Psychological distress and mental disorders which are less visible than many communicable diseases have also proven less newsworthy. Priorities in developing countries like Nepal are typically centered on communicable diseases, reproductive health, child health, immunization and family planning.
As a consequence, mental disorders have not been able to generate the attention they warrant given their pervasive presence in human societies and the toll they take on individuals, society as well as the economy. [break]
The World Health Organization (WHO) estimates that 450 million people worldwide suffer from mental/behavioral disorders or psychosocial problems, and that one in four will be affected by a mental disorder at some stage of life. Nepal, obviously not an exceptional, reportedly has 10 percent of its population suffering from one or more mental illness, with an estimated 1-3 percent suffering from chronic and severe mental illnesses. Thus the burden of mental illness is substantial and studies show that the prevalence of mental disorders is likely to rise further in coming years. Therefore this article emphasizes on greater investment in global mental health.
Here is why. Mental and neurological disorders account for 14 percent of global burden of disease, more than cancer or heart disease. Studies show that depression alone is number one contributor to non-fatal burden of diseases and disability for low and middle income countries (LMIC). There is strong association between mental disorder and disability as disability is also more common among people with mental disorders. According to the report Global Burden of Disease and Risk Factors (published by Oxford University Press & World Bank 2006):
Neuropsychiatric disorders (which include Depression, Bipolar Mood Disorders, Schizophrenia, Epilepsy, Anxiety Disorders, Mental Retardation, Dementia and Substance Abuse) account for 9.8 percent of the total burden of disease in LMIC; Unipolar depressive disorder accounts for 3.1 percent of total burden of disease attributable to non communicable disease; Self Inflicted injuries accounts for 1.5 percent of all deaths—348 suicide cases were reported in Nepal in 2011, an alarming situation; and Unipolar depressive disorders are the single leading cause of Years Lived with Disability.
The enormous sufferings from various mental disorders warrant substantial public health concern and investment. Mental disorders have been shown to increase the risk of heart disease, diabetes, stroke, HIV/AIDS, tuberculosis and accidental and non-accidental injuries (Prince et al. 2007; Rethink 2005). They also add to the risks of other health concerns in LMIC, e.g. Child Mortality Rate which is one of the focal concerns of the Millennium Development Goals in Nepal.
Also, many studies have demonstrated that Maternal Depression is common after childbirth and that it is a strong, independent risk factor for low birth weight, child growth failure and incomplete immunization. That will eventually lead to increase in Child Mortality Rate. Similarly, depression is noted to be independent risk factor for stroke, thus elucidating the complex and multidirectional association of mental disorders with other health issues.
The wider social cost of mental disorders is enormous.
It has also been demonstrated that a high proportion of people who have mental disorders do not seek or receive mental health treatment, thus leading to delayed diagnosis and decreased compliance with care. The gap in care is more pronounced in LMIC due to less accessible fundamental resources. Therefore effective interventions need to be generated and replicated. This article recommends the recognition of mental disorders as public health priority thus shifting the attention of policy makers to effective interventions for mental disorders. Progress relies on better understanding of the burden of mental disorders and increasing mental health literacy.
The authors are associated with Integrating Mental Health in Primary Health Care in a Post Conflict Setting Project being implemented in Dang district
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