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As a result, the majority of people with mental illness in developing nations go untreated despite the availability of effective treatment. These large treatment gaps are not surprising given that in many developing countries there is no budget for mental health services. This disproportionately affects poorer people who are at greater risk of having mental disorders. The stigma, myths and misconceptions surrounding mental illness contribute to much of the discrimination and human rights violations experienced by people with mental disorders Ndetei et al.
The laws, practices and social norms in many nations give extensive powers to guardians of people with mental disorders to decide where they live, their movements, their personal and financial affairs, and their care including their commitment to mental hospitals Ndetei et al. Stigma associated with mental disorders can also influence career choices resulting in fewer people choosing to work in the mental healthcare field. Disturbingly, physicians in training in some developing or economically disadvantaged countries hold these same beliefs, even after undergoing psychiatric training Roberts, These beliefs increase stigma, discrimination, and social isolation of individuals living with mental illness and limits resources for their care.
Without effective diagnosis and treatment options, mental disorders are seen as untreatable, resulting in patients being undervalued and perceived as not able to contribute to society.
In developing nations and in some communities in developed nations, the limited availability of modern mental health services and providers is offset by reliance on traditional and faith healers Beals et al. Although these alternative healers play a critical role, they often lack the necessary training and skills to provide effective care for people with serious mental illness.
The economic burden of mental disorder is great. The effect of mental disorders extends beyond individual and family suffering to national economic development. Mental health well-being is strongly related to many economic development sectors e. Depression, for instance, can negatively affect education, employment, and productivity Berndt et al.
Economic loss associated with decreased labour force participation and institutionalization of people with mental disorders is great.
Current research shows that many people suffering from debilitating mental illnesses, in the United Kingdom and elsewhere, also endure additional types of . Do the Mentally Ill Suffer Unneeded Distributive Injustice? by M. R. Harnden ( , Paperback). Be the first to . Psychology Paperback Mental Illness Books.
Unmet mental health needs can create social problems e. In many developing nations these social problems are further compounded by poor governance, corruption and social morbidity due to natural and manmade disasters e. The mismatch between the global burden of mental disorders and availability of mental health resources is alarming. According to WHO, there is less than one psychiatrist for every , people in much of south-east Asia, and less than one psychiatrist for every 1 million people in sub-Saharan Africa Jacob et al.
Given the scarcity of mental health providers in developing nations, the few psychiatric hospitals that exist are often understaffed, crowded, and may not provide the quality of care needed. Most psychiatric hospitals are located in urban settings and away from family members, which further increases the social isolation and cost for families. In developed nations e. One key strategy for addressing inequalities in mental health care is to ensure the integration of mental health with other primary care services.
Ongoing efforts to implement and enhance primary care in developing countries Rohde et al. Chan and Van Weel observe that:. For too long, mental disorders have been largely overlooked as part of strengthening primary care. This is despite the fact that mental disorders are found in all countries, in women and men, at all stages of life, among the rich and poor, and in both rural and urban settings.
It is also despite the fact that integrating mental health into primary care facilitates person-centred and holistic services, and as such, is central to the values and principles of the Alma Ata Declaration. Community mental health services can help reduce social stigma and discrimination by reducing the social isolation, neglect, and institutionalization of people living with mental health problems. Effective community management of mental disorders also helps people realize that people with mental illness can live productive lives, contribute to society, and be integrated with society.
Efforts to address mental health problems must also address the pervasive lack of reliable data within and across nations WHO, a. Health systems in many developing nations do not routinely collect mental health data Ndetei et al. Data limitations put mental health needs on the backburner for most policy makers and make it difficult for governments and international agencies to devote more resources to address mental disorders.
Strategies, such as adding reliable mental health measures to ongoing population surveys e. The Demographic Health Survey can significantly improve availability of data for advocacy, programme planning and policy formation in many countries. In conclusion, health reform agendas in the developed and developing nations need to provide legal protection, services, and human rights to people living with mental disorders. These policies must protect people with mental disorders from abuse, neglect, and discrimination, and afford them the care they need.
Justice requires that people with mental illness receive the same societal and legal protection given to other people with physical health conditions. Ethical and human rights challenges in caring for people living with mental illness and their families exist.
