HEALTH: WHO Moves to Improve Lot of Mentally Ill

By Marwaan Macan-Markar Reprint | | Print |

Marwaan Macan-Markar

MEXICO CITY, Mar 22 2000 (IPS) - The World Health Organisation (WHO) plans to focus on mental health for next year’s World Health Report, as part of its efforts to deepen global understanding about the disease. The Geneva-based body has also announced that mental health will be the theme for World Health Day 2001.

These twin initiatives underscore the current push by the WHO to move beyond the “limitations” of indicators that had been traditionally used to prioritise health problems “based normally on the mortality and prevalence of an illness.”

According to Dr. Gro Harlem Brundtland, the director general of WHO, the prevailing mortality rates do not take account of the “non-fatal outcomes of illnesses,” while the prevalence rates do not consider the “severity and duration of disability produced by diseases.”

As a result, she observes, for many years “the burden of psychiatric and neurological conditions has been underestimated.”

The situation in the developing world is particularly “worrisome,” given the prevailing disparities in treatment rates, states a WHO report on “Global Strategies for Mental Health.”

In India, for instance, the treatment rates for patients with schizophrenia and epilepsy are estimated at 20 percent in contrast with 80 percent treatment rates for the same disorders in industrialised countries. And in countries that make up Sub-Saharan Africa, treatment rates for depression are estimated around five percent.

Currently, some 400 million people worldwide suffer from mental disorders and neurological illnesses, while close to 288 million are affected by alcohol-related problems, and a further 60 million are afflicted with mental retardation.

In addition, the WHO reveals, there are 40 million registered cases of epilepsy, 20 million cases of dementia, 45 million with schizophrenia, 10 to 20 million attempted suicides, and one million suicides. These numbers have provided a strong case that “five out of 10 leading causes of disability worldwide are mental problems.”

And while major depression now ranks fifth in the 10 leading causes of the global disease burden, the situation is expected to take a turn for the worse in 20 years — “it will have jumped to second place according to current projections.”

By contrast, points the WHO, the picture in the developing countries of Africa and Asia for life expectancy and some infectious diseases reveals extraordinary achievements: infant mortality rates have dropped, life expectancy has increased, smallpox has been eradicated and some infectious diseases have been controlled by public health initiatives.

For health activists in the Americas, governments will have to demonstrate a new attitude towards mental health patients if this impending crisis is to be successfully handled.

A recently published report by the Washington-based Mental Disability Rights International (MDRI) about the situation in Mexico illustrates such a need. The report exposes the “pervasive human rights abuses against people with mental disabilities” in the country’s psychiatric institutions.

The MDRI’s team of experts say they spent three years studying psychiatric institutions and observing people in facilities throughout Mexico “living in inhuman conditions without basic medical care or rehabilitation.”

In a facility outside Guadalajara, west of Mexico City, the MDRI team saw “children tied to window screens, benches and beds. Some children are permanently tied in physical restraints, causing continual pain and unnecessarily allowing their limbs to atrophy.”

For Eric Rosenthal, the executive director of MDRI, the conditions witnessed in Mexico are “among the worst we have seen throughout the world.”

But research done by the World Federation for Mental Health (WFMH) reveals that similar attitudes toward mental health patients prevail in other countries, since “this is consistent with the history of the care and treatment of the mentally and emotionally disabled.”

Rosenthal attributes the conditions in Mexico and the situation in the psychiatric facilities of other Latin American countries to failure by governments to create mental health programmes that “protect the rights of people with mental disabilities.”

According to the Baltimore-based WFMH, the customary reasons governments trot out — lack of funding — is no excuse for such disregard towards mental health problems.

“Modification of (health) priorities would produce some funding,” says Richard Hunter, the deputy secretary general of WFMH.

“There is no excuse or justification for Mexico or any other country,” treating their mentally ill with such scant regard, he added.

In an effort to deal with mental health problems in the Americas, the Pan American Health Organisation (PAHO) has been pursuing a programme that transfers the responsibility of care from the mental hospital to the community.

In Asian nations like Pakistan, too, a similar approach has been encouraged by health experts in an effort to promote more “culturally relevant” ways to care for the mentally disabled.

The WHO has already acknowledged the usefulness of such initiatives. And in forging ahead with its global strategy, it intends emphasising the need for “mental care, community support, a strengthened evidence base, strengthened capacity of the health worker and better access.”

And in seeking public support to ease the burdens faced by the mentally disabled, the WHO will also pursue measures to fight the “social stigma, misconceptions and discrimination associated with neuropsychiatric conditions.”

Next year’s anniversary, in fact – marking 10 years since the Principle for the Protection of Persons with Mental Illness was adopted by the United Nations General Assembly – has provided an opportunity for the WHO to forge through with such efforts.

Brundtland has already set her sights on using that anniversary to secure global support for the development of an International Convention on the Rights of Persons with Mental Disorders.