Globally, mental disorders account for 13% of total disease burden. Stigma and limited resources mean few people in low- and middle-income nations receive the help they need. Studies show effectiveness of new ways of closing this treatment gap.
Mental disorders such as anxiety, depression and suicide attempts are a reality for the poor as much as they are for the rich, even though they are often overlooked.
Facts and figures from the WHO’s Mental health atlas 2014 show that suicide rates can be very similar between low- and middle income countries such as Vietnam and high-income countries such as the United Kingdom, with five and six suicides per 100,000 people, respectively. However, few people in the developing world get the mental healthcare they need, and many patients are treated inhumanely or offered treatments that do more harm than good.
Mental disorders account for 13% of the total global burden of disease. Depression is the third leading contributor to this burden, according to 2011 estimates: an estimated 13% of suicides are by people who suffer from depression, and people with depression are 20 times more likely to kill themselves compared to those who are not depressed.
Suicide is a major contributor to the number of deaths across all ages worldwide.
- Nearly 900,000 people take their own lives each year.
- This figure expected to rise to 1.5 million deaths by 2020.
While getting accurate information on suicide is difficult in the global South for reason of political, cultural and religious obstacles, the WHO’s first global report on suicide prevention suggests that 75% of suicides occur in LMICs.
The Million Death Study conducted in India shows how massive a problem suicide is in some LMICs: India’s suicide rates are among the highest in the world. The study’s estimates for 2010 show that about 3% of all deaths of those aged 15 or over were due to suicide, and that 40-50% of suicides were by people aged between 15 and 29, with women more affected than men.
Obstacles to treatment
Despite the huge burden of mental illness and proven efficacy of certain treatments in LMICs, only one in five people with severe mental disorders in these countries receives treatment.
Experts call this the ‘treatment gap’.
Treatment for mental disorders has received little policy focus in the developing world. According to the WHO’s Mental health atlas 2014, only 60% of the surveyed 171 countries reported data on or evidence of all of the following:
- A relevant policy or action plan;
- Relevant laws;
- Programmes to promote mental health and prevent mental disorders; and
- Mental health services and dedicated workforce.
The record is poorer when it comes to action plans: only about 15% of countries have a fully implemented plan, 14% have an unimplemented plan and 10% have no plan at all.
Promising practices for transformative change
Promising evidence-based strategies do exist.
Efforts to reduce the mental health treatment gap face many barriers. So innovative strategies are crucial to overcome them. Some programmes have attempted to do this by integrating mental health in primary care services, which makes care for mental illnesses more accessible and affordable. Another approach is to train lay or community health workers to deliver mental health treatments. This gets around the barriers of having enough human resources. Yet another approach is to adapt treatments in a systematic way to tackle stigma and other considerations that relate to the social environment, to address the acceptability barrier.