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 Table of Contents  
REVIEW ARTICLE
Year : 2016  |  Volume : 32  |  Issue : 3  |  Page : 254-256

Increasing burden of mental illnesses across the globe: Current status


Department of Psychiatry, M.S. Ramaiah Medical College, Bengaluru, Karnataka, India

Date of Web Publication3-Nov-2016

Correspondence Address:
Dr. Murali Thyloth
Department of Psychiatry, M. S. Ramaiah Medical College, Bengaluru, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0971-9962.193208

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  Abstract 

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 Aug 24];32:254-6. Available from: http://www.indjsp.org/text.asp?2016/32/3/254/193208


  Introduction Top


Mental health is a major health concern worldwide. It causes a significant burden to an individual and society across the globe.[1] Mental illnesses are responsible for nearly 13% of the global burden of disease.[2] 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.[3]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.[4] 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.[5] By 2020, an estimated 1.5 million people will die each year by suicide and roughly 30 million will make an attempt.[6] Hence, it is not surprising that the biggest risk for suicide is the poorly diagnosed and treated mental disease.[7] 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.[8] 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 Top


Stigma toward mental illness is known to occur globally.[9] 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.[10] 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.[11] 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.[12] 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 Top


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.[13] 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.[14] Majority of mental health systems in low- and middle-income countries are limited and often confined to hospitals with poor infrastructure.[15] 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 Top


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.[16] 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.[17]


  Conclusions Top


Psychiatric mental,neurological, and substance abuse disorders constitute nearly 13% of the global burden of disease, surpassing both cardiovascular disease and cancer.[2] 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,[18] 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.[19] 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[20] 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

Nil

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
World Health Organization. World Health Report 2001. Mental health: New understanding, new hope. Geneva; World Health Organization, 2001.  Back to cited text no. 1
    
2.
World Health Organization: The Global Burden of Disease: 2004 Update. Geneva: World Health Organization; 2008.  Back to cited text no. 2
    
3.
Jacob KS, Patel V. Classification of mental disorders: a global mental health perspective. The Lancet 2014;383:1433-35.  Back to cited text no. 3
    
4.
Global Burden of Disease Study 2013 Collaborators.Global, regional, and national incidence, prevalence, and years lived with disability for 301 acute and chronic diseases and injuries in 188 countries, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013. The Lancet 2015;386:743-800.  Back to cited text no. 4
    
5.
World Health Organization [Internet]. Mental health: suicide prevention (SUPRE). Available from http://www.who.int/mental_health/prevention/suicide/suicideprevent/en/index.html. [Last accessed on 2016 Jul 3].  Back to cited text no. 5
    
6.
Bertolote J, Flieschmann A: Suicide and psychiatric diagnosis: a worldwide perspective. World Psychiatry 2002;3:181-5.  Back to cited text no. 6
    
7.
Gonda X, Konstantinos NF, Kaprinis G, Rihmer Z. A prediction and prevention of suicide in patients with unipolar depression and anxiety. Ann Gen Psychiatry 2007;6:1744-859.  Back to cited text no. 7
    
8.
Saxena S, Thornicroft G, Knapp M, Whiteford H. Resources for mental health: scarcity, inequity, and inefficiency. The Lancet 2007;Sep 8;370:878-89.  Back to cited text no. 8
    
9.
Thornicroft G, Brohan E, Rose D, Sartorius N, Leese M, for the INDIGO Study Group.Global pattern of experienced and anticipated discrimination against people with schizophrenia: a cross-sectional survey. The Lancet 2009;373:408-15.  Back to cited text no. 9
    
10.
Thornicroft G, Brohan E, Rose D, Sartorius N, Lesse M, INDIGO study griup. Global pattern of experienced and anticipated discrimination against people with schizophrenia: a cross-sectional survey. The Lancet 2009;373:408-15.  Back to cited text no. 10
    
11.
Henderson C, Thornicroft G. Stigma and discrimination in mental illness: Time to Change. The Lancet 2009;373:1928-30.  Back to cited text no. 11
    
12.
Sartorius N. Short-lived campaigns are not enough. Nature 2010;468:163-5.  Back to cited text no. 12
[PUBMED]    
13.
World Health Organization. Country Resources for Neurological Disorders 2004. Geneva: World Health Organization; 2004.  Back to cited text no. 13
    
14.
World Health Organization.Mental Health Atlas 2005. Geneva: World Health Organization; 2005.  Back to cited text no. 14
    
15.
Saxena S, Lora A, Morris J, Berrino A, Esparza P, Barrett T, et al. Focus on global mental health: Mental health services in 42 low- and middle-income countries: A WHO-AIMS cross-nationalanalysis. Psychiatric Services 2011;62:123-5.  Back to cited text no. 15
[PUBMED]    
16.
World Health Organization.Comprehensive Mental Health Action Plan 2013-2020. Geneva: World Health Organization; 2013.  Back to cited text no. 16
    
17.
World Health Organization. Mental Health Atlas 2011. Geneva: World Health Organization; 2011.  Back to cited text no. 17
    
18.
Agarwal SP, Goel DS, Ichhpujani RL, Shrivastava S. Mental Health: An Indina Perspective 1946-2003. New Delhi; Directorate General of Health Services, Ministry of health and Family Welfare: 2004.  Back to cited text no. 18
    
19.
Patel V, Thara R. Meeting mental health needs in developing countries: NGO innovations in India. New Delhi: Sage; 2003.  Back to cited text no. 19
    
20.
Shankar R, Rao K. From burden to empowerment: The journey of family caregiversin India. In: Sartorius N, Leff J, López-Ibor JJ, Maj M, Okasha A, editors. Families and mental disorders. Chichester: John Wiley and Sons;2005. p. 259-90.  Back to cited text no. 20
    



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