Mental health still grossly underfunded but there are glimmers of hope

A StrongMinds mental health facilitator (center) speaks with former patients in Uganda. StrongMinds has treated more than 25,000 Ugandan women for depression with group talk therapy. Photo: Kevin Di Salvo

This was originally published on Global Health TV on February 28, 2018.

The problem with mental health and substance abuse in Africa and other developing countries is not that awareness has not been raised about these huge contributors to the global burden of disability.

Annually since 2009, the World Health Organization (WHO) Mental Health Gap Action Programme has been meeting to scale up services for mental, neurological and substance use disorders.

In 2013, the World Health Assembly adopted the WHO’s Mental Health Action Plan 2013-2020, which is designed to provide guidance for national action plans in all resource settings.

And most notably in 2015, world leaders recognized the importance of mental health and substance abuse in the newly minted Sustainable Development Goals. Within Goal 3 (the health goal) of the 17 SDGs, there is a target for mental health and another target for substance abuse. Here are the Goal 3 targets.

So mental health has finally been given a hard-fought and much-deserved seat at the global health table. It just has not been given much money or resources.

For global health, 2017 was a year of progress, near triumphs and threats

A trained community health workers in Bangalore, India takes photos of an oral lesion with a mobile phone during an oral cancer screening. Cancer is growing everywhere in the world. Photo: Biocon Foundation, Courtesy of Photoshare.

This was originally published on Global Health TV on Jan. 2, 2018.

In looking back over my last 12 blog posts here at Global Health TV, it is clear that 2017 was a year of progress, near triumphs and threats to global health.

In September, I reported that great progress has been made against diseases and health conditions that kill us (like respiratory infections, diarrhea, neonatal preterm deaths and communicable diseases like AIDS and malaria) while new threats had emerged  that are generally less fatal — things like obesity and mental illness.

In particular, we have made progress against communicable diseases but now face a rising tide of non-communicable diseases (NCDs) like cancer, diabetes, hypertension and cardiovascular diseases, as I wrote at the beginning of 2017.  Cancer is growing almost everywhere in the world. For example, cervical cancer causes over 500,000 new cases every year, even though vaccination, early screening and treatment of precancerous lesions can prevent most cases.

Dramatic global health improvements save lives but new threats emerge

This was originally published on the Global Health TV on September 26, 2017.

Over the last decade, we’ve made great progress against diseases and health conditions that can kill people, especially children under 5, but because of political and budget challenges, we risk backsliding on those gains. And we’re facing a tsunami from health issues that do not always kills us – namely, obesity, conflict and mental illness – but cause poor health.

Those are my take-aways from two major reports that came out this month, one tracking how we are doing against the Sustainability Development Goals, particularly in global health, and the other a scientific study focused solely on global health.

“Goalkeepers: The Stories Behind the Data 2017,” a report from the Bill & Melinda Gates Foundation, was aimed at last week’s United Nations General Assembly. To draw attention to the report, the Gateses held a high-profile event featuring former President Barack Obama. The report touts the many global health advances that have been made but also cautions about the risks of complacency.

Global health funding: Huge increases since 2000, but also huge disparities

This was originally published on Global Health TV on July 27, 2015.

As the end of the era of the Millennium Development Goals (MDGs) (2000-2015) draws near, we who work in global health can look back with some satisfaction at the $228 billion that was allocated to address the three health-related MDGs during that time.

Although spending grew rapidly in the first ten years, it was stagnant between 2010 and 2014, and actually decreased by 1.6% between 2013 and 2014. Global health funding in 2014 amounted to $36 billion in 2014 (of which $1 billion was for Ebola).

That information comes from Financing Global Health 2014: Shifts in Funding as the MDG Era Closes, the annual report of global health funding published last month by the Institute for Health Metrics and Evaluation (IHME).

And two weeks ago, the Kaiser Family Foundation and UNAIDS issued a report that showed that although there was only a slight increase in funding for HIV in low- and middle-income countries in 2014 (less than 2%), seven of 14 donor countries actually decreased funding despite the recent gains made against the epidemic.

In Africa, gap between need and funding of mental health is huge

Adolescent boys in talk therapy group near Kampala, Uganda. Credit: StrongMinds

This was originally published on Global Health TV on June 29, 2015.

Sean Mayberry has spent his entire life surrounded by mental illness. As a child and an adult, people close to him have endured this affliction. But he had an epiphany when he happened upon a young man behind a farmhouse in Uganda, sitting in his own excrement and digging in the dirt.

“It was a turning point for me,” he recalls. “I left that young man knowing that I had to do something for the mental health of that continent.  He gave me the courage to try to make a difference for some of his mentally ill brothers and sisters.”

Pauline Muchina is dealing with mental illness in her family in Kenya. Her 50-something sister lost her job due to depression and had to come home to live with her mother. She is now on medication and attends counseling.

Muchina also has a nephew suffering from depression. While in a government hospital, he was chained to a bed for one week and his condition got worse. Now the family has found a private rehabilitation center for him. He is getting better but it is costing the family $2,500 for six months. Muchina’s family is middle-class and can pay the treatment (with difficulty), but the vast majority of Kenyans could never afford such expensive treatment.

Mental disorders and substance abuse are the third greatest contributor to the global burden of disability with 23% of the burden – greater than cardiovascular disease or cancer.

Women trying to regain dignity by ending fistula

Djantou

This blog was originally published on Global Health TV on May 27, 2015.

BAMAKO, Mali — Djantou came here from Fangala, her village northwest of Bamako, to repair her fistula, a hole between the birth canal and the bladder or rectum caused by prolonged, obstructed labor without adequate treatment. Djantou’s fistula occurred while she was in labor during her first pregnancy. Her child was stillborn. She wants to have children in the future but she is afraid — both of the operation and of childbirth. Djantou is 15 years old.

Rokia

Rokia is from the village of Tarasso, near the border with Burkina Faso. Twenty years ago, she also developed fistula during her first pregnancy. The baby was stillborn. “The urine would not stop,” she said. Rokia has had two operations but both failed. She is now awaiting her third operation. Although she is 40 years old, she still very much wants to have children.

Fistula is a tragic condition that leaves women leaking urine, feces or both. It can lead to chronic medical problems and cause social exclusion. Women are often abandoned by their husbands and sometimes by their own families because of their incontinence and unpleasant smell. They face depression and social isolation — either self-imposed or by their sometimes unforgiving communities.