Media are widely covering a news story about global mental health. Lancet, the widely-respected medical publication, published a study calling for more money for mental health services in poor developing countries. World Health Organization promptly put out an endorsement of this call for more money. But MindFreedom asks, “more money for what”?
News Analysis – 4 September 2007
“More money” is too simplistic for global mental health problems!
by David Oaks, Director, MindFreedom International
A major medical publication issues a call for more money for mental health programs in poor and developing countries.
The World Health Organization agrees.
Major media cover the story.
So what is the problem?
For too long there’s been a far too simplistic solution in the field of international mental and emotional well being.
For far too long that simplistic solution has boiled down to two words:
At the bottom of his editorial is a copy of the Associated Press story about an article in the medical publication Lancet, calling for far more funding to mental health programs in poor and developing countries.
Following that is a World Health Organization editorial seconding this call.
Why would we at MindFreedom International, uniting 100 grassroots groups in the field of human rights and alternatives in mental health, put out a warning about this goal?
Because this simplistic “more money” position is an example of how democracies — and their citizens — have not truly tackled issues involving mental and emotional well being.
The two word “More Money” position is far too shallow, and even harmful!
The mind, our well being, and challenging issues of globalization are far more complex than that.
We must ask:
Money money FOR WHAT?
More money for the rise of forced electroshock that is now sweeping the world?
Well-meaning leaders in poor and developing countries have been convinced that they must be modern, like the West, and therefore must use a “medical model” for mental health. Drugs are expensive. But a few seconds of electricity is cheap.
And thus there is now a rise of electroshock — including forced electroshock sometimes even without anesthesia — internationally. A sponsor group for MindFreedom International, Mental Disability Rights International, has done a superb job in documenting rising human rights abuse related to electroshock in Turkey and South America.
In India, a MindFreedom sponsor group Center for Advocacy in Mental Health, based in Pune, India, has also documented this electroshock abuse there. Bhargavi Davar, a courageous key leader with this organization, has passionately warned about globalization of the psychiatric industry in India, and has called for humane alternatives.
Money money FOR WHAT?
More money for childhood psychiatric drugging where even three year olds are now given the super-powerful psychiatric drugs that used to be found only on back wards?
Throughout France, USA, Japan, we are seeing more and more psychiatric drugging, sometimes with multiple drugs, including of young children, without adequate information, advocacy, and alternatives.
Or what about more money for real help?
What about more money for real help, such as humane, caring, empowering alternatives to the conventional mental health industry?
What about more more money for real help, so we can hear the voice of the marginalized, the voice of those on the receiving end of mental health care?
What about more money for real help, such as micro-loans and micro-economic development so that poor and marginalized people in the mental health system can get jobs? This approach has worked for many people labeled with all kind of disabilities in poor and developing countries.
What about more money for training of leaders in the mental health consumer/user and psychiatric survivor communities in poor and developing countries?
An example of the kind of funding that ought to be increased, is the World Health Organization mini-grant that MindFreedom Ghana received in Accra Ghana, in order to hear the stories of people at risk of mental health care. To see photos of MindFreedom Ghana’s recent Mad Pride street march see:
The World Health Organization ought to know better.
WHO has done two major, famous studies finding that full — full — recovery following a serious mental health problem is far more likely in the poorer countries with the least psychiatrists and the least psychiatric drugs!
Author Bob Whitaker has done a great job summing up theor go to this link:
Our warning here is not meant to minimize some of the overwhelming problems experienced in poor and developing countries.
There are still people labeled “mad” chained to the ground in poor and developing countries.
There are still people living in filth in horrible institutions in poor and developing countries.
But by simply globalizing the mental health system found in the richer countries, we face a prospect of literally tens of millions of more people given drugs, drugs, drugs, drugs and shock, without adequate information, advocacy or alternatives.
The history of the mental health system shows that mild “reform” efforts actually fuel the growth of even worse problems. This is why we are calling for a nonviolent revolution in the mental health system, a revolution of empowerment, self-determination and alternatives.
Lancet, WHO, the World Bank and others are demanding billions of dollars for more mental health programs, largely funded by taxpayers internationally.
A copy of a media report about the Lancet report, along with the WHO news release are below.
Before citizens write a blank check to the global psychiatric industry, our democracies ought to ask exactly what we are purchasing, and what we ought to be purchasing.
It is time for democracy to get hands on with issues involving mental and emotional well being. Let’s start to by taking action and speaking out!
MindFreedom Action on Globalization of Psychiatry:
World Health Organizationrequires that all legitimate communications to them be logged and in some way addressed. In our experience,WHO really does receive, read and consider their messages, including e-mail. WHO has even compiledcomments about mental health care into a book.
You are encouraged to write a civil note to WHO about your own concern regarding the globalization of the psychiatric industry.
Hereis an online feedback form so you may make your comment in English theWorld Health Organization. You may also submit comments to WHO inlanguages other than English, contact WHO for more information:
BELOW is the Associated Press article today about the Lancet study, followed by the WHO news release today:
Associated Press article published in Washington Post
September 4, 2007
Poorer Nations Asked to Aid Mentally Ill
By MARIA CHENG
The Associated Press
September 4, 2007
LONDON — War, poverty and diseases such as AIDS are adding to mental health problems in poorer countries, which are generally ill-equipped to respond to depression, schizophrenia and other such ailments, according to health officials.
Experts say that has to change.
