Looking for Sexy: The Disparity of Mental Health in Global Public Health

The World Health Organization (WHO) estimates that over 450 million individuals suffer from mental disorders, and that more than 1 million people are estimated to commit suicide worldwide yearly, a vastly underestimated number due to official underreporting. In addition to the health and social costs of living with this disability, most experts acknowledge that mental illness makes victims vulnerable to human rights violations, stigma and discrimination, both inside and outside psychiatric institutions.

Yet, despite the fact that one in four families has a member with mental illness and the repeated call for further investment in research and treatment by the WHO, mental illness continues to be a neglected orphan in the field of medical research and development.

There are many reasons for this disparity, chiefly one of stigma and shame that continues to pervade perceptions of this category of illness, particularly beyond the Western hemisphere. Much has been said about the stigma of mental illness and its contribution to epidemiological underreporting. For example, in Iraq like much of the Middle East, many suicides caused by gunshots, motor vehicle accidents, and self immolation continue to be reported as “accidents” rather than intentional attempts at ending life.

Stigma coupled with economic disparity contributes to the lack of data on mental health that in a vicious circular pattern leads to a shortfall in government investment in the field. A recent study by Eaton et. al. (2008) examining the burden of mental disorders pointed out notable gaps in the research literature and data on mortality risks associated with obsessive-compulsive disorder and only two known studies on mortality associated with panic disorder, drug abuse or dependence, or personality disorder. While the prevalence of mental disorders has been well studied, this review shows that data on the simplest aspect of disability—death—is limited or nonexistent for many disorders.

But things are never this simple. After all, compared to other health measures such as vaccination or malaria control, interventions for mental disorders are not the most cost-effective interventions available to health planners. However, there is just as much of an economic justification for investing in cost-effective mental health care as there is in intervening in other chronic conditions such as anti-retroviral therapy for AIDS (which have comparable ratios of cost for each year of healthy life gained). But could it be that mental health in the realm of global health continues not to be sexy enough for the Gates and Clinton Foundations?