‘Mental health in poor countries needs attention’

With more people suffering from mental problems as a result of war, poverty and disease, experts say that unless widespread treatment becomes available, poor countries will be further handicapped in the future.

Nearly 90 per cent of mentally ill people in poor countries go untreated.

But simple solutions exist. Lay people can be trained to spot mental illness in the community. Those people and their families can then be referred for treatment. India has already introduced such a programme for schizophrenia.

“We’re thinking outside the box. We’re not thinking of more mental health specialists,” said Vikram Patel, a professor of international mental health at London’s School of Hygiene and Tropical Medicine and co-author of several of the papers in The Lancet’s series.

Nirmala Srinivasan, head of Action For Mental Illness, a lobby group based in Bangalore, India, says only 7-8 per cent of an estimated 40 million to 50 million people in India who are victims of some form of mental illness — schizophrenia, depression, obsessive compulsive disorder, anxiety – get proper treatment.

“The main reason is that people can’t access treatment,” Srinivasan said in an interview. “Psychiatric treatment is not expensive at all. But there is no treatment available in rural areas.”

N Vijaya, head of the Institute of Mental Health, a 1,600-bed facility with programmes for 400-500 more outpatients in the southern Indian city of Chennai, said awareness of mental health was increasing in India – leading more people to seek treatment.

She said nearly a third of her facilities patients have been “wandering mentally ill,” rescued from the streets by police and private aid groups. “Social workers help us in contacting their families later.”

In Brazil, mental health care rivaling that available in developed nations is available for those who can afford it. The Lancet said Brazil’s mental health care system has improved substantially over the past several decades, but gaps are easy to find. Mentally ill adults in the teeming cities of Latin America’s largest nation are frequently seen begging on street corners and sleeping under highway overpasses. In destitute rural communities, families living in poverty cope the best they can with mentally ill relatives, but are often unable to afford medication or specialized care.

Doctors and nurses in Africa are often too overwhelmed with illnesses like AIDS and malaria to care for mental patients.

Part of the problem of ensuring those in need get care has been how aid money has been spent. Most donor money in poor countries goes to fighting infectious diseases, perhaps because donors like to see tangible results. Unlike investing in mental health, which is rarely cured and requires long-term care, diseases like measles and polio can be prevented with a single shot.