Although the idea of health without mental health sounds absurd, mental health is perhaps the most neglected aspect of health in developed and developing nations. In defining health, the WHO clearly articulated the importance of mental health by including it with overall physical and social well-being. Neglect of mental health needs in health policies often translates to neglect in research, funding, services, and infrastructure e.
Mental health is vital to our understanding of health and economic development and must be prioritized in health planning, resource allocation and fully integrated with other primary care services. The authors report no conflicts of interest.
Moreover, intensive and more appropriately attuned ethics education is critically important in understanding and addressing mental health inequalities and in the preparation of clinicians caring for people living with mental illness Chipp et al. Conversely, poverty increases the likelihood of developing mental disorders Bostock, ; Das et al. The global burden of mental disorders is enormous, under-appreciated, and largely unmet. The treatment gap in mental health care. In the long term, discrediting the Nazi regime accomplished this, so much so that virtually any Nazi policy was discredited by association. From a different perspective, the key injustice is denial of euthanasia, seen as a person's right to die. Nevertheless, the same sorts of methods are involved.
The authors alone are responsible for the content and writing of the paper. National Center for Biotechnology Information , U.
Author manuscript; available in PMC Jan 1. The publisher's final edited version of this article is available at Int Rev Psychiatry. See other articles in PMC that cite the published article. Abstract The global burden of neuropsychiatry diseases and related mental health conditions is enormous, underappreciated and under resourced, particularly in the developing nations. Introduction The burden and inequalities in mental healthcare throughout the world are critically important health issues, and taken together present immense ethical challenges.
Table I Summary of key issues in global mental health. Issue Key points Burden of mental disorders The global burden of mental disorders is enormous, under-appreciated, and largely unmet. Depression, alcohol and substance abuse and psychoses are among the most prevalent conditions. Many nations have limited capacity e.
Human rights and social justice frameworks are critical in understanding and addressing mental health inequalities. In many nations, limited or no policies exist to address basic needs and human rights of people with mental illness and standards of ethical conduct of research and treatment of mental disorders are inadequate or lacking. Ethical principles of beneficence, autonomy, respect for persons and non-malfeasance for people living with mental disorders foster human dignity, and promote human rights and social justice.
Poverty increases the risk of developing mental disorders, which in turn increase the risk of living in poverty due disability or loss of gainful employment. Mental disorders are determined by multiple and interacting social, psychological and biological factors. The underlying social determinants of mental disorders e.
Unmet mental health needs contribute to profound suffering and deaths largely because people cannot access needed treatment. Shortage of mental health providers and resources result in unnecessary institutionalization of people with mental illness even though these conditions can be managed effectively in the community if services were available.
In most developing nations, the burden of caring for people with mental illness disproportionately falls on women and children. Mental health stigma and discrimination are major barriers to effective management of mental disorders. Stigma, myths, and misconceptions of mental illness contribute to much of the discrimination and human rights violation experienced by people with mental disorders.
Stigma and discrimination increase social isolation and unmet needs for mental health services, negatively influence choice of mental health careers, and limit development of policies and human rights protections for people living with mental disorders and their families. In many developing nations, mental health services are provided at the tertiary level with limited or no integration to primary care interventions.
The majority of individuals with mental disorders and their families live in overt poverty and cannot access, afford, appropriate and available specialized mental health services provided at tertiary levels health facilities serviced by psychiatrists. Extreme and growing shortage of mental health workers further compounds the problem of access to mental health services resulting in limited access to services and reliance on traditional healers in some nations.
In the absence of integrated proper functioning health systems it is impossible to provide mental health services for most individuals with mental disorders and their families in developing nations. Integrating mental health into primary care services is a critical, affordable, and cost-effective approach to delivering services for people living with mental disorders.
Such integrated systems of primary care can reduce unmet needs and social stigma and discrimination by decreasing social isolation, neglect, and institutionalization of people with mental disorder. The economic burden of mental disorders is great. Mental disorders significantly impair economic growth through their effects on labour supply, earnings, participation, and productivity.
