Mental illness and the developing world

Mental health is the invisible problem in international development. The World Health Organisation estimates that mental and neurological disorders are the leading cause of ill health and disability globally, but there is an appalling lack of interest from governments and NGOs.

One reason behind this apparent indifference is the market-driven nature of aid. At an NGO level, allocation of funds is strongly correlated with a project’s marketability to the general public.

The most marketable projects can distil a problem into a captivating image.Research has shown that people will give about twice as much if they can empathise with an individualised picture rather than being presented with stark statistics of need. With mental health it is much more difficult to generate that empathy: there are no externally apparent symptoms to create a good snapshot image, and indeed it is very difficult to understand what living with schizophrenia or bipolar disorder would actually be like. As a result, mental health charities struggle to raise funds.

There is still a stigma around mental health and this restricts the formation of any meaningful social pressure to affect individual or governmental action. In the UK,70% of people affected by mental illness experience discrimination at some time, and discrimination in developing countries similarly impedes mental health provision.

The World Health Organisation states that we are “facing a global human rights emergency in mental health”. Nora Mweemba, who works for the WHO in Zambia, explains that many people suffering from mental health problems don’t come forward for treatment because “communities still regard mental health as a misfortune in the family or some sort of punishment [from God]”. What treatment is delivered tends to rely on traditional healers who often interpret mental illness in terms of possession or curse.

Many countries also lack the basic legal framework to protect those with a disability. Human rights violations of psychiatric patients are common, with patients physically restrained, isolated and denied basic rights. There are therefore significant cultural barriers to overcome to deliver mental health policies.

With so many health issues affecting developing countries, tackling mental health tends to be seen as something of a luxury. Aid spending remains focused on the “big three” communicable diseases of HIV/Aids, malaria and TB, with many other health conditions receiving only a fraction of the attention and funding.

However, using “disability-adjusted life years” to compare different health conditions shows that while mental health problems account for an estimated14% of all global health conditions they receive less than 1% of most countries’ healthcare budget.

Chris Underhill from BasicNeeds also explains how mental health is not just a medical concern – but “part of a larger development related problem”. Mental illness adversely affects people’s ability to work, creates a potential carer burden on their families and generally leads to greater poverty. It therefore has a significant economic impact upon developing countries. Despite this, half of all countries in the world have no more than one psychiatrist per 100,000 people and a third of all countries have no mental health programmes at all.

There have been recent efforts to raise the profile of mental health as a developmental issue. In 2008 the WHO launched the Mental Health Gap Action Programme (mhGAP) to advocate a much greater focus on mental health in global health policies. The WHO has also praised improvements in countries such as Gambia, Lesotho and Ghana, which have recently created mental health policies and plans.

However, international mental health charities remain almost completely absent from the charitable sector. Out of 10,000 UK charities listed on GuideStar there is only one dedicated international mental health charity of any size. BasicNeeds works with partners in eight different countries and last year supported nearly 34,000 people with mental illness or epilepsy. It has also recently been involved in developing a new mental health bill in Uganda.

Minds for Health is a smaller charity that works with a number of partner organisations in southern Africa and India. It has raised over £70,000 to expand child and maternal mental health services and is also conducting research in this area.

These two charities were formed only in the last few years, in response to the lack of NGO involvement in this area. Both see raising the profile of mental health as an essential part of their work.

There are a number of reasons why mental health has such a low profile in international development, yet these are not insurmountable or an excuse for such lack of interest.

Tim Lawes from Minds For Health outlines the way forward. Large numbers of community (lay) health workers and traditional healers could be trained to deliver basic mental health care, and to refer more serious cases to a healthcare professional. NGOs, meanwhile, should also work with governments to advocate mental health and disability legislation and policies.

For this change to happen it is essential that the profile of mental health in international development is raised among the public, NGOs and governments. Without changing public perceptions of mental health conditions, mental health will continue to be woefully neglected both here in the UK and in the field of international development.