12 - 18 April 2001
Issue No.529
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Al-Ahram Weekly On-line 12 - 18 April 2001 Issue No.529 |
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It can happen to you or me
Tremendous progress has been achieved in the treatment of mental health disorders, yet millions are left untreated, writes Faiza Rady
"Great numbers of mentally ill still live shut away behind hopeless walls by the prejudice and incomprehension of society. The efforts to have the mentally ill treated as other sick people who can be cured, are likely to remain fruitless as long as irrational fear of 'madness' is not conquered, as long as the influential members of the social hierarchy do not understand that mental health is not only the business of specialists but must concern the whole community." A statement from the World Health Organisation on the occasion of World Health Day 1959, which was dedicated to mental health.
Each year the World Health Organisation (WHO) selects a new theme to highlight public health issues of global concern. This year, and for the second time in its history, the WHO dedicated 7 April, World Health Day, to focus on the plight of the mentally ill. In a message for World Health Day, UN Secretary-General Kofi Annan denounced the stigma still attached to mental disorders, 42 years after the WHO first addressed societies' pervasive and "irrational" fear of what people refer to as 'madness'. "Mental illness ravages the hidden landscape of the human mind, often with no outward physical signs to betray its debilitating effects. In turn, many who suffer from such disorders suffer in silence, trapped by the shame or stigma of their often very treatable diseases," said Annan.
While the treatment and cure of many life-threatening diseases have registered dramatic progress as evidenced by decreasing mortality rates in many countries, including developing countries, mental health disorders are on the rise. In 1999, mental illness accounted for 10.5 per cent of the disease burden worldwide. "Mental illness doesn't only happen to other people," warned Dr Gro Harlem Brundtland, Director General of the WHO. "One person in every four will be affected by a mental disorder at some stage in life. It is a rare family that will never have an encounter with it."
The figures speak for themselves. It is estimated that more than 400 million people are currently suffering from some form of mental illness. Among the most widespread and prevalent of these disorders is a major and debilitating form of depression, characterised by depressed moods and a general loss of interest and pleasure. If depression alternates with exaggerated elation or irritability, the condition is defined as bipolar disorder -- also commonly known as "manic depressive" disorder. Worldwide, 340 million people are afflicted with major depressive diseases. Specialists estimate that 70 per cent of patients can fully recover if treated with antidepressants and cognitive therapy. However, less than 25 per cent receive treatment. Depression is ranked fourth among the 10 leading causes of the global burden of disease. And the future looks even more ominous. The WHO estimates that depression will have leaped from fourth to second place by the year 2020.
Possibly the most stigmatised of mental disorders, schizophrenia is also the most tangible and visible. Characterised by a profound disruption in thinking and feelings, schizophrenia affects language, thought, perception, and sense of self. It often includes psychotic experiences such as hearing voices or holding fixed aberrant beliefs, which practitioners call "delusions". According to conservative estimates some 45 million people worldwide suffer from schizophrenia at some point in their life. While confinement in mental institutions with minimal intervention used to be the norm, the discovery of neuroleptics in the early 1970s constituted a revolutionary break-through, and the disorder can now be largely controlled. Nevertheless, only 25 per cent of diagnosed cases are treated. The unavailability and exorbitant cost of treatment naturally takes its toll on human lives: untreated depression and schizophrenia account for 60 per cent of all suicides. Between 10 and 20 million people attempt suicide each year. One million die.
Another pervasive, if more familiar, form of mental illness is alcoholism. Long dismissed as a character flaw and an inherent sign of weakness, alcohol and substance dependence is now classified as a genetically transmitted predisposition. Besides triggering severe physical illness like heart and liver diseases, alcohol dependence can induce alcohol psychosis and is related to social problems including crime, violence, marital breakdown and suicide. According to WHO estimates, there are 140 million alcohol dependents in the world, while some 400 million drink excessively. In 1992, the aggregate economic cost of alcohol in the United States alone reached $ 48 billion.
Notwithstanding the tremendous human toll and the staggering loss of revenue caused by debilitating mental disorders, governments worldwide have largely failed to address the problem. "Mental health and well-being have nearly always had a lower priority than communicable diseases and other 'physical' maladies, despite their significant impact on mortality and morbidity," says the WHO.
A global WHO study shows that 43 per cent of 181 countries surveyed have no mental health policy, 23 per cent have no legislation on mental health, 38 per cent have no community care facilities, and in 41 per cent treatment of severe mental disorders is unavailable in primary health care.
Although considerable progress has been achieved in the treatment of mental disorders over the past five decades, most of the world's mentally ill still go without the most basic of health services. More than 25 per cent of countries do not have the most commonly prescribed antipsychotic, antidepressant and antiepileptic drugs considered essential for the treatment of common mental and neurological disorders at the primary health care level. The situation is especially dramatic in the South where social budget cutbacks, imposed by the World Bank and the International Monetary Fund as loan conditionality, have further curtailed initially insufficient mental health expenditures. Sub-Saharan Africa is a case in point, where mental health care constitutes less than 1 per cent of the overall health budget. As a result, Africa suffers from a severe shortage of trained mental health professionals and researchers. According to available figures, only about 1,200 trained psychiatrists serve a population of 700 million on the continent.
As if this was not bad enough, the bleak picture is likely to further deteriorate, predicts the WHO. Increasing areas of conflict in the South will contribute to an ever-increasing population of poverty-stricken refugees and displaced peoples vying for space and limited services in -- at best -- substandard conditions. Traumatised by violence and poverty, and subjected to daily abuse in their struggle to survive, such populations are at high risk, having manifested growing rates of mental disorders including post-traumatic stress, depression and alcoholism.
Until and unless governments work at resolving the political situation and commit themselves to the provision of adequate health services, the collective mental health profile will further deteriorate.
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