Developing countries face a plethora of health challenges. Not only are they disproportionately affected by infectious diseases, they are increasingly beset by the ‘double burden’ of disease.
In this context, mental health is a hidden and often neglected problem. Many people suffering from mental health disorders lack access to adequate treatment or care – if it is even available in the first place. Deep cultural stigmas associated with mental health disorders mean that in some communities they are still seen as a form of divine punishment or interpreted by traditional healers as a possession or curse.
International funding frameworks have also largely neglected mental health. The ‘big three’ – HIV/AIDS, malaria and tuberculosis – have received disproportionate amounts of funding and policy attention. That is why initiatives like Mental Health Day are so important in bringing vital attention to mental health issues.
Many countries lack the basic legal framework to protect those with a disability. This is so important because people with mental health difficulties experience a wide range of human rights violations. Not only are they vulnerable to abuses in institutions, many do not have access to basic mental health care and treatment they require. Many are excluded from community life and denied basic rights such as shelter, food and clothing. They are discriminated against in the job market, education and in access to housing. Many are denied the right to vote, marry and have children. As a consequence, many people with mental disabilities are living in extreme poverty.
Despite this grim picture, there are some signs of hope. The United Nation’s sustainable development goals, which replaced the millennium development goals in January 2016, have an explicit commitment to improving mental health. Target 3.4 requests that countries:
‘By 2030, reduce by one-third premature mortality from non-communicable diseases through prevention and treatment and promote mental health and well-being.’
This is supported by the commitment to delivering universal healthcare which places public policy support into strengthening holistic health and care systems.
The World Health Organisation has also taken steps to raise the profile of mental health as a development issues. It has taken a firm human rights approach to mental health and introduced a number of initiatives to address the challenge. In 2008 the WHO launched the Mental Health Gap Action Programme to advocate a much greater focus on mental health in global health policies, and in 2013 introduced their mental health action plan.
In the United Kingdom, the department for international development has included mental health provision in its health support for refugees affected by the Syria crisis and have dedicated programmes in Ghana, Malawi, India and Nepal. They are also implementing a £6m project to provide evidence on how to strengthen and integrate health services to identify and treat mental health disorders. This project aims to get mental health better reflected into annual operational plans at the district and national levels in low income countries.
But what more needs to be done?
First, we need to raise awareness and advocate for change – this includes gathering proper data to help identify where the need is and adequately training the people who are in regular contact with people with mental disabilities. Second, we need creative ways to overcome the significant cultural barriers that exist to deliver mental health policies. For instance, Gambia is building a coalition between formal health services, traditional healers, NGOs, communities and families to support the treatment and rehabilitation of people with mental disorders and to promote development.
Finally, a human rights lens is crucial. Mental health is not just a health concern. As we have seen it is linked to a wide range of social and economic rights issues. It is a development issue that affects people’s ability to work and contribute fully to their communities. Mental health needs to be mainstreamed in developing programming if we are truly to reach our ambition to leave no one behind.
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Jessica Toale is a political and international development consultant and former political advisor to two shadow secretaries of state. She tweets at @JessicaToale
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