On Tuesday, health officials called for new strategies and more money to treat the mentally ill in the developing world in a special issue of the British medical journal, The Lancet. Unless mental health treatment becomes widely available, the futures of poor countries will be handicapped, the writers argue.
Among the simple solutions offered: training lay people to spot mental illness in their community. The ill people and their families can then be referred for treatment. India has already introduced such a program for schizophrenia in certain provinces.
“We’re thinking outside the box. We’re not thinking of more mental health specialists,” said Dr. Vikram Patel, a professor of international mental health at London’s School of Hygiene and Tropical Medicine and co-author of several of the papers in The Lancet.
Nirmala Srinivasan, head of Action For Mental Illness, a lobby group based in Bangalore, India, said only a small percentage of Indians who suffer from some form of mental illness _ schizophrenia, depression, obsessive compulsive disorder, anxiety _ get proper treatment.
“The main reason is that people can’t access treatment,” Srinivasan told The Associated Press, adding that “there is no treatment available” in rural areas.
Dr. N. Vijaya, head of the Institute of Mental Health, a 1,600-bed facility with programs for 400-500 more outpatients in the southern Indian city of Chennai, said awareness of mental health was increasing in India _ leading more people to seek treatment.
She said nearly a third of her facility’s patients have been “wandering mentally ill” rescued from the streets by police and private aid groups.
“Social workers help us in contacting their families later,” she said.
In Brazil, mental health care rivaling that in developed nations is available for those who can afford it. The Lancet said Brazil’s mental health care system has improved in the past several decades, but gaps remain.
Mentally ill adults in the teeming cities of Brazil, Latin America’s largest nation, are frequently seen begging on street corners and sleeping under highway overpasses. In destitute rural communities, families living in poverty cope the best they can with mentally ill relatives, but often can’t afford medication or special care.
In some poorer countries, people turn to chains or cages to restrain those with mental illness.
In African countries, doctors and nurses are often too overwhelmed with illnesses such as AIDS and malaria to care for those with mental health problems.
But mental health advocates argue that because psychiatric problems such as depression and psychoses often lead to physical problems, investing in treating mental illness could prevent other diseases. That can in turn aid the overall economy.
Treating mental illness can’t be solved simply by sending in foreign doctors, experts said. Counseling for mental health problems must come from someone who speaks the language and understands the local culture.
In countries such as Zambia, where mental illness is believed to be a sign of witchcraft or being possessed by the devil, people who are sick are reluctant to seek help. When they do, or when others alert the authorities, they are often locked up in institutions.
“You can’t just parachute into a system and expect to solve their complex mental health problems,” said Cornelius Williams, who helps treat emotionally scarred former child soldiers in Uganda for UNICEF.
Dr. Richard Horton, The Lancet’s editor, wrote in an accompanying commentary that the World Health Organization has not done enough to support nations’ mental health needs. Although the agency pledged in 2001 to bring “new hope” to treating the mentally ill, “WHO has not backed its words with resources,” Horton said.
WHO officials declined to comment.
Associated Press writers Ashok Sharma in New Delhi and Alan Clendenning in Sao Paulo, Brazil, contributed to this report.
WHO news release:
WHO urges increased investments and services for mental health
04 Sep 2007, 05:20
The World Health Organization (WHO) is today appealing to countries to increase their support for mental health services. The appeal is part of a series of six reviews on global mental health which are being published today in the journal The Lancet. WHO has worked closely with the journal The Lancet to generate the evidence and formulate the call for action.
Mental disorders are common but as many as half of all people with severe mental disorders and a vast majority of those with mild or moderate disorders worldwide do not receive any treatment. Even when treatment is available, it is often delivered in institutional settings which in many countries are associated with stigma and human rights violations.
The reasons for this bleak situation are clear: mental health services are being starved of both human and financial resources. WHO’s Mental Health Atlas database shows that a majority of countries in Africa and South-East Asia spend less than 1% of their health budget on mental health. Low income countries have an average of 0.05 psychiatrists and 0.16 psychiatric nurses per 100,000 population (about two hundred times less than in high income countries); these extremely low rates make it impossible for satisfactory services to be delivered in these countries.
WHO is supporting a call for action to increase the coverage of mental health services for mental disorders in low- and middle-income countries. The call is targeted at public health planners and urges them to assign a higher priority to mental health.
“This topic should matter to everyone, because people living with mental disorders in low- and middle-income countries are systematically locked out of the benefits of development that are open to others. When not addressed, mental disorders deprive people of opportunities to escape from poverty and deny them a voice to claim their rights,” said Dr Catherine Le Galès-Camus, WHO Assistant Director-General for Noncommunicable Diseases and Mental Health.
“The current situation means that people with mental illnesses are at best ignored and at worst actively discriminated against in many countries. We can only improve the services available to people with mental disorders if there is a major and rapid increase in investment in this area,” said Dr Benedetto Saraceno, WHO Director of Mental Health and Substance Abuse.
Estimates show that the amount of money required to deliver a core package of mental health care is approximately USD 2 per person per year in low-income countries and USD 3-4 in lower-middle income countries. This package, based on treatment of mental disorders in primary health care and in community-based facilities would increase the treatment coverage to 80% for severe mental disorders and 25-33% for less severe ones. These targets are currently the best attainable level for most low- and middle-income countries given the current poor infrastructure and scarcity of human resources for mental health care.
The Call for Action further reinforces WHO’s global action programme on assisting low- and middle-income countries in providing mental health care.
– end of article –