D. et al. (2016) Scaling-up treatment of depression and anxiety: a global return on investment analysis. The Lancet Psychiatry. 3(5):415–24.

• Cuijpers P, Beekman AT, Reynolds CF. (2012) Preventing depression: a global priority. JAMA. 307(10):1033–4.

• Durkheim, E., Spaulding, J. A., & In Simpson, G. (1966). Suicide: A study in sociology.

• Huxley, P. (1993) Location and stigma: a survey of community attitudes to mental illness: enlightenment and stigma. Journal of Mental Health UK, 2, 73–80

• Kohn R, Saxena S, Levav I, Saraceno B. The treatment gap in mental health care. Bull World Health Organ. 2004;82(11):858–66.

• Lora A, Kohn R, Levav I, McBain R, Morris J, Saxena S. (2012) Service availability and utilization and treatment gap for schizophrenic disorders: a survey in 50 low-and middle-income countries. Bull World Health Organ. 90(1):47–54B.

• Petersen I. et al. (2016) Promotion, prevention and protection: interventions at the population-and community-levels for mental, neurological and substance use disorders in low-and middle-income countries. Int J Ment Heal Syst. 10(1):1.

• Sweetland AC, Oquendo MA, Carlson C, Magidson JF, Wainberg ML. (2015) Mental health research in the global era: training the next generation. Acad Psychiatry. 40:1–6.

• Thornicroft G. (2012) Evidence-based mental health care and implementation science in low-and middle-income countries. Epidemiol Psychiatr Sci. 21(03):241–4.

• Wainberg, M. L. et al. (2017). Challenges and Opportunities in Global Mental Health: a Research-to-Practice Perspective. Current Psychiatry Reports, 19(5). Retrieved From: https://doi.org/10.1007/s11920-017-0780-z

• WHO. (2016) mhGAP intervention guide for mental, neurological and substance use disorders in nonspecialized health settings version 2.0. Geneva: World Health Organization;

• WHO (2018). Global Health Estimates 2016: Deaths by cause, age, sex, by country and by region, 2000-2016. World Health Organization, Geneva.

• WHO. (2019). Suicide: one person dies every 40 seconds. WHO. Retrieved From: https://www.who.int/news/item/09-09-2019-suicide-one-person-dies-every-40-seconds

Image references:

• Figure 1: Unknown. (1975) Scene from One flew over the cuckoo’s nest. Directed by Miloš Forman. [Photograph]. Retrieved from: https://www.intofilm.org/news-and-views/articles/one-flew-over-the-cuckoos-nest-feature

• Figure 2: Manet, E. (1877). Le Suicide [Painting]. Retrieved from: https://www.manet.org/le-suicide.jsp

• Figure 3: WHO. (2021). World Mental Health Day 2021 [Illustration]. Retrieved from: https://www.who.int/campaigns/world-mental-health-day/2021/about