Shaping the global mental health divide
09 October 2020
Stigma, culture, religion and poor knowledge all play a part in creating the lack of understanding that exists in many developing countries when it comes to diagnosing and tackling mental illness. So what can be done to bridge this divide? What does the future hold when it comes to mental health trends? And in a hyper-globalised world where it is increasingly difficult for workers to switch off, how can employers help to protect mental well-being in the workplace?
Global mental illness is a reality and a major challenge of our time. On an individual level, mental health refers to our state of the mind. On a world stage it means that individuals and societies, as a collective, experience anxiety, depression, stressful events, substance abuse and suicides.
The issue has been thrown back into the spotlight following the COVID-19 pandemic. Medical experts and scientists recently published a paper in The Lancet Psychiatry calling for mental health and brain research to take a higher priority in the global response to tackling the virus which they warn will have a ‘’profound’’ and ‘’pervasive impact’’ on minds across the world.
Indeed the latest statistics addressing the issue are sobering. The World Health Organization has estimated that 4.4% of the world’s population suffers from depression and 3.6% from anxiety, this equates to approximately 550 million people globally. Across all mental health disorders, the number of sufferers has been estimated to be almost 800 million people, or slightly more than one in ten of the world’s population.
These dramatic numbers provide a snapshot of the strain mental health disorders place on the world’s healthcare systems. They also show, like all health conditions, that the distribution and effect of mental health disorders is not equal across the world but divided.
Stigma, culture, religion and poor knowledge all play a part in creating the lack of understanding that exists in many developing countries when it comes to diagnosing and tackling mental illness. On the other hand, technology and awareness has influenced the way in which mental health has evolved, and crucially is tackled, in many western countries.
So what can be done to bridge this divide? What does the future hold when it comes to mental health trends? And in a hyper-globalised world where it is increasingly difficult for workers to switch off, how can employers help to protect mental well-being in the workplace?
COVID-19 instigates the need for a fresh global conversation about mental health
The need for a global conversation to address the importance of mental health has emerged following the opinions of 24 medical and science professionals. They highlight that we need to urgently tackle the harmful impact of the COVID-19 pandemic on mental health, and that this needs to be central to our global response to the pandemic.
The expert group, established and supported by the Academy of Medical Sciences and the mental health research charity, MQ, includes neuroscientists, psychiatrists, psychologists and public health experts. In a paper recently published in The Lancet Psychiatry, they are calling for ‘moment to moment’ monitoring of anxiety, depression, self-harm and suicide, in addition to other mental health issues in the UK and globally. The paper also calls for rapid roll out of evidence-based programmes and treatments which can be accessed by computer and increase mental resilience.
Professor Matthew Hotopf CBE FMedSci, Vice Dean Research at King’s College London’s Institute of Psychiatry, Psychology & Neuroscience and Director NIHR Maudsley Biomedical Research Centre, is one of the contributors to the paper.
He said: “This paper gives us a research roadmap to help protect our mental health at this incredibly difficult time and in the future. We are calling for real time monitoring of the mental health of the population to develop effective treatments. This needs to be on a bigger scale than we have ever seen previously and must be co-ordinated, targeted and comprehensive to give us an evidence-based picture of what is really going on in societies around the world.”
His sentiments are echoed by Lwanele Khasu, a clinical psychologist and managing director of the Oasis Mental Wellness Hub in South Africa. She said: ‘’The pandemic caught a lot of nations unprepared and inaccessible and has heightened suicide levels and panic. The high levels of fear, worry, and anxiety related to the threat of death or infection from COVID-19 are undeniable.
‘’Loneliness, substance abuse, and depression will also surface for individuals based on unprocessed traumas and the psychological impact of isolation and quarantine. Globally it has caused a rise in mental illness which threatens the social, psychological, and economic wellbeing of countries.
‘’The loss of jobs, psychosocial needs not being met, and deaths in families due to COVID-19 are among the reasons for heightened mental illness. The bigger challenge is that budgets are contributing extensively to the fight of COVID-19 but mental health is not as prioritised, which is understandable given the imminent danger. However, if mental health is not focused on soon, there will be devastating effects in the long term for individuals and countries.’’
