Global Mental Health
Movement for global mental health.
Today’s blog is from Justin Healy, a fourth year medical student at the University of Manchester. He says: “I’ve increasingly grown to think that it’s simply impossible for doctors to escape questions that relate to global health. As the world we live in gets smaller, the casualties and consequences of global health get closer to our own doorsteps. Global health is fast moving from a niche interest to a fundamental topic of modern medicine.”
The latest article to be published on TLS is a report on an elective at Massachusetts General – check it out!
In global health policy, mental illness and other conditions are often neglected as the world’s attention and chequebook is directed at infective causes of ill-health.
An infectious disease ward is normally a place for viruses, parasites and bacteria. It is a place for exotic fevers and unusual syndromes, for HIV-related infections and drug-resistant tuberculosis. On an infectious diseases ward the aim is to isolate the pathogen and to treat it. It was unusual therefore for me to see a patient with psychiatric catatonia on the ward. This rare condition is typified by bizarre motor symptoms and profound unresponsiveness; limbs are left rigid in bizarre postures, patients are silent apart from a few chance mutterings. If untreated it can cause death from exhaustion.
The reason that this psychiatric illness found its way on to an infectious disease ward is because the patient was initially diagnosed with a brain infection. It was thought that a rare encephalitis, rather than schizophrenia, was responsible. This case is a fitting metaphor for lop-sided global health priorities. Here, a patient’s mental health was overlooked in favour of a possible infection. In global health policy, mental illness and other conditions are often neglected as the world’s attention and chequebook is directed at infective causes of ill-health.
Mental health is poorly managed across the world, even nations with substantial health budgets struggle to effectively support and care for patients with mental illness. In the developing world, resources for mental health care are woefully inadequate. It is the poorest areas, often the areas with the greatest need for resources, which is especially struggle. According to the 2007 Lancet Series on Global Mental Health, mental illness accounts for 14% of the global disease burden. Yet many low-income countries allocate less than 1% of their health budgets on mental health services.
The reasons for this neglect are multiple and complex – it would therefore be wrong to suggest a single cause. However, the global health community’s emphasis on specific conditions does distort health priorities towards those conditions. The focus on HIV/AIDs, malaria and other infections has certainly saved millions of lives but some argue that it has been to the detriment of health-care systems, systems that are fundamental to the care of all.
It is easy to see why infections attract such attention and investment, malaria and tuberculosis are exotic and exciting in a way that depression or schizophrenia can never be. Donors will always find magic bullets more attractive than community out-reach programs, even though the latter is a far more cost effective way to save lives.
What is needed is for the global health community to change the terms of debate, to refocus the attention on general health rather than certain diseases. Global health must move towards a holistic model; to recognise that infection, low mood and atheroma are all potential killers and that to prioritise one over another is to do a disservice to health itself.
Justin Healy,
University of Manchester.
justin.t.healy@googlemail.com
For more information, there is a The Lancet Series on Global Mental Health.