Sunday, March 01, 2009

Untangling the Mental Haywire

Globally, an estimated 450 million are suffering from mental and neurological disorders such as epilepsy, dementias (e.g. Alzheimer’s disease, vascular
dementia), and bipolar affective disorder. According to the 2001 World Health Report entitled “Mental Health: New Understanding, New Hope,” depression ranked fourth in the global disease burden; it is projected to jump to second place by 2020.

In the Asia-Pacific region, an estimated 13.7 million have dementia; as the region’s population ages, the number of those with dementia is expected to hit 64.6
million by 2050.

Substance addiction, whether alcohol, drugs, or tobacco, is also considered a mental health issue. Asia accounts for close to 55 percent of amphetamine-type stimulants (ATS) abuse worldwide, and majority of ATS addicts are youth. Alcohol abuse, on the other hand, account for 5.5. percent of the Asia-Pacifi c region’s burden of disease. In some Pacifi c countries, the percentage of alcohol-related abuse and violence is staggering: in Papua New Guinea, close to 90 percent of emergency room trauma are due to alcohol; while in Guam, 62 percent of murders are also alcohol-related.

Mental health defined

The World Health Organization (WHO) defines mental health as “a state of well-being in which the individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her community.” With this holistic defi nition, mental health is simply not the absence of disorders; it also encompasses a person’s emotional stability to handle pressures and other stressors.

Mental disorders can also have co-morbidity with other physical illnesses; either the illness may be a psychosomatic reaction to mental stress, or the stress may come from the diagnosis of a physical illness.

Either way, this co-morbidity has a negative effect on a patient’s treatment compliance; depressed patients are thrice more likely to default on treatment than nondepressed patients.

Mental health and poverty

While mental health problems can affect anyone, regardless of race, age, and gender, there have also been studies showing that the poor are more vulnerable. A study conducted by the Harvard Medical School in the 1990s showed that the rate of mental retardation and epilepsy was fi ve times higher in poor nations than in richer ones. Those belonging to lower income brackets are also 1.5 to two times more likely to become depressed.

A Gallup study published in 2007 reiterated the correlation between having a higher income and a relatively excellent state of mental health. Only 27 percent of Americans earning less than US$20,000 a year reported having an “excellent” mental health and wellbeing, while the percentage increased to 58 for those who were earning more than US$75,000.

Mental disability and poverty feed on each other, perpetuating a vicious cycle. Poverty itself is strictly not a cause of mental disability, but it generates enough
stressors and circumstances.

Treatment gap

While it is true that mental health has been included in the international agenda as early as 1991, policies are yet to be translated into concrete actions: a large percentage of patients still do not have access to treatment, and stigma still persists.

Even in developed countries, 44 to 70 percent of patients do not have access to treatments; the situation in developing and least developed countries is far 90 percent. This is because more than 40 percent of countries have no mental health policy in place. In the ATLAS study conducted by the WHO in 2001, 32 percent of countries had no specifi c budget for mental health. Of those with mental health budget allocation, 36.3 percent spent only less than one percent of the total health

With the inadequate budget for mental health, the burden of mental disorders falls heavily on poor patients and their families. The Harvard study found out that in some Asian and African nations, about 90 percent of epileptic and mentally-impaired patients did not receive any treatment because of the high cost of medicines. The high cost of treatment is not the only reason why patients often do not seek treatment; stigma is another compelling reason to hide one’s mental illness. Stigma
may come from the personal perception that mentally impaired individuals are prone to violence. It also has cultural factors where a patient is either seen as having a weak disposition, or is possessed by supernatural elements. Stigmatization may also come from a patient’s very own family.

At the National Center for Mental Health in the Philippines, some of the patients who
are already treated are still staying at the hospital because their families have already abandoned them.

Stigmatization often results in the violation of human rights of individuals with mental and neurological disorders. According to the WHO, some forms of abuses include seclusion and isolation, inhumane conditions in mental health facilities, and rape and physical abuse. Worsening the problem is the fact that in most countries, patients often do not have legal personalities; they are largely looked upon as persons who are unfi t to make decisions or even testimonies that have legal consequences.

The importance of ensuring the people’s mental health has been largely overshadowed by the focus on physical health. It is high time for the global health community to recognize the fact that mentally impaired individuals, when given proper treatment and support, can still live productive lives.

Internet Addiction

Another emerging area of concern for mental health experts is Internet addiction. As a relatively new type of addiction, experts are still debating the criteria to be used for a clinical diagnosis, its clinical defi nition, and even what to call the
disorder. Some quarters are even proposing to broaden the definition to cover addiction to other gadgets as well.

However, they are one in saying that the addiction is characterized by the compulsive use of computer, which can affect a user’s interaction with other people. In extreme but rare cases, players of violent computer games have carried out their fantasies in the real world. With a low user to computer ratio, a relatively unreliable Internet connection, and the lack of fi nancial means of the population to purchase gadgets, experts in the Asia-Pacific region may be quick to dismiss this addiction as an irrelevant concern. However, South Korea, China, and Taiwan have long acknowledged that Internet addiction is indeed a problem. In South Korea alone, an estimated 14.4 percent of its schoolchildren are said to be Internet addicts. These three countries have already responded to the problem by opening treatment centers and boot camps to wean addicted users away from computers.

This article is culled from Issue No. 14 of Health Alert Asia Pacific newsletter produced by Health Action Information Network.

“Internet addiction in South Korea.”

Block, Jerald. “Issues for DSM-V: Internet Addiction.” http://ajp.

World Drug Report 2008. United Nations Office on Drugs and Crime.

WHO: Alcohol abuse must be tackled in Asia-Pacific; disease and injury top global levels . The Associated Press.

Dementia in the Asia Pacifi c Region: The Epidemic is Here. cEpidemicSept06.pdf

Investing in Mental Health. WHO.

Barbara Crosette. “Mental Illness Found Rising in Poor Nations.”

Newport, Frank. “Strong Relationship Between Income and Mental Health.” Gallup.