Stigma, technology and the global mental health divide
The research roadmap created by Professor Hotopf and his peers is an attempt to iron out the differences that exist between countries when tackling mental health on a global scale – but why do they appear in the first place?
According to the latest statistics from the World Health Organisation up to 50% of chronic sick leave within EU countries is due to depression or anxiety and approximately 50% of major depressions are untreated. The cost of mood disorders and anxiety in the EU is estimated to be around 170 billion euros per year.
In contrast, around 6.5% of the Indian population is thought to suffer from mental illness and the country experiences 230,000 suicides a year, around 0.02% of the population. In China another study suggests that 9.3% of the population suffer from mental health disorders and 9.7 per 100,000, around 0.01%, commit suicide.
According to Mrs Khasu, the divide exists not because there is higher mental illness in certain areas but because there is better understanding. She explained: ‘’African countries and specifically South Africa where I practice don’t understand or relate as well as western countries when it comes to mental health. Individuals believe because they don’t have the words in their own languages to describe the mental illness or disorder, that means it doesn’t exist. There is also a narrative to be strong and do what the natives have done, which means repression of emotions and going on undiagnosed.
‘’Disorders as obvious as schizophrenia and psychosis are often denied and labelled as relating to witchcraft and spiritual demons. All these ‘alternatives’ into understanding mental illness attribute to the low reports of mental illness in developing countries.’’
Stigmatisation is another pronounced social side effect of mental health disorders. A research study reported by World Psychiatry interviewed 729 people with a clinical diagnosis of schizophrenia across 27 countries and found that more than 90% had experienced discrimination directly related to the status of their mental health.
In the UAE, mental health issues are associated with shame, disgrace, and disrespect. In Nigeria, a national survey on stigma and mental illness among nursing professionals reported that 40% of the respondents viewed mentally ill individuals as violent, whilst 26.5% would distance themselves from those with mental illness, and a third associated mental illness with “lack of self-discipline and will power”.
Elaborating on the prejudice individuals encounter in developing countries, Mrs Khasu said: ‘’It also seems as though when one is mentally ill, they are weak and that vulnerability is shunned upon. Additionally, in developed countries, the idea of being in therapy doesn’t raise eyebrows as much but in developing countries, there is a question of “have you run out of relatives and friends to enquire”? “ why would you see a stranger” or why would you want to talk to someone who may even be younger than you or even from a different cultural background or even tribe as you?’’
So how long will it take to close the global mental health divide? It is not going to be quickly or simply fixed, says Mrs Khasu: ‘’There is a lot of psycho-education and awareness still needing to be done, but even governmental institutions don't prioritise it as much and therefore the discrepancy will continue as long as there is no awareness and education.’’
And while greater understanding may exist in western countries, the grip technology has on the hardwiring of young brains is relentless and is a source of mental health problems for teenagers which will only get worse, claims Mrs Khasu.
Depression and anxiety are two of the leading causes of mental health disability, affecting 6% of adolescents globally each year. Across European countries, 29% of 15-year-old girls and 13% of 15-year-old boys reported “feeling low” more than once a week, according to the Health Behaviour in School-aged Children survey. Moreover, more than 10% of adolescents were regular weekly drinkers by the age of 15 – 9% of girls fell into this category and 16% of boys.
Mrs Khasu said social media is a driving factor in this trend: ‘’As much as there is awareness about it [mental health in developed countries] I think it will probably get worse. It doesn’t change the insecurities people have that either cause people to compare themselves to “perfect” people on social media or the bullies that assert their power and control through causing others harm. The idea of wanting to portray yourself as someone desirable and relatable will still exist. With talks of removing the number of likes in a post is meant to reduce anxiety, stress, and self-esteem issues but it also leaves the individual wondering a lot, which may cause negative thoughts, and wanting to be validated in other ways.’’
