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“Sometimes I think God is angry with us to be giving us so many problems.”
The week of 17th June saw a gathering of public health experts, policy makers and academics at the Global Health Metrics and Evaluation Conference 2013 in Seattle, USA. Their agenda: to discuss the Global Burden of Disease 2010 (GBD 2010) study and perhaps to again celebrate its completion, the work of 500 researchers in 187 countries. The study, funded by the Bill & Melinda Gates foundation, was led by Seattle’s Institute for Health Metrics and Evaluation (IHME) and officially published in the Lancet’s December 2012 edition.
The study findings are of particular significance to the global mental health community. Mental illness was found to be the largest contributor to disability. Actual numbers in the study show that almost a quarter (22.7 %) of disabilities in the world are caused by mental and behavioural disorders, and that the burden of anxiety, depression, Alzheimer’s is on the rise. Why is this finding so important? It is because it underlines the urgency that is required in tackling mental disorders which already constitute a global crisis.
Mental illness is not an immediately apparent ‘killer’, and so, to quote a leading contributor Alan Lopez, mental health has remained ‘the most neglected of neglected diseases in global health’.
A further and perhaps even more serious neglect has been the failure of the global community to comprehend the devastating link between mental illness and poverty. Consequently, the downward spiral into poverty of those individuals and families affected by mental illness (the majority of whom live in less developed countries) have received scant attention from the global health community and do not register on the MDG agenda.
Chris Murray, lead architect of the GBD 2010, has said that the purpose of the study is to help set priorities. I would argue that any priority setting exercise related to mental health must factor in the relationship between poverty and mental illness in order for the outcome to be effective and meaningful.
In the last 12 years since I set up BasicNeeds, our work in 12 low and middle income countries taught us what the burden of mental illness actually feels like for affected individuals and their families in their daily lives.
...........We depend on daily wage labour. Sometimes we only have half a stomach full to eat after giving food to our children. How can God give us so many problems? Sometimes I think He is angry with us to be giving us so many problems.” Buddhiman Kisan, 37 years, from rural Nepal was diagnosed with Acute Psychotic Disorder.
Fatalistic as this may sound, we have learnt that that things do not need to be like this. In fact it has been an invigorating experience for me and for all of us at BasicNeeds to play a part in bringing change into the lives of mentally ill people and their family members. In the twelve countries where we work, we deploy our community based field approach, the Model for Mental Health and Development (MHD). Through our field programme operations we demonstrate improvement in mental health, everyday functions, household poverty levels and indeed quality of life outcomes for affected individuals. The evidence for this comes from annual impact assessments, routine collection of monitoring data, and academic partner studies including a 2 year outcomes study in Kenya in collaboration with the University of Cape Town.
From the time we started in 2000 we have mobilised 570,158 people which includes 111,142 affected individuals, 88,914 caregivers and 370,103 family members. Our current programmes work with 24,226 affected individuals and carers who participate as active members of 572 Self Help Groups. For people who have experienced exclusion, stigma and even abuse the opportunity to work, and to belong to a community group is crucial to sustained recovery and acceptance back into their family and community.
Bernard from rural Tanzania was a successful student until mental illness meant he failed his sixth grade exams. Feeling frustrated he wandered about aimlessly, talking to himself. As his condition worsened he became violent, threatening people with a machete. The community stigmatised him and his father remarried leaving Bernard’s mother solely responsible for his care. When she found out about the BasicNeeds programme she encouraged Bernard to participate, he was diagnosed with Schizophrenia and given medication. BasicNeeds also provided him with start up funds for a small grocery business which enables him to contribute to the family income. With increased confidence he is now chairperson of a group of stabilised people with mental disorders.
Energised by the 2013 Skoll Award for Social Entrepreneurship Award that I was privileged to receive, we are now planning a much larger scale up through a social franchise of the Model for Mental Health and Development supported by online training and mentoring.
The GBD 2010 is hugely significant to these efforts in highlighting to a global audience the growing significance of mental ill health to the overall global disease burden. Armed with this knowledge, and with the understanding that mental ill health is as much about how society treats us as it is about how we manage our illness, it is clear that there is much to be done in scaling up models that are comprehensive and draw on community development approaches.
We see the GBD data as an urgent call to the global community to change the lives of its most vulnerable and neglected people.
“I gave birth to two children but I couldn’t care for them. They got love and caring from my mother and sister. I never felt that I am their mother and they too did not want to come near me or get close to me because of my illness. Now both my children care for me. I love them too. I want to see my son married…. I want to live and cherish the experience of being a mother, which I could not do before. I hope I can be a good mother when caring for my grandchildren.”