|Year : 2016 | Volume
| Issue : 3 | Page : 254-256
Increasing burden of mental illnesses across the globe: Current status
Murali Thyloth, Hemendra Singh, Vyjayanthi Subramanian
Department of Psychiatry, M.S. Ramaiah Medical College, Bengaluru, Karnataka, India
|Date of Web Publication||3-Nov-2016|
Dr. Murali Thyloth
Department of Psychiatry, M. S. Ramaiah Medical College, Bengaluru, Karnataka
Source of Support: None, Conflict of Interest: None
Psychiatric disorders cause significant burden to individuals and society across the world, accounting for nearly 13% of the global burden of disease. Eighty percent of people with mental disorders now live in low and middle-income countries. With one million deaths per year, suicide is the major reason for years of life lost due to mental illness. Estimates suggest that the burden due to mental illness is likely to increase over next decade and appropriate interventions are need of the hour. We discuss this increasing burden as a consequence of (1) lack of resources, (2) low budget for mental health in lower and middle income countries, and (3) under-utilization of services and stigma attached to mental illnesses.
Keywords: burden, mental illness, global
|How to cite this article:|
Thyloth M, Singh H, Subramanian V. Increasing burden of mental illnesses across the globe: Current status. Indian J Soc Psychiatry 2016;32:254-6
|How to cite this URL:|
Thyloth M, Singh H, Subramanian V. Increasing burden of mental illnesses across the globe: Current status. Indian J Soc Psychiatry [serial online] 2016 [cited 2019 Jan 18];32:254-6. Available from: http://www.indjsp.org/text.asp?2016/32/3/254/193208
| Introduction|| |
Mental health is a major health concern worldwide. It causes a significant burden to an individual and society across the globe. Mental illnesses are responsible for nearly 13% of the global burden of disease. Most of the studies estimated the magnitude of burden by using various indicators, such as incidence and prevalence rates, life expectancy, person years of life lost, mortality rates; disability adjusted life years , and years lived with disability (YLDs). Nearly 80% of people with mental disorders live in low- and middle-income countries, which account for more than 10% of total burden of disease in these countries.Among the several causes of YLD, depression is leading as the second cause. Anxiety disorders, schizophrenia, bipolar disorders, prescription drug overuse, headache, other substances abuse, Alzheimer’s disease, alcohol use disorders, and epilepsy are global neuropsychiatric causes of YLD. It is obvious that psychiatric illnesses are often disabling, and this is reflected in the markedly higher proportion of overall disease burden caused by the mental illnesses. It is of importance to note, untreated mental illnesses also cause mortality due to suicide. Worldwide, suicide is a major cause for concern. According to the WHO, every year, almost one million people die from suicide; a "global" mortality rate of 16 per 1,00,000 or one death every 40 seconds. In the last 45 years, suicide rates have increased by 60% worldwide. Suicide is among the three leading causes of death among those aged 15-44 years in some countries, and the second leading cause of death in the 10–24 years age group. These figures do not include suicide attempts which are up to 20 times more frequent than completed suicide. Suicide worldwide is estimated to represent 1.8% of the total global burden of disease in 1998 and projected to reach 2.4% of total burden of disease in countries with market and former socialist economies in 2020. By 2020, an estimated 1.5 million people will die each year by suicide and roughly 30 million will make an attempt. Hence, it is not surprising that the biggest risk for suicide is the poorly diagnosed and treated mental disease. Across all countries, investment in fundamental research for preventing and treating mental, neurological, and substance abuse disorders is disproportionately low relative to the disease burden. Here, we would like to discuss the challenges that are indirectly or directly maintaining the burden of mental illnesses and how to overcome these hurdles so that burden of mental illnesses might be effectively minimized.
| Stigma and discrimination|| |
Stigma toward mental illness is known to occur globally. As per International Study of Discrimination and. Stigma Outcomes on the global pattern of experienced and anticipated discrimination against people with schizophrenia, anticipated discrimination affected 64% in the matters of applying for work and in training or education, 55% while looking for a close relationship, and 72% felt the need to conceal their diagnosis. This unfortunately increases their marginalization ,vulnerability, and indirectly causes burden to so family and society. In England, time to change program was initiated to reduce stigma and discrimination against people with mental illnesses. The evidence of evaluation of phase 1 of time to change (2008–2011) shows the need for a focused, determined, and long-term approach to challenge this problem. In low- and middle-income countries such efforts can be tested to reduce the risk of homelessness and inappropriate incarceration of mentally ill patients.
| Limited availability of mental health services|| |
As a result of advancement in the understanding of biological basis of several mental illnesses, there are effective available treatments. However, these are rarely available to those in greatest need. In 83% of low-income countries, there are no anti-Parkinson drugs in primary care; in 25% there are no antiepileptic drugs. Unequal distribution of human resources between and within countries further weakens the access. WHO’s European region has 200 times as many psychiatrists as in Africa. Majority of mental health systems in low- and middle-income countries are limited and often confined to hospitals with poor infrastructure. In India, there is a huge disparity between available mental health resources and mental illnesses where, on an average one psychiatrist serves 2,00,000 or more people. Though, majority of patients in low- and middle-income countries do receive treatment, they are unable to get quality treatment and care due to the large unmet need of requisite number of mental health professionals.
| Financial burden|| |
Health care systems have not adequately responded to the burden of mental disorders; as a consequence, the gap between the need for treatment and its provision is large all over the world. As per WHO's Mental Health Atlas More Details 2011, annual spending on mental health per capita was US$ 1.63 with large variation among different income groups, ranging from US$ 0.20 in low-income countries to US$ 44.84 in high-income countries. Globally, 67% of financial resources are allocated to stand-alone mental hospitals, despite their association with poor health outcomes and human rights violations.
| Conclusions|| |
Psychiatric mental,neurological, and substance abuse disorders constitute nearly 13% of the global burden of disease, surpassing both cardiovascular disease and cancer. Increasing burden is probably due to lack of resources, low budget for mental health in low- and middle-income counties, underutilization of services, and stigma attached to mental illnesses. Mental illnesses are viewed to be more disabling than infectious diseases and cardiovascular diseases put together.
The incremental efforts are required is to address the burden of mental illnesses and bridging the treatment gap.
There is a need for paradigm shift from finding the loopholes in the existing mental health delivery system to developing cost-effective indigenous preventive measures and collaborative approaches to minimize the direct and indirect burden of mental illnesses. In this regard, in India, various strategies were adopted such as involving family members in mental health care, integration of mental health into general health care, and the utilization of nonspecialist personnel for a wide variety of mental health tasks, public mental health education, and mental health care of children and the elderly. However, efforts of family involvement in care of mentally ill have not received the support of professionals and policy makers to make such initiatives as a part of routine of psychiatric care hence, there is an urgent need to revisit the policy to implement cost-effective interventions and focus on generalization of such interventions globally. Various indicators of burden help to compare the magnitude of problem across various income groups, for planning rehabilitation programs and policy to face the present challenges. However, there are limitations of studies on burden in mental disorders as most of the studies are cross-sectional and long-term follow-up studies are few. Majority of services and reporting of data on burden are about the hospitalized / clinic-based sample. Similarly, studies of functional outcome of mental illnesses are sparse though clinical outcome studies are abundant. Long-term prospective researches on burden are the need of the hour and WHO needs to pay attention on global burden and mortality due to mental illnesses especially in low- and middle-income counties where nearly 80% of mentally ill people live.
Considering all these factors, it is time for respective governments and stakeholders to take much more serious note about treatment and rehabilitation of the persons affected with any psychological disturbance.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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