Future digitisation of mental health & greater employee responsibility
So what does the future hold for global mental health? It seems that some of the issues and strategies required have technological solutions. Many businesses have responded to the coronavirus crisis by accelerating the use of digital tools to hold virtual meetings and allow for the creation of a ‘new normal’ when it comes to workplace practices.
The next 10 to 20 years will also see a steady and similar digitisation of mental health support said Mrs Khasu. She predicts a rise in online therapy and assessments with people placing more trust in virtual meetings with practitioners, which will reduce the need to wait for an appointment for a face-to-face meeting in a physical space, as well as the provision of micro and more frequent touchpoints.
More people will rely on wearable technology to help them track their mental health, said Mrs Khasu: ‘’It’s an innovation that doesn’t seem to be popular now but like neuro-imaging, it helps individuals track their reactions and states throughout the day.’’ Being aware of the trends and triggers is a major step in the effective support and treatment of any condition.
She also predicts an increase in the number of people who will seek to help themselves with their mental health issues: ‘’With the help of social media, self-help books and apps, individuals will start to take ownership of their mental health even more than before.’’
“The domino effect of these changes will be a reduction in the stigma associated with mental health” said Mrs Khasu “and an increasing emphasis in the future amongst employers to look after the mental health of their employees.”
She explained: ‘’Even new working environments cause anxiety’’ and in a world where it is not uncommon for companies to have clients or offices abroad, employees can find themselves in a foreign country at short notice and having to adapt to a new team or workplace culture.
The impact on the world’s businesses as a result of mental ill-health is calculated to cost Hong Kong’s professional services industry up to HKD 12.4bn (circa. USD$1.6bn) a year, UK businesses £35bn (circa. US$46bn) annually and almost AU$11bn (circa. USD$7.8bn) in Australia.
The provision of employee wellness programs is a key element in tackling this issue, said Mrs Khasu ‘’In seeking to move from rhetoric to reality, employers must mainstream good mental health and make it a core business priority.
‘’A mentally healthy workplace and increased employee engagement are interdependent – by looking after an employee’s mental wellbeing, staff morale and loyalty, both innovation, productivity and profits will rise. In order to create a mentally healthy workplace, we recommend that employers put in place a comprehensive strategy to help people stay well at work, to tackle the root causes of work-related mental health problems and to support people who are experiencing a mental health problem. Many of the measures we recommend are small and inexpensive. Regular catch-ups with managers, flexible working hours, promoting a work/life balance and encouraging peer support; can make a huge difference to all employees, whether or not they have a mental health problem. But above all, creating a culture where staff feel able to talk openly about mental health at work is the most important part.’’
What next steps should we take?
In conclusion, it is important to circle back to the opportunity COVID-19 has provided to tackle mental health on a global stage and not waste the chance it has presented to close the divide that exists.
Our scientists and medical experts are clear, the impact upon the emotional wellbeing of humans as a result of the virus has reached every corner of the world. To tackle the issue requires countries, Government departments and businesses around the world to come together like never before and make mental health a priority.
In doing so, countries that are lacking in terms of awareness and education when it comes to tackling the issue will have to change - but can they overcome the challenges they face?
In developing countries, there aren’t enough resources in both private and state enterprises to treat people. In severe cases where a person needs to be hospitalised, there aren’t enough governmental institutions to treat them, so often only severe cases are admitted even though others could benefit too. Moreover, poverty and the majority of the public not being able to afford private therapy treatment means they have to wait for months to be seen as outpatients and even then, only be given a few sessions to ‘band-aid’ the situation rather than receive proper treatment.
Too often the visible symptoms of mental illness such as medical disorders are prioritised more than psychological symptoms and seeking therapy is still not considered an option in many parts of the world. Greater knowledge and understanding of mental health are imperative in narrowing the divide between developed and developing countries when tackling mental health.
In countries where advanced attitudes exist towards the subject and more money and resources are available, the focus should be on encouraging employees to become actively engaged in their own health and wellbeing and seek out employers who understand the importance of well-being in the workplace. After all, a workplace that supports mental wellbeing among its staff has an advantage wherever it happens to be in the world.
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