For most reasonable people, the right of anyone suffering from an illness to be treated in a clinically appropriate and respectful manner is so obviously true and morally correct that it is baffling to think that the position has to be defendedfor any medical condition. However, in the case of those suffering from mental illness, there is little doubt that few are able to access their right to appropriate care. As World Mental Health Day is fast approaching on October 10, this is an appropriate moment to reflect and ask, ‘why?’
There can be little doubt that the stigma and discrimination surrounding mental illness has contributed significantly to pushing conditions ‘into the shadows’ and keeping them there. Readers will be all too aware of the well-worn stereotypes employed throughout the media, for example, which equate mental illness only with madness, irrational behaviour and unexpected bouts of extreme and often life threatening violence. Such caricatures often tend to dominate popular culture at the expense of a more nuanced and empathetic portrayal of the more common mental disorders such as anxiety, substance abuse, depression and stress. And who among us, in a fast paced world, can claim never to have been touched, in one way or another, by these conditions?
But we are often more comfortable with the stigmatising stereotypes because they dehumanise an essentially human condition and perhaps make us feel more secure that ‘’it could never happen to me’. These attitudes persist even though research tells us that 1 in 5 people will, at some stage in their lives, suffer from a significant mental health ‘issue’, and that suicide is the leading cause of death in teenagers around the world.
Health care systems themselves, while often well intentioned,have also helped to compound the sense of isolation and stigma related to those suffering from mental illness. Government approaches to care and support have tended to focus on running large, often urban-based, mental health institutions, while the lack of mental health expertise in country (some sources estimate less than 200 psychiatrists are currently working in Government service, supported by 5 psychiatric nurses per 100 000 people) has created a significant ‘treatment gap’ in which the number of experts available to treat conditions is far outweighed by the numberneeding them. The nationwide lack of appropriate medication also makes treatment doubly challenging. To make matters worse, mental health remains outside the scope of most health information systems, so evidence based decision making continues to be problematic at best.
This situation, however, is not as bleak as it may first appear,and several recent developments give hope for increasingly appropriate approaches to care and support given to those suffering from mental illness, as well as those who care for them – and we should never forget the significant burden which carers so often carry.
Government and development agencies are increasingly placing non communicable diseases towards the top of their health priorities and only last week, the United Nations adopted the new Sustainable Development Goals which included, for the first time, commitments to promote positivemental health and to address the damaging impact of mental illness. With such recognition comes greater levels of support – including, in time, financial. Although international development targets are often rightly open to derision, there is little doubt that when such targets include specific health conditions, there is a tendency for society at large to believe that they must therefore be both important and pressing. In this case, they are right.
Evidence suggests that the younger generation are less quick to judge those with mental health challenges than older generations and that an approach to stigma reduction (based on the ‘social engagement’ of those suffering and recovering from conditions) is proving a powerful tool in many countries around the world in combatting negative stereotypes which reinforce a sense of ‘otherness’ in those who need our support. Such approaches also chip away at the frequent ill-informed myths about mental health – that it is contagious, a religious crisis, based on family curses, and can result only in insanityand then death.
There can be little doubt that social media is starting to play an important role in disseminating information which shows the impact of common mental disorders on so many people as they go about their daily lives. It does not need medical training to intuitively acknowledge the impact of stress and anxiety on getting enough sleep, or following a good diet. With such insights, the edifices of stigma and discrimination start to be chipped away at as we all start to share a more common humanity.
There are also approaches being developed which help to leverage the limited number of mental health professionals in Nigeria in order to ensure that care and support is provided as close to the community level as possible, while being supported, when appropriate, by hospital care. The Gede Foundation, for example, is working with leading national and international partners to develop ways in which key skills related to the screening, treatment and referral of mental health conditions for those living with HIV-AIDS can be integrated into community based health workers. It is utterly essential for community based health workers to be given the skills and resources needed to act as the first line of support for people suffering from mental health conditions – and much of these skills will also be based on addressing the causes of stigma and discrimination which prevent so many suffering from mental illness from coming forward. This is one of the Foundation’s key initiatives in helping to bring underserved and stigmatised health burdens ’out of the shadows’ through cutting edge research, partnerships and advocacy which brings positive change at the community level.
While a significant amount of work remains to be done before those suffering from mental health challenges can truly be said to be receiving appropriate care and support, there is clearly some ground for optimism. Perhaps the greatest cause for hope in the future is this – the next time you find yourself in a gathering of over 100 people, consider the fact that, as mentioned, 1:5 will suffer from some form of significant mental challenge in their lifetime. If you are one of the 20 who will suffer from mental illness, how would you like to be treated? Isn’t it time to act – now?
John Minto and Jennifer Douglas-Abubakar are Managing Director and Founder respectively, of Gede Foundation, a non-profit that caters to underserved and highly stigmatized health burdens in Nigeria