Mindfulness: As the pressures of modern living exerts ever more strain on our collective mental health
Giles Crosse examines the situation, and how society might manage these issues better.
Mental health remains a massive challenge to developing a healthier, happier global society. It’s important to remember this is not something that only affects city high flyers, or pressurised nurses or schoolteachers.
A couple of years ago, the World Health Organisation (WHO) launched its mental health Gap Action Programme (mhGAP). This aims to scale up services, especially amongst poorer global societies.
Some of the WHO data is tragic. According to its web portal, ‘Hundreds of millions of people worldwide are affected by mental, behavioural, neurological and substance use disorders.
‘For example, estimates made by WHO in 2002 showed that 154 million people globally suffer from depression and 25 million people from schizophrenia; 91 million people are affected by alcohol use disorders and 15 million by drug use disorders. A recently published WHO report shows that 50 million people suffer from epilepsy and 24 million from Alzheimer and other dementias’
‘About 877,000 people die by suicide every year,’ WHO data continues. ‘Barriers to effective treatment of mental illness include lack of recognition of the seriousness of mental illness and lack of understanding about the benefits of services.’
The WHO also suggests there’s widespread discrimination throughout society regarding mental health. And it points to low percentages of spending on mental health as failing to target tomorrow’s solutions effectively.
Thinking ahead
Simon Lawton-Smith is Head of Policy for the Mental Health Foundation, a UK based researching charity seeking a mentally healthy world. He points to a lot of misunderstanding and complexity when it comes to treating and dealing with mental health in society, and what its implications can be:
“Imprisonment (detention in prison following a criminal conviction), and sectioning (admission to hospital as a result of mental disorder) are different things.
“People with a history of mental health problems should not be exempt from conviction after due legal process and imprisonment if that’s appropriate. However, we know far too many people in prison have mental health problems that are not getting properly addressed there.
“We therefore want to see more court diversion schemes (diverting people with mental health problems from the criminal justice to the health system), and better mental health support for prisoners, including transfer to hospital where appropriate.
“It is important not to presuppose that someone with a mental health problem is going to be violent. Far more people with mental health problems are victims of crime than commit crimes, and they are much more likely to harm themselves, or tragically take their own lives, than anyone else.”
An important question is exactly who within society is qualified to make decisions on mental health, and what qualifies them to do so.
“Judgements are made by mental health and social care professionals, who have built up a body of expertise and experience,” suggests Lawton-Smith. “The UK law (Mental Health Act 1983 as amended), makes it clear what criteria need to be met before anyone can be assessed, detained or treated without their consent.
“Part of the process involves a risk assessment. The system has been in place for many years without significant challenges, so can be said to work, although by its very nature risk assessment is a matter of individual judgement by professionals.”
It’s a challenging area, especially when one asks whether any State necessarily has a right to force antidepressants or psychotics onto individuals for benefit to themselves and wider society.
“The UK law (Mental Health Act 1983 as amended) allows the compulsory treatment of patients in certain circumstances, and with certain safeguards. So the State does in effect have a ‘right’.” confirms Lawton-Smith.
“There is little doubt that advances in medication have significantly helped many people with mental health problems. However not all medication necessarily works for a particular individual, so there should be a discussion between the doctor and the patient in every case.
“NICE Guidance sets out what medication has the best evidence base for particular types of mental disorder, and should be followed. There are concerns about the significant increase in antidepressant prescribing over the past ten years, and calls for a greater range of alternative evidence based treatments to be offered, such as psychological therapies or exercise prescriptions.”
There’s a real need to remember not all States use the same law. So it’s good news that the Indian Law Society is working with WHO to create the International Diploma in Mental Health Law and Human Rights, which starts in October 2010. It’s to be hoped qualifications like this can help mitigate global mental health and human rights conflicts.
Saving lives
Either way, lots more needs to be done globally, because mental health is also key to development.
A 2008 WHO report suggested: ‘Attention to mental health is fundamental in attaining the Millennium Development Goals of improving maternal health, reducing child mortality, promoting gender equality and empowering women, achieving universal primary education and eradicating extreme poverty and hunger.’ So the impacts and repercussions of improving things run deep, especially in low and middle income countries.
Coalitions, like the The Future Vision Coalition, are seeking ways to enhance quality of life and mental health, producing reports like A Future Vision for Mental Health. But what does society need to do to improve attitudes, fears and misrepresentation?
“Society needs a better public understanding of the myths and realities of mental illness,” says Lawton-Smith.
“This is not easy, but it is very necessary. Many people with mental health problems say one of the biggest barriers they face is the stigma and discrimination that comes with a diagnosis of mental illness.
“People can only be sectioned for as long as they meet the criteria set out in the UK Mental Health Act 1983 (as amended). Some people do stay under section for some months, or a year or longer.
“What is important is that they have every support they need to recover from what is sometimes a very severe and chronic disorder, and that there are opportunities for them to step down into less controlled environments, e.g. from medium secure care to low secure care to independent living in a home or their own flat.”
There’s also a lot changing in Westernised societies. More people live alone, work longer hours, and rely on the internet for communication rather than real world contact.
“There is work being done, e.g. Mentally Healthy Workplace (MHW) Training, to address workplace mental health issues, and create mentally healthy workplaces.” says Lawton-Smith.
What’s clear is that more understanding and more support is needed. “The link between mental health and dangerousness is grossly over exaggerated and there is a widespread misconception that homicide by people with mental health problems is much more common than it really is,” argues a spokesperson for Mind, another UK charity campaigning for good mental health for all.
“People with mental health problems are extremely unlikely to be dangerous, and while every violent incident that does occur is a tragedy, it’s important to remember that such cases are very rare.”
Globally, establishing laws and procedures to protect people suffering from mental health difficulties is vital. In September 2009, The Movement for Global Mental Health set up the first Global Mental Health Summit in Athens.
Elsewhere, the World Psychiatric Association is working to advance care in the field. It plans to fund a new international programme involving some of its 135 member societies and 200,000 psychiatrists.
With better global communication and collaboration, hopefully more sensitive and effective approaches to mental health can be developed. With economic recessions, challenges surrounding the environment and resource scarcity around the corner, we may well need them.
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Resources:
Integrating mental health into primary care - A global perspective
The prevalence and correlates of DSM-IV disorders in the Iraq Mental Health Survey (IMHS)
Maternal mental health and child health and development in low and middle income countries
World Health Organisation -New efforts to tackle growing mental health problems in the Pacific Wellington, New Zealand, 22 February 2008 The Future vision coalition - A future vision for mental health
Mental Health Foundation – The lonely society?
WPA News - Mistakes to avoid in the implementation of community mental health care
PLAN ON THE ORGANIZATION OF MENTAL HEALTH SERVICES IN PALESTINE
