World Mental Health Day was on October 10, 2021. The theme for this year was "Mental Health in an unequal World". This is an appropriate focus given the extreme inequities to access to mental health services that exist in our society.
We are three providers committed to mental health equity across the globe-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 commonalities in the diverse impact that mental illness has on the most vulnerable members of our communities.
While there has been some focus on the poor access to mental health services in high income countries, between 75% to 95% of people with mental disorders in low- and middle-income countries are unable to access mental health services at all
Mental health disorders are considered the second leading cause of disease burden in terms of Years Lived with Disability (YLD) and sixth leading cause of Disability Adjusted Life Years (DALYs) in the world. Mental health and substance use disorders are a major source of disability across the globe, regardless of location or income.
While there has been some focus on the poor access to mental health services in high income countries, between 75% to 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 is dependent on a milieu of advantages and disadvantages. Adversity, trauma, insecurities, poverty, power disabling environment and physical morbidities, among other factors, all contribute to poor mental health. These issues are all augmented in under-resourced areas and exacerbated among the most vulnerable.
Wealth inequality has impacted general health, including mental health. Women are nearly twice as likely as men to suffer from mental illness, including depression. This gender disparity may relate to social inequalities and living standards across nations.
While public health discourse has begun to address the mental health burden and address it, social inequalities must be understood to achieve any form of equality in the mental health landscape. Addressing disparities in mental health not only involves reducing the stigma associated with mental health diagnoses and treatment but also involves increasing access to care.
According to the United Nations, there are 9 per 100,000 mental health workers for the global population. However, when taking into account low versus high income countries this number varies substantially.
While this shows that mental health services are available, access is important in treating mental illness as well as an understanding of factors such as the social determinants of health that greatly contribute to one's mental health.
Therefore when we attempt to reduce inequality in mental health, we must also make a worldwide commitment to promote policies that advance equality across gender, wealth, education and participation must be made to achieve the highest possible level of mental health for all people.
Reducing mental health inequalities and their impact on us is one of the most immediate problems that we face and needs urgent action. We suggest four ways to focus on mental health equity locally and globally with a greater focus on effective, pragmatic, scalable solutions that address disadvantages and foster resilience in people.
We need to co-create mental health services that integrate and not isolate people; options to access services should focus on keeping individuals within their own environment of comfort. Services should be provided to increase accessibility. This includes the provision of services at convenient locations within a community and during times beyond normal work hours, including evenings and weekends. Utilization rates will peak and mental well-being and outcomes will improve drastically.
The health care community needs to shift its mind-set to adopting holistic mental health processes and outcomes that embrace openness and creativity. Mental well-being should be normalised in the practice and policy of healthcare provision. This can help reduce the stigma associated with both seeking and providing treatment.
Communities should be engaged in grassroots efforts that focus on training members to become mental health gatekeepers and liaise with clinical practitioners. Strong and sustainable examples include Zimbabwe's grandma benches, healing circles, and Mental Health First Aid education programs that have invested in the community to engage the solutions that best serve their purpose and needs.
Mental Health cannot be addressed in isolation since it is centered in a complex socio-cultural context. Solutions to enhance equity have to address the environmental and sociopolitical factors in play in the community and divest from oppressive systems that perpetuate marginalization of mental illness.
If the COVID-19 Pandemic and its associated lockdowns has not highlighted the urgent need to promote Mental health, then nothing will. We need to treat Mental health promotion as a public health emergency which needs immediate action necessary to generate equity in outcomes. Awareness is only the first step. High quality, affordable and normalized mental health should not be a privilege but a right, that everyone can claim.
Equal Mental Health Care for all; let's make it a reality!
Shubha Nagesh is a medical doctor and a 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 Mary Nakame is a Registered Nurse, Public Health Specialist, and Executive Director of REMI East Africa in Kampala, Uganda.