By Mushtak Parker
As million observed World Mental Health Day (WMHD) on Friday, the annual exercise in raising global awareness about the state of mental health resurfaces, albeit with a different theme each year. Last year it was suicide prevention. This year it is increased investment.
The intentions are noble, the challenges are ginormous, the stigma unbearably cruel, the resource allocation from public health budgets scandalously deficient.
To what extent the rhetoric of aspiration is matched on the ground by the progress towards redeeming policies, requisite investment and well-being is what is at stake.
We all know a relative, friend or someone who is suffering from a mental health disorder. No country or society is spared. According to the World Health Organisation (WHO), 50% of people with mental disorders in high-income countries do not receive treatment, while 85% of persons in low-and-middle income ones have no access to treatment.
Perhaps poverty and affluence in a twisted way are bedfellows in generating a susceptibility to mental health issues.
The reality is that mental health remains one of the most neglected areas of public health, whether in developed or developing societies.
WHO stresses that a billion people are living with a mental disorder, 3 million people die every year from the harmful use of alcohol and one person dies every 40 seconds by suicide!
Today Covid-19 has been wreaking havoc with billions of people’s mental health due to lockdowns and shielding, as if its economic and health impact is not enough!
A survey of 130 countries published by the WHO last week revealed that the pandemic has disrupted or halted critical mental health services in 93%, while demand for mental health services is increasing.
In Britain, The Centre for Mental Health estimates that 10 million people will need either new or additional mental health support as a consequence of the pandemic, with the number of adults suffering from depression doubling.
That the shifting landscape of Covid-19 restrictions including localised lockdowns in the wake of spikes and second waves of infection is taking its toll on the mental health of workers is clear.
As such, WMHD 2020, organised by the WHO, United for Global Mental Health and World Federation for Mental Health, assumes greater importance and urgency.
The pandemic, they stress, has affected the lives of everyone. Healthcare workers are providing care in difficult circumstances, going to work fearful of bringing the virus home.
Students are taking classes from home, with little contact with teachers and friends, and anxious about their futures. Workers’ livelihoods are threatened. Vast numbers are caught in poverty or in fragile settings with extremely limited protection from Covid-19. Many people with mental health conditions are experiencing even greater social isolation than before.
There is also the spectre of managing the grief of losing a loved one, sometimes without being able to say goodbye. The conomic consequences have led to companies letting off staff to save their businesses, or indeed shutting down completely.
Activists assert that the need for mental health and psychosocial support will substantially increase in the coming months and years. Investment in mental health programmes at the national and international levels, which have suffered from years of chronic underfunding, is now imperative.
The case for investment is compelling. Countries spend on average only 2% of their health budgets on mental health. According to the WHO, for South Africa it is 3%.
Total mental health expenditure per person in 2018 was just under R100. Poor mental health costs the global economy US$2.5 trillion per annum through lost productivity.
The investment dividend is potentially game-changing! For every $1 invested in scaled-up treatment for common mental disorders such as depression and anxiety, there is a return of $5 in improved health and productivity.
But as Tedros Adhanom Ghebreyesus, the WHO’s director-general, warns: “Unless we make serious commitments to scale up investment in mental health right now, the health, social and economic consequences will be far-reaching.”
Data released by the South African Depression and Anxiety Group (Sadag) at the end of last year confirms that one in six South Africans suffer from anxiety, depression or substance-use problems. This excludes more serious conditions such as bipolar disorder schizophrenia. Government policy is driven by the “National Mental Health Policy Framework and Strategic Plan 2013-2020”, which is weighed down by its cornucopia of aspirations and targets, and effectively obsolete in the wake of Covid-19.
Official data and frequency are woefully lacking. The South African Federation for Mental Health is trying to fill the gap, with the publishing of an inaugural Mental Health Country Profile on October 29.
The call to Pretoria is “to act swiftly in making mental health-care a priority, ensuring its accessibility to everyone everywhere”.
* Parker is a writer and economist based in London.