Global Mental Health – Part of a fuller picture of health
July 9, 2021
by Guest Contributor
by Julian Eaton, MBBS, MSc, Mental Health Director, CBM Global, and Assistant Professor, London School of Hygiene and Tropical Medicine
Many of us will have experienced personally, or through our relationships, the impact the COVID-19 pandemic has had on mental health and wellbeing. For example, there is a lot of evidence to show increased levels of loneliness and distress, as well as conditions like depression and anxiety. We have seen the importance of community support, including through churches and other faith groups. Many churches and other groups have found innovative ways of maintaining supportive connections. We have also seen the degree to which those who are already marginalized are disproportionately affected, and the need for care and support for people who are isolated, have lost jobs, or are sick or bereaved.
In principle, mental health has been a part of the overall global health agenda since the foundation of the World Health Organization (WHO), but in reality, it has been a hugely neglected area. The Global Burden of Disease studies in the late 1990s compared high-quality data on mental health with other conditions, and found that around 10 percent of the total health needs globally were attributable to mental conditions.
Despite the high levels of need identified, in many low- and middle-income countries, only about 1 percent of health budgets are used for mental health, and a similar proportion of Official Development Assistance for Health is used for mental health. This injustice was a shock to many, and prompted the emergence of the modern field of Global Mental Health, which has called for a massive scale up in access to evidence-based mental health care, and for attention to be paid to the scandal of huge levels of abuse and neglect of people with mental health conditions. In 2007, The Lancet published a ‘call for action’ in global mental health.
Over the last 15-20 years, there has been a revolution in the way that mental health is being considered in broader global health, and in this blog, I want to share some of the key issues and developments.
Human Rights and Mental Health
First; human rights are at the core of mental health. People with mental conditions are among the most marginalized in any community. Especially for those with more severe conditions like schizophrenia, it is common for people to be confined within formal or informal facilities, including prisons, health institutions, but also faith settings like churches, temples or mosques. It is also all too common for people with severe mental illness to be shackled – often as a response to absence of effective and dignified treatment options. Such treatment is often in part justified by belief systems that give a spiritual cause, or blame people affected. Faith communities have the capacity to play an important positive role in supporting people in distress and with mental conditions, but must avoid being part of coercive or abusive practices of confining people against their will without offering hope of recovery.
Access to Quality Mental Health Care
Second, linked to this, is the right to access to mental health care, which is often not a priority for governments and other providers. There are many barriers to access mental health care, especially in rural areas, as services remain focused in specialized hospitals in large cities. This means many people cannot travel to reach services, or cannot afford them. Important research has led to clear guidelines for scaling up mental health care through decentralized services, delivered by non-specialists, described in a WHO programme called the Mental Health Gap Action Programme, mhGAP.
This ‘task sharing’ approach is revolutionary, and makes mental health an integral part of all health, not something to be separated out in often stigmatized tertiary hospitals. Most people can receive good care from local providers in primary or secondary health care, linked to support for other needs such as social welfare, education or employment. Community-based services have been hugely impactful in transforming lives when they put people at the center of what they do. See this CBM End The Cycle of Poverty and Disability video.
A Holistic Approach to Recovery
Third, although their voices are often not heard, people affected themselves have made important contributions to shaping the field. They have emphasized, for example, how stigmatization and social exclusion often causes the most painful suffering, and so our approach must include a range of supports that can help people to live full and flourishing lives, and not just focus on medication to reduce symptoms. In many countries, a spiritual component of a whole-person approach is often emphasized by local communities. Peer support, and self-help groups have emerged as extremely important means of supporting this more holistic approach to recovery, in addition to engaging with wider communities to reduce stigma and discrimination.
Finally, in addition to the urgent need to improve access to good quality care and support, there has been an increased recognition of the social determinants of mental health. Many of the factors that drive increased risk of mental ill health, like poverty, violence, unemployment, gender, or poor access to education or health, are issues of justice and equity. Even with the proposed huge scale up of services, we will never reduce the number of people who experience distress and mental conditions, unless we start to address these underlying causes. They are also integral to achieving the broader Sustainable Development Goals, all of which contribute to wellbeing. A recent landmark Commission on Global Mental Health lays out the evidence for the importance of action across sectors, as a means of promoting mental health, and not just being reactive.
What can faith communities do?
Such action, along with provision of compassionate care for those suffering is closely aligned to a Christian perspective of justice being at the core of human flourishing. Other faiths share this view, and given the fact that in most parts of the world, people will often consider their faith to be at the heart of mental health issues, we must include faith communities in the wider Global Mental Health endeavor.
Key ideals include:
Church communities should be places of acceptance and support, not judgement and exclusion. Providing emotional support is anessential part of the skill-set of faith leaders, and should be taught as part of the ethos of the whole community. It is a positive thing to see mental health becoming more often discussed openly, which reduces stigma, and helps people to seek support when they need it.
Faith-based health service providers need to strengthen their mental health work, making sure that appropriate provision is made in their services for good quality mental health care, that conforms to the highest standards of compassionate care, based on good evidence. There are increasing resources becoming available to do this work, and excellent technical support available to carry it out.
Mental health and wellbeing are additional arguments in our ongoing fight for a more equal world; further reason for challenging the injustices that disproportionately affect the already marginalized.
Bringing mental health into the open has been important for acknowledging that we need support during difficult times. Faith communities, including churches, already play an important role in providing such support, and can use the growing evidence and experience in global mental health to more fully realize their mandate in community health in a holistic way.
CBM Global Good Practice Guides: The guides focus on Peer-Support, Community Mental Health Forums, Stigma and Awareness Raising, Mental Health System Strengthening, and Neglected Tropical Diseases and Mental Wellbeing.
About the Author: Julian Eaton is a psychiatrist focused on public mental health, promoting greater access to services, social inclusion, and realisation of rights for people with mental illnesses, especially in low and middle income countries. He lived in West Africa between 2003 and 2016.