About half of mental disorders begin before the age of 14. Around 20% of the world’s children and adolescents are estimated to have mental disorders or problems, with similar types of disorders being reported across cultures. Yet, regions of the world with the highest percentage of population under the age of 19 have the poorest level of mental health resources. Most low- and middle-income countries have only one child psychiatrist for every 1 to 4 million people.
Depression is characterized by sustained sadness and loss of interest along with psychological, behavioural and physical symptoms. It is ranked as the leading cause of disability worldwide.
On average about 800 000 people commit suicide every year, 86% of them in low- and middle-income countries. More than half of the people who kill themselves are aged between 15 and 44. The highest suicide rates are found among men in eastern European countries. Mental disorders are one of the most prominent and treatable causes of suicide.
Mental disorders are among the risk factors for communicable and non-communicable diseases. They can also contribute to unintentional and intentional injury.
Stigma about mental disorders and discrimination against patients and families prevent people from seeking mental health care. In South Africa, a public survey showed that most people thought mental illnesses were related to either stress or a lack of willpower rather than to medical disorders. Contrary to expectations, levels of stigma were higher in urban areas and among people with higher levels of education.
Human rights violations of psychiatric patients are routinely reported in most countries. These include physical restraint, seclusion and denial of basic needs and privacy. Few countries have a legal framework that adequately protects the rights of people with mental disorders.
There is huge inequity in the distribution of skilled human resources for mental health across the world. Shortages of psychiatrists, psychiatric nurses, psychologists and social workers are among the main barriers to providing treatment and care in low- and middle-income countries. Low-income countries have 0.05 psychiatrists and 0.42 nurses per 100 000 people. The rate of psychiatrists in high income countries is 170 times greater and for nurses is 70 times greater.
In order to increase the availability of mental health services, there are five key barriers that need to be overcome: the absence of mental health from the public health agenda and the implications for funding; the current organization of mental health services; lack of integration within primary care; inadequate human resources for mental health; and lack of public mental health leadership.
Governments, donors and groups representing mental health workers, patients and their families need to work together to increase mental health services, especially in low- and middle-income countries. The financial resources needed are relatively modest: US$ 2 per person per year in low-income countries and US$ 3-4 in lower middle-income countries.
Photo credit by: Guim