What comes to mind when you think of the big challenges to global health?
Catastrophic infectious outbreaks like Ebola in West Africa during 2014 and 2015? Or perhaps you focus on long-term threats, like the sickness caused by polluted air in mega-cities like Beijing and New Delhi, the growing worldwide epidemic of diabetes or the threats to health posed by climate change?
All valid and serious concerns that must be addressed, certainly. But often overlooked are the silent killers such as mental illness. As we deal with the physical side of wars and violence across the world, we must not forget the physiological burden which can follow weeks, months and even years after.
As with all health conditions, the best approach is to prevent the problem before it gets too severe and becomes a crisis. But sometimes it can be difficult to persuade hard pressed governments, especially in poorer countries, of this truth. However, this is the essence of good public health. To do this with mental health, it is imperative that we break the stigma and I want to see the World Health Organization (WHO) employ a relentless international focus, which is long overdue.
We are not spending enough money on mental illness. On average, just 3% of government health budgets are invested in mental health, varying from less than 1% in low-income countries to 5% in high-income countries. We need to let the world’s governments know that investment in mental health makes economic sense: Every dollar invested in scaling up treatment for depression and anxiety leads to a return of $4 in better health and ability to work.
Mental illness can include anxiety, addictive behaviour, schizophrenia and dementia, but by far the most common malady is depression. More than 300 million people—5% of the world population—suffer from depression at any time. This is a truly staggering number, and it’s on the rise; the number of sufferers has increased by one fifth since 2005. When we are depressed we lose energy and are less able to concentrate. Our appetites and sleep patterns change. We may feel worthless or guilty, we might lose hope and start thinking about harming ourselves. Indeed, hundreds of thousands of lives are lost due to suicide each year. People who are depressed are more likely to abuse drugs and other substances, to eat the wrong foods and become diabetic, or to be at risk of heart disease.
How can depression be better understood and treated? First—we must recognize the problem. Second—we must talk about it. Third—we must ensure that depressed people are effectively treated.
Let us begin by focusing on recognition. The number of people who experience depression and its consequences is often underestimated. Even in high-income countries, nearly 50% of people with depression do not get treatment. That is partly because they do not know that it works.
So talking is also key. We must speak freely about depression and its treatment, and fight the stigma that surrounds all mental illness. In many communities people do not share their anxieties or sadness with health workers because they are embarrassed, and fear being shunned or ridiculed. It leads them to suffer in silence.
We must all together, as a global society, work together to tackle this issue directly. Days like World Health Day encourage us to reflect and this year the focus from WHO is ‘Depression: Let’s Talk About It.’
Effective treatment is essential, and access to it. The World Health Organization has set some useful standards for depression care, based on the best evidence of what works, with a training programme that helps health workers treat people who are depressed. Treatment usually involves either a therapy based on talking and listening, or antidepressant medication, or a combination of the two. It can be remarkably effective, and can be provided by non-specialist health-workers following a short course of training.
Importantly, patients themselves should be involved in the planning and implementation of the treatment. I know that well-trained health workers increasingly recognize the importance of mental health, particularly depression. More than 90 countries, of all income levels, have introduced or scaled-up programmes that provide treatment for depression and other mental disorders.
This is a good start, but clearly more can and must be done. Mental health must be mainstreamed into all healthcare services, all over the world. The WHO, through country and its regional offices, should spearhead this effort – in countries which are rich, poor, in conflict or in peace. Mental health should be in the DNA of the WHO and all its staff.
In many countries, speaking up about mental illness is still seen as a weakness. In other countries, people with the expertise and the medicines to treat it are simply not available. I think there is a clear role for the WHO to do more in tackling these issues, and I will make it a priority.
The WHO needs help governments to identify the research gaps, train health workers with the necessary skills and help the public to appreciate the importance of prompt diagnosis and treatment. As a global organisation, WHO is well placed to share experiences and knowledge from across the world on what works best. I want to see it utilise its regional offices and embed best practice, encouraging more training, more treatment and more openness. There are incredible charities, NGOs, faith groups and indeed governments with whom WHO can partner to make real progress—and I want to transform the WHO into the type of catalytic organization that can and does partner with others like this to great effect.
The WHO should not only dismantle stigma but go further and make people everywhere able to express mental health issues openly. It is good to talk. The time is right for a mental health movement, and we must seize the moment.
The position of WHO Director–General falls vacant on July 1 when Margaret Chan’s term of office ends, and I am one of the three nominees for the post. It is a job that I’ve been training for my whole life—and I guarantee that mental health will be one of my top priorities if I’m elected.