The battle for better mental health care

“The World Bank shouldn’t give loans for health, they should give grants for health. And we hope the WHO shares that view,” Dlamini-Zuma said at the opening ceremony of the World Psychiatric Association International Congress in Cape Town.

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Her comments followed an address by Dr Shekhar Saxena, director of mental health and substance abuse at the WHO, who announced the World Bank had committed, following a meeting with the organisation in April, to supporting mental health in a far bigger way.

The main message was that any country applying for World Bank loans for health projects would have to ensure a mental health component was included.

Bill of Rights

Continuing the call for activism for the mental health cause, Professor Dinesh Bhugra, president of the World Psychiatric Association, told the audience they had launched a Bill of Rights for those with mental illness in the House of Lords in London two weeks ago.

A total of 61 organisations around the world had signed it, and the South African Society of Psychiatrists had indicated it too would sign the document.

“I need every bit of help from everyone here to change the way we treat our patients, who are the most vulnerable,” Bhugra said.

Shocking survey results

Earlier in his speech, Bhugra revealed the World Psychiatric Association had just completed a global survey of 193 countries, which threw up shocking results.

These included that people with mental illness could vote in just 11% of the countries surveyed, that they enjoyed no employment rights in more than half the countries, and that 42% of nations prevented those with mental illness from entering into any kind of contract, including signing a will or inheriting property.

“There are people from 92 countries here, more than half the number of countries that participated in the survey. I appeal to you all to use any power you have to change attitudes, to make sure those with mental illness are able to lead fully functional lives in communities without discrimination and stigma. Let the movement begin here,” the professor urged.

Investment in mental health

Saxena added, meanwhile, that the WHO had the necessary ammunition in the form of research and statistics, to back anyone fighting the battle for better mental health services and facilities.

They had proved, he told delegates, that any investment in mental health was just that – an investment, rather than a drain on resources.

“Every effort in mental health pays back much more than the investment. We have evidence of that and we will give you that ammunition you need,” he said.

The case for Africa

Addressing the case for Africa specifically, Dlamini-Zuma pointed to WHO statistics which indicated that 40,5% of countries globally had no mental health policy, in spite of estimates that one in every four people would suffer a mental health condition.

While there were an average nine psychiatrists to every 100,000 people in the west, the comparative figure for the African region was just 0,05 per 100,000 people.

“We need a pan-African movement to ensure there is no discrimination against mental health patients, and we need to develop programmes and proper policies around mental health,” she warned.

As a continent, Africa needed to not only update existing mental health policies and community-based interventions, but to see these formalised at AU level.

With the enormous lack of human resources, Africa also had to find other ways of helping improve mental health, without relying exclusively on psychiatrists.

“In Africa we cannot rely on Western models where there are abundant resources. We need to look at creative ways of using what we have,” Dlamini-Zuma said.

But what should never be lost sight of was the importance of treating mental health patients with dignity, and working to break down the stigma hindering treatment across the globe.

“With health, the economy can’t grow … We can’t do anything without health,” she said.