Unmet mental health care needs are associated with increased risk of social problems e. In many developing nations, limited efforts have been made to address or modify the social determinants of health, including actions that allow people to adopt and maintain healthy life styles and those that create living conditions and environments that support health. Mental health promotion is an integral part of health promotion theory and practice where persons with mental illness need affordable, available, accessible, and appropriate sustainable mental health services for them to continue education children and youth or remain in an economic sustaining livelihoods employment.
These associations play a major role in risk behaviours, such as unsafe sexual behaviour, road trauma and physical inactivity resulting in lack of meaningful, or dismissal from, employment, and in turn becomes an associated cause for depression and alcohol and drug use among people with mental disorders and their families. Lack of reliable mental health data within and across nations is pervasive and a critical barrier in addressing unmet mental health needs.
Limited data hinder better understanding of mental health needs, limit policy, interventions, and resources needed to address mental disorders. Data limitations put mental health needs on the back burner of policy development and resource allocation.
Better collection of mental health data are needed in the developing nations and among rural and racial groups in developed nations. Open in a separate window. Inequalities in mental health Inequalities in mental health exist, are pervasive and often ignored as illustrated by the neglect of a mental health focus in the Millennium Development Goals United Nations, Unmet mental health needs Mental health inequalities have contributed to profound suffering and death worldwide largely because people cannot access the treatment they need.
Mental disorders and economic development The economic burden of mental disorder is great. Integrating mental health into primary health care services The mismatch between the global burden of mental disorders and availability of mental health resources is alarming. Chan and Van Weel observe that: Data and the global burden of mental health problems Efforts to address mental health problems must also address the pervasive lack of reliable data within and across nations WHO, a.
Footnotes Declaration of interest: Social distance towards people with mental illness amongst Nigerian university students. Social distance towards people with mental illness in southwestern Nigeria. Effects of a psychiatric education. Prevalence of childhood and early adolescence mental disorders among children attending primary health care centers in Mosul, Iraq: Prevalence of mental disorders and utilization of mental health services in two American Indian reservation populations: For six years, he boarded at Homefield School near Bournemouth before winning a sixth-form scholarship to Malvern College, in Worcestershire.
He went up to the University of Newcastle-Upon-Tyne to read politics and history but three years later, when Mark should have been sitting the final exams of his degree, he found himself admitted into psychiatric hospital four times and diagnosed with manic-depressive psychosis. Learning to cope with manic depression, or bipolar disorder, has proven achievable but remains, nonetheless, an endeavour fraught with difficulties and seemingly insurmountable challenges. Since , Mark has worked free-lance in mental health education as an inspirational public speaker and tactical corporate advisor.
It is the sequel to 'In The Dark Backyard', and continues a genuinely insightful and witty first hand account of the journey from academe to psychiatric ward to wellness. In his spare time, Mark is a keen amateur cricketer. He is also a published poet, has written and presented a national television series, been a male model, appeared on the silver screen in a series of art-house spectaculars and even been elected Mayor of his home town.
I am functioning well now, according to experts, with a keenness to make the most of the years ahead without being cowed by some distant memories of chaotic, acute times. I am a versatile all-rounder hoping for the best and prepared to try and make it happen. Book Extract People who suffer from severe and enduring mental illnesses also experience such high levels of social, economic and political inequality that the notion of there being a fair and just society is absurd without fundamental change.
The scale of deprivation affecting people with mental illness impacts upon their chances of continuing, physical survival. The longevity of mentally ill people is reduced by great inequalities in physical healthcare, relative to people without psychiatric conditions: Not only do people with mental illness live shorter lives, their lives are blighted in further, inter-related ways: One combined effect of poorer physical health and the distress of mental illness is the increased incidence of sufferers occupying trivial roles in familial and commercial affairs.
In the UK, tackling the issues that have created a pattern of low levels of education, high unemployment, increased chances of physical illness and shorter lives has led to recommendations and legislation aimed at healthcare professionals, employers and those directly affected by mental illness. A philosophical matter is also raised by these instances of further deprivation suffered by the mentally unwell; does anything in our canon help explain how these inequalities have arisen and how they can be reduced?
By utilising the work of prominent thinkers on the subject of justice, it should be possible to learn how injustice can be understood with regards to the mentally unwell. Do the mentally ill suffer unneeded distributive injustice?