The biggest non-story in global health

Neon Brain

It’s what I like to call the “most neglected disease” in all of global health.

Mental illness.

Paul Southworth, a visiting scholar on malaria and vaccine science at the NIH, seems to have been diverted from his primary studies by one of the great anomalies of global health — this gap between the disease burden of mental illness and the amount of funding and attention devoted to solving the problem.

In a blog post entitled “What We’re Not Talking About,” Southworth first lays out the evidence that mental illness is one of the world’s biggest killers. Yes, it kills as well as disables.

Here’s a pie chart that shows Disability Adjusted Life Years (aka DALYs), which takes a number of factors into account to measure diseases, injuries and disorders according to their impact on survival.

Causes of death and disability, by 'Disability Adjusted Life Years' (DALY)

As you can see from the pie chart, mental illness (aka “neuropsychiatric disorders”) is the biggest slice in the pie. Yet it is rarely even mentioned at global health meetings or confabs, says Southworth:

At global health events I have attended, mental health has barely been mentioned and when it has, it has been very much a peripheral issue considered of little importance.

This is obviously not borne out by the evidence regarding global burden of disease, he notes. And he goes on to cite studies demonstrating that treatment for mental illness can be done effectively and inexpensively even in poor countries.

Here’s a story I did a while ago about two Seattle women, the UW’s Debra Kaysen and Shannon Dorsey, who are among those proving mental illness can be tackled in even some of the poorest and most war-torn or unstable parts of the world.

There really is no rational reason for continuing to ignore mental illness in global health, Southworth says:

This is not a problem we can sweep under the rug until we’ve solved every other health problem. As has been said so many times, “there is no health without mental health”. Mental illness kills as many people each year as malaria and causes more disability than any other illness. There are huge advantages to be gained both to societies and to individuals by including mental health as a key part of the global health agenda instead of a fringe issue to be sniffed at.


About Author

Tom Paulson

Tom Paulson is founder and lead journalist at Humanosphere. Prior to operating this online news site, he reported on science,  medicine, health policy, aid and development for the Seattle Post-Intelligencer. Contact him at tom[at] or follow him on Twitter @tompaulson.

  • Isabel Otero

    This is a very interesting article that touches on a very important issue and growing problem – mental illness in low and middle income countries.  It is hard to expect the United States government to fund mental health abroad when it hardly funds mental health here (domestic projects.)  Mental health has been underfunded not only internationally, but also in the United States, where millions of people stricken with mental disorders are living in poverty because they do not have access to treatment and thus less likely to succeed in the US society.

    One of the disadvantages of funding mental health not mentioned in this article is the lack of evidence-based mental health interventions out there.  NIH has established an institute to address this gap in knowledge.  It is called the National Institute of Mental Health.  The sad reality is that treating AIDS/HIV with anti-retroviral drugs or preventing cervical cancer with a vaccine are both still much more effective than trying to change human behavior with interventions like counseling.  Treatment for many mental disorders are still substandard and there is still a lot of debate as to how the field treats various diseases and/or whether a disease is really a disease (DSM IV ).   This is one huge problem that the field will need to address before funding for interventions can be garnered, especially internationally.

    • Colette

      I am disappointed that there doesn’t appear to be any link to trauma and adverse childhood experiences contributing to the rising cause of mental illness. If we continue to look at mental illness from a medical model approach, the only people who will benefit will be the pharmaceutical companies.
      In my opinion the biggest diasaster we could impose on developing countries is to encourage the adoption of our ‘models of care’.
      First ‘do no harm’, what is our own understanding of the results of trauma both physically and psychologically? Why do we focus on the end results (called symptoms), as opposed to the ‘often’ root causes (trauma). Treat the resulting human conditions with humanity, compassion and understanding, not dangerous pharmaceuticals.