Mental Health in a Global Context

When I think of global health, my first thoughts are of cholera epidemics, projects to provide clean drinking water, and undernourished children. However, with statistics indicating that in middle income countries depression accounts for twice the disease burden of HIV/AIDS and that in low income countries depression is almost as large a problem as malaria, it is evident that I am not paying enough attention to the impact of mental illness on the world at large.

The sad thing is, I'm not the only one.

1/3 of countries do not have a budget for mental health services.

This is a great disservice to the 15 million people estimated by the WHO to suffer from depression, the 26 million people with schizophrenia, the 125 million people affected by alcohol use disorders, the 40 million people with epilepsy, and the 844 thousand people who die each year from suicides. These people are not having their needs met.

During our seminar on mental health, we were led by Daniel Yang of Project FOCUS and Mary Black of the Heartland Alliance Kovler Center. They not only opened our minds to the immense disparities that exist in the treatment of mental illness, but also to the particular skills necessary to make a difference.

One of the skills emphasized should be quite familiar to individuals well versed in global health-- cultural competency. This is a phrase that often gets thrown around quite liberally when it comes to interacting with people of various backgrounds. However, it takes on special meaning when discussing the beliefs of a person from Senegal as to why they think they are experiencing epileptic fits or when attempting to counsel a woman who survived the genocide in Rowanda, but is now experiencing PTSD symptoms. An understanding of the language, the culture, the experiences of the people is necessary to make a difference. It is important not only in developing a therapeutic relationship with the patients, but also in ensuring that interventions do not bring additional scrutiny or negative consequences to an already vulnerable group. As future physicians and global citizens, our mantra must continue to be "first, do no harm."

So, for those of us who don't possess a background conducive to providing individualized treatment, there are still ways to help. One way is to "train the trainers" by providing education to members of the community so that they may serve as counselors and therapists. Secondly, people can serve as mental health advocates by increasing awareness of disparities in care and demanding that individuals with mental illness receive equal civil and political rights.

There are many ways to help, so start the dialogue and raise awareness of the disparities in delivery of mental health services!