Getting treatment for a mental illness when you live in the developing world is hardly as easy as making an appointment with a therapist or psychiatrist. Mental illness is often not treated with the same sense of urgency as physical illness, and resources to provide care are simply not available in many areas.
In this moving talk at TEDGlobal 2012, mental health care advocate Vikram Patel gave a startling statistic — that in developed countries roughly 50 percent of people don’t receive appropriate care for mental disorders but that, in developing countries, the treatment gap rockets sky-high to 90 percent.
Why? Another statistic from Patel’s research illuminates the problem. If you translate the percentage of psychiatrists in the population in the United Kingdom to India, you’d expect to see about 150,000 of them. But in the world’s second most populous country, the actual number of psychiatrists is closer to 3,000. The situation is as dire in other countries, too. In Zimbabwe — a country of nearly 3 million — there are only about a dozen psychiatrists, almost all of them practicing in the same city.
Below, read some more startling statistics about mental illness, followed by Patel’s promising ideas on how to get people the care they need.
- More than 450 million across the globe suffer from mental illnesses. [World Health Organization]
- Schizophrenia, depression, epilepsy, dementia, alcohol dependence and other mental, neurological and substance-use disorders make up 13% of the global disease burden, surpassing both cardiovascular disease and cancer. [National Institutes of Health]
- By 2030, depression will be the second highest cause of disease burden in middle-income countries and the third highest in low-income countries. [WHO]
- In the United States, people with severe mental illness die 25 years earlier than the general population on average. [Time] In Denmark, the life expectancy gap has been shown to be as high as 18.7 years with certain disorders. [Psychiatric News] And the differential in life expectancy is believed to be even wider in developing countries.
- In the last 45 years suicide rates have increased by 60% worldwide. [WHO] More than 90% of people who kill themselves have a diagnosable mental disorder. [NIH]
- Suicide is among the three leading causes of death among those ages 15-44 years in some countries, and the second leading cause of death in the 10-24 years age group. [WHO]
- In the UK, 70% of people affected by mental illness experience discrimination, and discrimination is believed to be worse in developing countries. [The Guardian]
- Mental and psychosocial disabilities are associated with rates of unemployment as high as 90%. [WHO]
- Meanwhile, those with severe mental illnesses are more likely to have other health risk factors, as well. In the Untied States, while about 22% of the general population smokes, more than 75% of people with severe mental illness are tobacco-dependent. And people with depression or bipolar disorder are about twice as likely to be obese as the general population. [Time]
But Patel — the co-director of the Centre for Global Mental Health and the co-founder of Sangath, an NGO dedicated to mental health — believes that a lot can be done to disrupt these statistics worldwide.
In his powerful talk, Patel describes a novel approach — training whoever is available, be it a local nurse or a family member, to provide mental health interventions — no psychiatrist required. Inspired by books like Where There Is No Doctor: A Village Health Care Handbook, Patel focuses on empowering everyday people to help the members of their community. In 2003, he published the tome Where There Is No Psychiatrist, which explains more than 30 clinical disorders to readers, teaching them to problem-solve when they encounter each. Sections in the book range from “Assessing someone who refuses to talk” to “When to suspect physical complaints are related to mental illness.”
So far, Patel notes that approaches similar to his are making a big difference. In rural Uganda, villagers were taught to deliver psychotherapy for depression — and 90% of those who received it recovered. Meanwhile in Pakistan, maternal health workers were taught to give cognitive therapy to depressed mothers, leading to 73% of the new moms recovering. And in Patel’s own study, he found that training lay counselors to give depression and anxiety interventions helped 70% of patients recover. In his comparison group, who went to primary health care centers, only 50% bounced back.
“It doesn’t simply make healthcare more accessible and affordable, but it is fundamentally empowering,” says Patel. “It empowers ordinary people to be more effective for caring for the health of others in their community, and in doing so to become better guardians of their own health.”