Putting the global spotlight on mental health

Anxiety and depression are two of the most common mental health conditions worldwide. — Photos: Filepic

I write this column from London where the World Congress of the World Federation for Mental Health (WFMH) is currently taking place.

It was in August 1948 that the WFMH held the first International Congress on Mental Health, also in London.

The Congress now returns 74 years later to the same historical multi-purpose venue of Central Hall Westminster, with the common aim of continuing the journey of mainstreaming the conversation on mental health.

The theme for the four-day conference is “Making mental health a global priority”.

There is no better time to bring together all stakeholders to discuss this issue as there have been concerns over the historical absence of mental health from the development agenda, despite it being regarded as a major obstacle to development.

There was great hope when there was inclusion of mental health indicators in the United Nations Sustainable Development Goals (UN SDGs) in 2015.

It was even touted as a “historic step” for mental health.

However, the fact that mental illness can affect anyone and have a direct impact on development was somehow forgotten or ignored in lieu of “more pressing concerns” by policymakers, with many countries merely paying lip service to mental health issues.

Fortunately, current perceptions regarding the importance of mental health are shifting at a global level.

Once described as an “invisible problem” in international development, mental health is now being framed as one of the most pressing development issues of our time.

Direct link to economy

Highlighting the economic burden of mental disorders has been an effective strategy in getting increased attention and resources channelled into mental health.

The disease burden of mental conditions is projected to surge to US$6 trillion (RM26.4 trillion) by 2030.

In Malaysia, mental health conditions at the workplace cost the economy RM14.46 billion in 2018.

However, our mental health spending hovers at around only 1% of the health budget, with minimal increase in recent years.

The positive association between poverty and mental health problems is one of the most well-established theories in epidemiology.

Mental ill health increases the likelihood of becoming or remaining poor.

Conversely, poverty also increases the risk of developing mental health problems, resulting in a “vicious cycle”.

This again, points to the crucial role mental health plays in the development agenda.

However, the pathways to receiving adequate and humane mental healthcare vary within countries and between countries.

This mental health inequity remains a challenge to be explored and for recommendations to be thought of to attain better health for all nations, thus making the theme of the Congress even more relevant.

Mental health conditions have a direct impact on productivity and the economy.Mental health conditions have a direct impact on productivity and the economy.

Ripple effects

Studies estimate that at least 10% of the world’s population is affected by mental conditions.

One in five children and adolescents suffer from some features suggestive of psychological distress.

Significantly, mental disorders account for 30% of the non-fatal disease burden worldwide, and 10% of the overall burden of disease, including death and disability.

It is a known fact that two of the most common mental disorders – anxiety and depression – respond well to treatment.

However, due to a lack of funding, these disorders are not treated adequately in most countries.

For governments and healthcare authorities, investing in the treatment of mental illness may not seem a priority.

Nevertheless, mental disorders have many ripple effects, including a strong economic impact on society.

The fact that mental disorders account for almost one in three years lived with disability globally, should say something.

Additionally, there is a strong link between mental disorders and potentially fatal conditions such as cancer, cardiovascular disease, diabetes, HIV/AIDS and obesity.

Tackling anxiety and depression

Several action plans are being discussed at this Congress, among which are considerations on depression and anxiety.

The effective care of depression and anxiety requires a comprehensive mental health system with healthcare institutions and community settings endorsing holistic mental health plans.

Mental health planners and policymakers need to develop – through public awareness and community engagement – care delivery systems that are sensitive to social, economic and cultural contexts to ensure that services are appropriately sought out and utilised.

Anxiety and depression also play large roles in the health of expectant and new mothers and their children.

Antenatal depression can increase the likelihood of preterm birth, low birth weight and cognitive disturbances.

Significantly, 10-15% of new mothers suffer from post-partum depression.

Studies have shown that antenatal and postnatal interventions are effective in reducing depression and anxiety, which improves infant outcome.

In this context, a visit to a UK charity MIND by the Malaysian delegation impressed us with their effective perinatal interventions at the community level by volunteers.

These community interventions underscore the effectiveness of non-medical approaches in preventing the emergence of more sinister symptoms.

Children are also affected by depression and anxiety, which causes a negative effect on their ability to learn and study.

Integrating mental health intervention into standard paediatric healthcare would not only improve students’ learning outcomes, but also allow children to obtain treatment at an early stage.

This could also be done through school-based health screening and care.

It cannot be denied that digital platforms provide an alternative method of mental healthcare delivery when resources are scarce, while also addressing long-standing obstacles in mental health delivery, such as transportation barriers, stigma associated with visiting mental health clinics, clinician shortages and long waiting periods.

Psychiatric and psychotherapy services have been successfully implemented through digital platforms, demonstrating improvement in depression and anxiety symptoms, reduced costs and patient acceptance.

In addition, patient participation is rapidly expanding in peer-to-peer social networks, where patients can access around-the-clock support with demonstrable improvements in symptoms.

Working together

The role of non-governmental organisations (NGOs) outside the health sector play a crucial role in stigma reduction.

Stigma associated with mental disorders can result in social isolation, low self-esteem, and limited chances in education and employment.

Therefore, anti-stigma campaigns are powerful tools to confront mental disorders.

There is a huge amount of evidence that investing in workplace wellness programmes is good for employees and companies.

Organisational-level workplace mental health training to provide appropriate support to employees should be embraced by employers, particularly in the corporate sector.

This training should also include policies to enable the organisation to implement non-judgmental and inclusive practices in the workplace.

Such investments will result in good returns through restored productivity, as well as improved mental health among employees.

“It is now understood across the board that mental health is not the responsibility of government or healthcare professionals alone.

“The urgency with which we must address mental health should not be solely confined to champions of mental health advocacy, many of those who, like myself, have lived experience or have cared for those going through difficult times,” said the Congress’ Patron Tengku Puteri Raja Tengku Puteri Iman Afzan Al-Sultan Abdullah during her speech at the opening of the Congress.

This message clearly underscores the fact that the synergistic collaboration between clinical providers, and community support by NGOs and the corporate sector, can go a long way in achieving the healthy mental well-being of society.

Datuk Dr Andrew Mohanraj is a consultant psychiatrist, Green Ribbon Group policy advisor and Malaysian Mental Health Association president. For more information, email starhealth@thestar.com.my. The information provided is for educational and communication purposes only, and it should not be construed as personal medical advice. The Star does not give any warranty on accuracy, completeness, functionality, usefulness or other assurances as to the content appearing in this column. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.

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