With mental health issues affecting one in six, it’s time for the UN to update its development goals

Why is mental health such a low priority for the UN?

With mental health issues affecting one in six, it’s time for the UN to update its development goals

Austerity or opportunity? How mental health services can thrive

Graham Thornicroft and Vikram Patel

Guardian Professional, Tuesday 2 September 2014

DiabetesTreatments available for mental health problems are as powerful as those for diabetes, write Graham Thornicroft and Vikram Patel. Photograph: Hugo Philpott/PA

Imagine a health problem that affects one in six of us, that has a deep and damaging impact on our family and working lives, where effective treatments are available, and yet where only about a quarter of people with this condition get any treatment. Is this a scandal of neglect affecting people with cancer or heart disease diabetes? No – this is the real situation for people with mental health problems in Britain today. These conditions span the range from autism to alcohol use disorders, and from depression to dementia. More than 50 years ago when mothers suffered from post-natal depression in England, they were given electroconvulsive therapy to aid their recovery. Yet there is little evidence that we treat provide better mental health treatment now than we did then.

In global terms, the United Nations plays a leading role in identifying which health conditions are the highest priority. In 2000, 189 countries made a commitment to help achieve the eight millennium development goals (MDGs) by 2015. Three of these goals were to do with health: to reduce child mortality; to improve maternal health; and to combat HIV/AIDS, malaria, and other diseases. None referred to mental illness.

In the field of mental health we work with colleagues in many countries of the world and repeatedly find that Ministry of Health staff tell us that it “is not a priority”. The consequence is that although mental health problems are responsible for almost a quarter of all the disability in world, the poorest countries dedicate just 0.5% of their health budgets to mental health. But this under-investment is not because resources are scarce in these poor countries, where up to two-thirds of people with physical illnesses such as diabetes do get treatment. The scale of this neglect of people with mental illness is truly breathtaking.

Governments and international donors do listen to the priorities agreed by the United Nations. There is a very important opportunity now to make sure that the new goals, for the period after 2015, will clearly address the needs of people with mental illness. Now in the final stages of their drafting, these sustainable development goals (SDGs) refer to 17 areas of health, economic or environmental progress. At the moment just one phrase of one “target” of one “goal” mentions mental health at all, with no specific indicators given about how to measure progress. Why is mental health seen as such as a low priority by the United Nations?

This is negligent because mental health problems affect so many people across the world, and have such wide ranging ways to exclude people from the mainstream of life. For example, it is true to say that poverty is a trigger for mental health issues, and that they can trip people into poverty. Without treatment people with mental health problems are less productive in their jobs, more likely to be unemployed and to rely on state or family support. Indeed the World Economic Forum estimates this loss of global economic output as in excess of $16tn.

Some policy makers say, “but we don’t have effective treatments that can be put into practice”. This is wrong. The World Health Organisation has produced practical treatment guidelines for use in primary care in low income countries, based upon the very best evidence of what works. We know that the treatments available for mental health problems are as powerful as those for high blood pressure, diabetes or rheumatoid arthritis.

The fundamental point is that any serious attempt to address health must include mental health.

The new SDGs being developed by the United Nations need to acknowledge the vital role of mental health. We therefore call upon the United Nations to include within the overall health goal a specific target for “the provision of mental and physical health and social care services for people with mental illness, in parity with resources for services addressing physical health.” The stigmatising exclusion of mental health from the global health agenda must end now.

#FundaMentalSDG is an initiative which aims to include a specific mental health target in the post-2015 SDG agenda. 

Prof Graham Thornicroft works at the Centre for Global Mental Health, King’s College London. Prof Vikram Patel is at Centre for Global Mental Health, London School of Hygiene & Tropical Medicine; Sangath and the Public Health Foundation of India.

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