Mental illness in developing nations: many kids,little care

Up to a fifth of children in these countries have such problems,says study in Lancet.

Up to 1 in 5 children in developing countries have a mental health problem,yet treatment is woefully inadequate,says a new series on global mental health launched by The Lancet on Monday. Lead editor Dr Vikram Patel told The Indian Express from Cape Town that mental health problems affect 10-20 per cent of children and adolescents worldwide.

The authors,who include Prof Atif Rahman of the University of Liverpool,say that only 10 per cent of trials of mental health interventions come from low and middle-income countries,though children and adolescents form half the population in these countries. Most of these interventions are drug-based and not psychosocial strategies. Progress is hampered by lack of government policy,inadequate funding,and a death of trained clinicians,the study says.

How do we scale up mental health care,Patel asks,when as few as one in 50 people with mental health problems have access to treatment in developing countries,compared with one in three in wealthy nations.

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He says India is woefully short of psychiatrists,with just 4,000 of them. A district mental health programme is in place in only 123 of 640 districts,with total coverage anticipated only by 2017. Even then,there will be insufficient psychiatrists,says Patel.

The national mental health programme too lacks guidance and leadership,he says. No mental health policy existed before the programme,and the 1987 Mental Health Act has been largely non-functional. Experts have identified apathy,an absence of leadership,and issues of political power as barriers.

Evidence on the number of mental health workers comes from WHOs 2011 Mental Health Atlas on 183 nations,covering 99 per cent of the worlds population. Globally,psychiatrists form the second largest workforce in the mental health system,after nurses. The population-based median for psychiatrists varies 172 times between high-income and low-income countries,with the former showing faster growth too. The atlas estimates a shortage of 1.18 million mental health workers for all 144 countries of low and middle income.

The Lancet Series on Global Mental Health 2011 follows up on a set of papers published in 2007. It tracks progress over the past four years,with updates to provide a resource for health workers and policymakers,Patel says.

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