One of the things you can always count on this time of year are stories in the media about the ‘holiday blues’ and how to combat the sadness or depression that, for many, accompany the Yuletide.
For those whom ‘the blues’ are not a seasonal phenomenon, people with mental illness, the combination of being bombarded by messages proclaiming (demanding?) holiday cheer and dealing with the stress that often attends Christmas celebrations can exacerbate their struggles.
So ’tis the season to make a New Year’s resolution and finally deal with one of the world’s leading cause of disability. In the last two decades, the world has achieved great gains against AIDS, child mortality, maternal deaths and other global health scourges.
Yet mental illness, as explored in my post last month, remains as great a burden as it has ever been.
The lack of progress in mental health is especially sobering in a day and age when public health and medical interventions have made a difference in improving health outcomes. Below is just one such typical trend showing a decline in years lost over time from leukemia (Figure 1):
Figure 1: Healthy years lost to leukemia globally, 1990-2013
Compare the steady decline in the above graph for leukemia (which, again, is the kind of progress seen with many other diseases over the same time period) with the trend in mental illness worldwide below:
Figure 2: Burden of mental disorders globally, both sexes, 1990-2013
Why has mental health been so neglected during this supposed ‘golden age’ of global health?
I recently gained some insight from two mental health experts and co-authors of the Global Burden of Disease study, Drs. Harvey Whiteford and Alize Ferrari from the University of Queensland, during their visit to Seattle and the University of Washington.
Whiteford suggested two main factors: The complexity of doing research on the brain; and the stigma surrounding mental health.
“The same stigma that leads people in developing countries to chain people suffering from mental illness (has) also afflicted funding bodies that pay for medical research,” Whiteford said. “People often see mental illness as mysterious. They wonder if it is something people bring on themselves.”
For example, the New York Times recently chronicled the lives of mentally ill individuals in West Africa, where witchcraft is often believed to be the cause of mental illness, leading families to seek assistance from religious leaders, placing their loved ones in prayer camps where they are restrained against their will.
And it’s not as if ignoring mental illness is saving money; rather, it is costing us dearly.
A report by the World Economic Forum and the Harvard School of Public Health estimated that mental health problems would contribute to a $16 trillion loss of economic output globally over 20 years. A new article published in Foreign Affairs entitled “Darkness Invisible: The Hidden Global Costs of Mental Illness” notes that, despite its “dramatic and disturbing” conclusions, “the report had virtually no impact on debates about public health policy….”
Another possible explanation for the neglect is the world lacks a highly effective toolkit for dealing with mental health problems, one that would allow us to prevent mental illness from occurring and treat it when it does occur.
In the Global Burden of Disease study, researchers identified only one risk factor related to depression: Sexual abuse and violence. This is dramatically different from conditions such as cardiovascular diseases, for whic GBD researchers identified 11 different risk factors.
Research on treatment and prevention of mental health problems has lagged behind treatments for other diseases that once seemed just as complex.
“I estimate that mental health is 30 years behind the progress that has been made against other diseases such as childhood leukemia,” said Whiteford.
As a medical resident in 1978, Whiteford watched children die of leukemia. At that time, he noted, 75% of children died from the disease, but today, 90% of children survive the disease.
The effectiveness of treatments for mental health problems is limited.
“Even if you had really good coverage [of treatment for mental disorders], you could only address up to 30% of the burden of the worst type of depression (major depressive disorder), schizophrenia, and bipolar disorder,” said Ferrari.
This insight about the limitations of current treatments for mental health comes from a 2004 study published in the British Journal of Psychiatry. Ferrari noted that treatment is more effective for other types of depression.
Despite the persistent neglect of mental health by by the global health and biomedical research community (as Humanosphere’s Tom Paulson has written about here and here), Whiteford finds reasons to be optimistic. People with epilepsy and even cancer, he noted, used to be stigmatized but today, no one thinks twice about it.
Here’s to hoping that, in this New Year and beyond, we can reverse the course of this disabling illness.