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‘By 2020 depression is likely to become the most common disease’

October 12, 2016 By biospectrumasia

In Asia, suicide is among the top three causes of death in the population aged between 15 and 34. A recent study by the world Health Organization claims that around 12 billion working days - or 50 million years of work - will be lost to mental illness each year from now until 2030. The study, published in the journal Lancet, also elaborated that a failure to treat symptoms of depression and anxiety is costing the global economy $925 billion (£651bn) a year in lost productivity.

Almost ten per cent of the global population - around 740 million people - now suffers with a mental disorder. Depression is a common illness worldwide, with an estimated 350 million people affected. Though these figures are staggering, Asian nations have not jumped into action to solve this crisis. Currently, governments spend an average of just three per cent of their health budget on nation's mental health and building a mentally fit society.

Also another major cause of concern is that the available mental health services tend to be urban-centred and hospital-based, leaving the rest 80 -90 percent of populations with no access to proper treatment. People labelled as mentally ill are the worst victims of social violence; mainstream society still fails to acknowledge their suffering as a valid human experience that requires attention and support. Once people are labelled as mentally ill, as far as society is concerned, their civil and human rights are suspended for ever. They are exposed to discrimination that results in a non-human identity and damaged personality.

Despite global advancements, mental health issues are still somewhat of a taboo subject in Asia. They are associated with weakness, guilt, and shame. In many Asian countries like India and China there is a widespread belief that mental illness is a punishment for the ancestors' misdeeds or possession by a evil spirit, effectively shaming several generations of the family simultaneously. In order to build a mentally healthy society it is important to rebuild an environment that acknowledges, accepts, and wants to help those with mental disorders and illness.

BioSpectrum Asia Magazine recently spoke to Prof. Dinesh Bhugra, president World Psychiatric Association, on Asia's mental health scenario and the challenges faced in treating mental illness. Professor Bhugra is also the Emeritus Professor of Mental Health & Cultural Diversity, Institute of Psychiatry, Kings College London.

Q. 50 million years of work could be lost to mental illness by 2030, says a World Health Organisation report. Is there a serious problem of mental health in Asia?

This is a global problem and not only in Asia. In Asia lack of supported employment, moral support is creating additional difficulties. Training individuals with mental illness and offering them ongoing support is critical. An additional issue is the ‘presenteeism' in the work place where people who may be depressed or have mental illness , although present physically may not be able to perform to their full capacity and the employers are not aware of mental illness and mental health issues and therefore creating additional losses.

Q.Mental health and mental health care have not become a high priority in most Asian countries, in your opinion what could be the major reasons?

In Asia there are a number of reasons. The most important one is about lack of knowledge where people may think that mental illness is caused by external locus of control such as evil eye or a result of what they did in their previous life therefore causing delays in seeking help. The other reasons include stigma which as a result of lack of knowledge will produce negative attitudes and negative behaviours seeing individuals with mental illness as inferior or second class citizens. This stigma leads to discrimination which affects the legal rights of the mentally ill citizens and also affects funding for services and research. There are many countries in Asia who have recent updated mental health laws but in few countries laws still date back to 19th century with no changes. This reflects low priority given to mental illness, mentally-ill patients and those who work in the field. There are examples of good global practices which can be studied and used as frameworks to tackle this issue. It is important to recognise the rates of mental illness, resources and needs of each country and make provisions for its citizens. One size does not fit all.

Q.Are there enough clinical facilities and doctors in Asia to treat mental illnesses?

No, in many Asian countries there are not enough specialities. In India for example even though 53000+ doctors graduate every year there are only 450 training posts in psychiatry for a population of 1.25 billion. In order to provide well equipped and trained work force we need at least 10 % of medical students going into psychiatry upon graduation. Again stigma plays a major role in recruitment into psychiatry. Negative attitudes shown towards mental illness by the society also deters young professionals from entering the field and specializing in psychiatry. In a recently conducted survey of medical students in 22 countries we found that recruitment levels in psychiatry were far lower than numbers needed. For example, in the UK we barely get 1.2 applications per vacancy whereas surgery and other branches often get 7 applications per vacancy.

Q.Please elaborate on the social stigma associated with mental illnesses. How do we weed out this stigma ?

Social stigma associated with mental illness is enormous. Major challenges include, discrimination which means that mentally ill patients cannot find employment , housing, cannot get married, or even vote so they are not seen as active members of the society. Stigma also means lesser financial rewards, fewer resources, less likelihood of research funding -all of these act as negative factors in building a mentally fit healthy society. To weed this out we need to generate public awareness regarding mental health issue and its treatments. Public education campaigns set up by WPA, goodwill ambassadors such as Mohan Agashe can provide leadership. The fact that Ms. Deepika Padukone talked about her own experiences of depression has got people talking about it. As cricketers, politicians and other opinion formers come out with their experiences of mental illness things will change. In the UK for example over 20 MPs talked about their personal experiences of mental illness which changed the shape of dialogue. Getting patients to teach medical students and others will also help reduce stigma.

5.Is there enough awareness in the Asian society about mental illnesses?

In most of Asia, the concept of mental health has long had to suffer from stigmatisation and a pronounced lack of attention, professional care, and resources. Some of the explanations and attitudes are still very old fashioned. Among Punjabi women in the UK we found that depression was seen as a result of life's ups and downs and not as a medical condition. In many languages there is no word for depression which does not mean that the condition does not exist but that help is sought from other sources.

6.In your opinion, what can be done to change the societal views on mental health to build a mentally fit nation?

As compared to physical ailments, mental health is not considered a major issue and hence is neglected. There is economic evidence that shows that global burden of disease as a result of psychiatric disorders is higher than many physical conditions. By 2020 depression is likely to become the most common disease. In the UK for example heart disease and cancers have lower burden of disease but get a higher proportion of health budget in comparison with psychiatric disorders. Early awareness of resilience, mental illness and stress from a young age is necessary. It is important to include mental health is school curriculum and teach students. Ensuring that physical health is seen together with mental health and emphasis on physical exercise, good healthy diet, stress management, meditation, yoga etc will all help.

7.Are Asian governments working towards the mental well-being of their citizens? If yes, can you please highlight some activities/initiatives?

I am not fully aware so am not in a position to comment. However in Gujarat the government invested in working with faith healers and professionals to provide dava-dua project which has been successful.

8. Your thoughts on building a mentally healthy nation?

We need to work with patients, their care givers and families to impress upon policymakers that mental health is important and deserves same amount of funding and emphasis. Heart disease and cancer have lower burden of disease than mental illness yet get more funding, that needs to change. We know that if individuals with diabetes or hypertension become depressed both conditions become difficult to treat and recovery is prolonged. We need to change the way medical courses are taught. Psychiatry should be taught from day 1 of medical school. We need clear platforms for public mental health, mental health promotion and prevention of mental illness.

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