The global health crisis of mental illness is not widely understood by the general public. Even for organizations like the World Health Organization (WHO), it makes more sense to launch specialized attacks against diseases like malaria and polio than to tackle mental health. This is because it is simplest to undertake a project that can be solved with quantitative approaches rather than solving more ambiguous problems like treatment for mental illness. Ailments that can be fixed with what scholars in the world of public health call a “magic bullet approach”, or a technologically honed treatment that is usually in the form of one pill or vaccine that theoretically should solve all of the patient’s problems, have historically been the focus of most global health initiatives. However, relying on technology in the form of vaccines and treatment as the gold standard of global healthcare is not enough. By taking the initiative to adopt an interdisciplinary approach to healthcare, mental health treatment and global health in general, can become an “intrinsically biosocial analytic endeavor.”1 This means to take biological research and combine it with social work like ethnography to create the best plan to tackle issues of health that have an all encompassing view of the situation of need.
Understanding the concentration of burden of disease and environmental stressors for the poor in developing countries is absolutely vital to understanding how mental illness is approached. According to the WHO, the disproportionate morbidity and mortality in people of low-income households are due to the “[…] consequence[s] of poverty, such as poor nutrition, indoor air pollution and lack of access to proper sanitation and health education.”2 The disgusting reality is that many of the physical illnesses impoverished people experience are completely preventable, but there is a lack of adequate infrastructure for the prevention and treatment of disease. Whether it is an intervention to prevent malaria with DDT and bug nets, tuberculosis with better nutrition and DOTs therapy, or HIV with better sexual and general education3, when working with susceptible populations, a huge amount of capital and infrastructure is required for implementation. In addition to these large public health initiatives, impoverished communities face neglected tropical diseases such as river blindness, hook worm, and ringworm that just only require a cheap drug to be prevented. Lack of access to distributed treatment and scarcity of medicine allows over 500,000 people a year to perish from these diseases.4 The poor in these countries lack access to healthcare for illnesses of physical nature and this pattern is sustained when evaluating treatment of mental illness.
There is only small amount of organized assistance that is available to people living in poverty – whether it may be in the form of medical care, education, or even opportunity for employment and to have income – all factors that contribute to creating a very stressful environment. When you wake up every morning not knowing how to feed your struggling family of an equally exhausted spouse and four children, one of whom has contracted polio and cannot walk, two that are very young and weak from malnutrition, and another who cannot stop coughing, your own feelings of anxiety and depression come last. In a study published in the NCBI about depression in developing countries with a focus on Zimbabwe, the authors note how common somatic symptoms like headaches and fatigue are in many patients that are also coupled with cognitive and emotional symptoms as well.5 Depression is common but is not taken very seriously in relation to other diseases in these communities, and it is sometimes not even identified as a disease at all, but rather a feeling of being downcast or overwhelmed. The same study reports findings that the one-month prevalence of depression and anxiety disorders being at a staggering 15.7% in the women in one community in Zimbabwe.6 With this type of prevalence and the fact that with the presentation of depression you see the theft of “years of productivity, health, and life from the world’s population,”7 the difficulty of providing for a family and self rises significantly. Not only do people in poverty have the burden of dealing with physical disease with limited resources, but they are also lacking care for their emotional and mental needs. Mental illness strikes people equally around the world, but in industrialized countries like the US, treatment is just another trip to the doctor. For people in developing countries, mental illness is usually not diagnosed or dealt with, making quality of life decrease drastically.
In order to make mental health more of a priority, we need to have deeper understanding of social realities in the communities that are being reached out to. It is not enough to roll through a town, hand them some medication and exit promptly. To make a lasting impact on health, we need to more deeply understand these people’s lives through ethnography and train the types of professionals that these people desperately need. In the most common cases of mental disorders (depression and anxiety), mental health needs to be taken seriously because “they are among the most important causes of morbidity in primary care settings and produce considerable disability.”8 One critique voiced by the writer of the book Will to Live: Aids Therapies and the Politics of Survival of organizations on the ground dealing with the HIV epidemic in north eastern Brazil is that they “[…] speak in the name of neediest but don’t help with what is actually needed… some food, a job.”9 Alleviation of stressors such as the scarcity of food and resources would be immensely helpful in this fight against common mental disability as well as the creation of more clinics for treatment. As for less common forms of mental illness, we need to begin to provide further options of treatment. This would involve training more professionals in the field of mental health and giving them the tools to practice abroad in areas that are in need.
As a global community we need to take responsibility for our brothers and sisters who do not have the resources that we do, and if we care about their quality of life medically, we should focus on their social and mental care as well their physical needs.
1 Farmer, Paul, Jim Yong Kim, Arthur Kleinman, and Matthew Basilico. Reimagining Global Health: An Introduction. Berkeley: U of California, 2013. Print.
2 Philips, Steven. “Diseases of Poverty and the 10/90 Gap.” N.p., n.d. Web. 8 Nov. 2016. http://who.int/intellectualproperty/submissions/InternationalPolicyNetwork.pdf
3 Ibid., Philips
4 “NTD Overview.” NTD Overview. N.p., n.d. Web. 08 Nov. 2016.
5 Patel, Vikram, Melanie Abas, Jeremy Broadhead, Charles Todd, and Anthony Reeler. “Depression in Developing Countries: Lessons from Zimbabwe.” BMJ : British Medical Journal. 2001. Accessed November 12, 2016. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1119689/
7 Yaleglobalhealthreview, By. “Depression in Developing Countries.” Yale Global Health Review. 2015. Accessed November 12, 2016. https://yaleglobalhealthreview.com/2015/05/16/depression-in-developing-countries/.
8 Patel, Vikram, and Arthur Kleinman. “Poverty and Common Mental Disorders in Developing Countries.” (n.d.): n. pag. Web.
9 Biehl, João Guilherme, and Torben Eskerod. Will to Live: AIDS Therapies and the Politics of Survival. Princeton, NJ: Princeton University Press, 2007.