World Mental Health Day was October 10, 2021. This year’s theme was âMental Health in a Unequal Worldâ. This is an appropriate goal given the extreme inequalities in access to mental health services that exist in our society.–
We are three providers committed to mental health equity across the world, in India, Uganda and the United States. While our countries and contexts may differ, our commitment to equality in mental health is the same. We recognize the commonalities in the diverse impact mental illness has on the most vulnerable members of our communities.
Mental health disorders are considered to be the second cause of the disease burden in terms of years lived with disability (YLD) and sixth cause of disability-adjusted life years (DALY) worldwide. Mental health and substance abuse disorders are a major source of handicap in the world, regardless of location or income.
While the focus has been on poor access to mental health services in high-income countries, between 75% and 95% of people with mental disorders in low- and middle-income countries are unable to access mental health services at all. Lack of investment in mental health disproportionate to the overall health budget contributes to the mental health treatment gap.
Mental health depends on a set of advantages and disadvantages. Adversity, trauma, insecurity, poverty, the power crippling environment and physical morbidities, among other factors, all contribute to poor mental health. These problems are all heightened in underfunded areas and exacerbated in the most vulnerable.
Inequality of wealth has had an impact on general health, including mental health. Women are almost twice as likely as men suffer from mental illness, including depression. This gender disparity can be linked to social inequalities and living standards between nations.
As the public health discourse has begun to address and address the burden of mental health, social inequalities must be understood to achieve any form of equality in the mental health landscape. Addressing disparities in mental health involves not only reducing the stigma associated with mental health diagnoses and treatments, but also improving access to care.
According to the United Nations, there are 9 per 100,000 mental health workers for the world’s population. However, when considering low income versus high income countries, this number varies considerably.
While this shows that mental health services are available, access is important in treating mental illness as well as understanding factors such as the social determinants of health that greatly contribute to mental health.
Therefore, when we attempt to reduce inequalities in mental health, we must also engage globally to promote policies that advance gender equality, wealth, education and participation in order to achieve the highest possible standard of mental health for all.
Reducing mental health inequalities and their impact on us is one of the most immediate problems we face and requires urgent action. We suggest four ways to focus on mental health equity locally and globally with a greater emphasis on effective, pragmatic and scalable solutions that address disadvantage and promote people’s resilience.
- We need to co-create mental health services that integrate and do not isolate people; options for accessing services should focus on keeping individuals in their own comfortable environment. Services should be provided to increase accessibility. This includes providing services at convenient locations within a community and during periods beyond normal working hours, including evenings and weekends. Usage rates will peak and mental well-being and results will improve dramatically.
- The healthcare community needs to change its mindset to embrace holistic mental health processes and outcomes that embrace openness and creativity. Mental wellness should be standardized in the practice and policy of health care delivery. This can help reduce the stigma associated with both seeking and providing treatment.
- Communities should be engaged in local efforts that focus on training members to be mental health gatekeepers and to liaise with clinical practitioners. Strong and lasting examples include Zimbabwe’s grandmother’s benches, healing circles, and Mental health first aid education programs that have invested in the community to engage the solutions that best meet their purpose and needs.
- Mental health cannot be approached in isolation since it is centered in a complex socio-cultural context. Solutions to improve equity must take into account the environmental and socio-political factors at play in the community and withdraw from oppressive systems that perpetuate the marginalization of mental illness.
If the COVID-19 pandemic and its associated blockages haven’t highlighted the urgent need to promote mental health, then nothing will. We must treat mental health promotion as a public health emergency that requires immediate action needed to generate equity in outcomes. Awareness is only the first step. High quality, affordable and standardized mental health should not be a privilege but a right, which everyone can claim.
Equal mental health care for all; let’s make it happen!
Shubha Nagesh is a physician and public health consultant and works at the Latika Roy Foundation, Dehradun, India.
Gabrielle Jackson is a Licensed Clinical Social Worker, Therapist and Facilitator in Private Practice at Diasporic Healing LLC in Washington DC.
Rose Marie Nakame is a registered nurse, public health specialist and executive director of REMI East Africa in Kampala, Uganda.