By Drs. Sylvain Ehrenfeld and Reba Goodman
A leading cause of ill health and disability worldwide is not AIDS, heart disease or cancer; it is depression. Globally, more than 300 million people of all ages suffer from depression.
The majority of those with the condition are not receiving adequate care; in high-income countries, about 50 percent don’t get treatment. In the United States, it is 56 percent, and in low-income countries, it rises to 80 percent to 90 percent. In part, this stems from the stigma attached to mental illness and from a lack of funding. On average, only 3 percent of a government’s health budget is spent on mental-health programs.
People with mental health disorders are some of the most neglected people in the world. In many communities, mental illness is not considered a real medical condition, but viewed as a weakness of character or as a punishment for immoral behavior.
Mental disorders are truly universal and found in all regions, all countries and all societies. They are found among poor and rich, in both urban and rural areas. The overall prevalence is the same among men and women. The prevalence of the severe mental disorders, schizophrenia and bipolar disorder, is also the same between men and women.
Depression is more common among women, while substance abuse disorder is more common among men.
Untreated mental illness in prisons
In the past, in some societies, sufferers have been given high social status in the belief that they could mediate with gods and the dead. In medieval Europe, these people have been burned at the stake. Some have been locked up in large mental institutions where they often have been beaten and abused. In the United States, it is estimated that half of the prison population has a mental-health problem, often untreated.
How do you provide services for mental health in poor countries? Drugs are expensive and most poor countries have few psychiatrists or psychologists outside of private clinics.
An innovative strategy being used is one that is curing disease all over the world in areas with too few health-care professionals: task sharing. That means training people with lower levels of education to do the work of doctors and nurses. It is better if the people are local. As for training local laypeople to treat depression, field studies have shown that therapy for depression can be delivered, with some success, to the poorest population by laypeople.
Depression is not only the most common mental illness, it is also the most tenacious. Up to 80 percent of people who experience a major depression episode may relapse.
Treatment is trial and error
One treatment for depression is drugs. Treatment remains a process of trial and error. A drug that helps one person can make another one worse. Also, drugs may lose their effectiveness over time.
A growing body of research is pointing to an intervention that appears to help prevent relapse by altering destructive thought patterns without side effects: mindfulness-based cognitive therapy. Mindfulness is paying attention to one’s experience in the present moment. Cognitive therapy is changing patterns of thought.
At the UN, World Mental Health Day was observed on Oct. 10. The focus in 2018 was young people; symptoms begin by age 14 in half of those afflicted with mental illness. Most cases go undetected and untreated, sometimes leading to suicide. Here, the suicide rate for Americans between ages 10 and 17 rose by more than 70 percent between 2006 and 2016.
Prevention begins with better understanding of early warning signs and building resilience from an early age. What is particularly important is removing the stigma of mental illness.
Dr. Sylvain Ehrenfeld, an IHEU representative to the UN, and Dr. Reba Goodman are members of the Ethical Culture Society of Bergen County.