World Mental Health Day 2021 on Sunday was getting on the public’s nerves amid the worst pandemic in history. One in four people in the world will be affected by mental or neurological disorders at some point in their lives. That could be a family member, a friend, a colleague, or it could be you.
Mental health is one of the most misunderstood and neglected areas of health globally. This is due to stigma and shame, or that there may be little to ‘show’ in comparison with a rash or a broken leg, or that treatment has been unavailable or ineffective. This was all true before COVID-19, but COVID-19 has made it worse.
Mental health is important at every stage of life, from childhood to old age. It affects how we think, feel, and act. It helps determine how we handle stress, relate to others, and make choices.
Some sobering facts: nearly 1 billion people worldwide have a mental disorder. Every year, close to 3 million people die from substance abuse. Every 40 seconds, a person dies by suicide. About half of mental health disorders start by the age of 14.
Shortsightedly, countries spend less than 2 percent of their health budgets on mental health, while, according to WHO, every $1 invested in mental health yields a $4 return on investment. A kilobyte of spending today saves a gigabyte of spending in the future. In other words, very few health measures generate such outsized economic returns
There is no one single cause for mental illness. Several factors contribute to the risk for mental illness, including genetics, physical and sexual abuse in youth, medical conditions, biological factors or chemical imbalances in the brain, use of alcohol or drugs, and feelings of loneliness, rejection, or isolation.
There are surprisingly strong links between physical and mental health; depression increases the risk for diabetes, heart disease, and stroke. In reverse, chronic illnesses, and their risks factors like smoking, are linked to mental illness. There is still much to learn: only recently has the link between gut bacteria and mental illness been recognized.
Mental health has a significant worldwide economic burden, upon governments, individuals, families and employers. Yet shortsightedly, countries spend less than 2 percent of their health budgets on mental health, while, according to WHO, every $1 invested in mental health yields a $4 return on investment. A kilobyte of spending today saves a gigabyte of spending in the future. In other words, very few health measures generate such outsized economic returns.
At worst, people with mental health conditions often experience severe human rights violations, discrimination, and stigma.
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On a daily basis, doctors assess ‘mental capacity’ to ascertain the ability to make one’s own decisions. A person might suffer from intellectual disability, a brain injury or a mental illness (for example, dementia), and be unable to make a will, manage their financial affairs, or be responsible for criminal acts. This is a decision not taken lightly, for without mental capacity we are non-persons in the eyes of the law and our decisions have no legal force.
COVID-19 deserves special mention. COVID-19 has led to a dramatic rise in mental health problems globally, and the full impact is yet to be seen. The effect is greatest among COVID-19 patients, families and healthcare workers. People diagnosed with COVID-19 are more likely to develop depression, dementia, psychosis and stroke
The Paralympics now welcomes athletes from six disability categories, one of which is intellectual disability. Intellectual disabilities can impact sport performance by causing slower reaction times, less strength, endurance, agility, flexibility and balance, as well as the ability to cope with a training regime. All competitors have to fulfil the World Health Organization definition of intellectual disability: ‘An IQ below 75. Impairment in social, domestic and communication skills. The disability must have occurred before the age of 18.’
There are many different mental disorders. The main warning signs are excessive paranoia, worry or anxiety; perennial sadness or irritability; extreme mood swings; social withdrawal; and dramatic changes in eating or sleeping pattern. All of us feel anxious, depressed or fearful occasionally. We return to check that we have indeed locked the front door. We forget names, especially as we get older. But if symptoms are interfering with daily life, we should not put off seeking help.
Mental illness includes depression, bipolar, anxiety, personality, psychosis such as schizophrenia, eating disorder, post-traumatic stress, obsessive-compulsive, substance abuse, developmental disorders, and dementia. Of these, anxiety is the most common mental illness in the world, affecting 284 million people.
COVID-19 deserves special mention. COVID-19 has led to a dramatic rise in mental health problems globally, and the full impact is yet to be seen. The effect is greatest among COVID-19 patients, families and healthcare workers. People diagnosed with COVID-19 are more likely to develop depression, dementia, psychosis and stroke.
The general population is affected by the wider fear of infection or vaccination, strict infection controls, quarantine, physical distancing, lockdowns, and job and financial concerns. During the initial phase of the COVID-19 outbreak in China, more than half of the respondents rated the psychological impact as moderate to severe.
World Mental Health Day is an opportunity for governments to take more serious action; for us all to reflect, recognize mental illness as an illness, and to create a supportive environment for people to talk about mental health if they want to
A Hong Kong study showed stress levels, anxiety and depression similarly increased during the COVID-19 outbreak. In young people there are additional worries about loss of schooling, online instruction, testing delays, re-marking, missing friends and teachers, shifts in scheduling, and in some cases more family tensions with confinement at home, affecting students’ daily routine and eating, sleeping, exercising habits, which may in turn affect learning and mental health.
However, while the demand for mental health services is increasing, the COVID-19 pandemic has disrupted or halted critical mental health services in 93 percent of countries worldwide.
Some mental illnesses require hospitalization; all require support. Many can be effectively alleviated or treated at relatively low cost, yet there is a yawning gap between people needing care and its provision. In low- and middle-income countries, more than three-quarters of people with mental disorders receive no treatment.
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World Mental Health Day is an opportunity for governments to take more serious action; for us all to reflect, recognize mental illness as an illness, and to create a supportive environment for people to talk about mental health if they want to. Support can be a barbecue in the country park, a tea break with colleagues, or a visit, email or Zoom call with family or friends
And, finally, to avoid inviting mental illness: get vaccinated against COVID-19 .
The author is a special adviser to the Global Center for Good Governance in Tobacco Control, senior policy adviser to the World Health Organization, and director of the Asian Consultancy on Tobacco Control.