People with mental disabilities must be included in development programmes – UN

A mental health counsellor talks with clients in the Democratic Republic of the Congo. Photo: WHO/Marko Kokic

16 September 2010 – The United Nations health agency today called on governments, civil society and aid agencies to confront the “enormous challenge” of helping the millions of people in developing countries with mental and psychosocial disabilities, among the world’s most vulnerable groups.

“Almost three quarters of the global burden of neuropsychiatric disorders occurs in low- and middle-income countries,” World Health Organization (WHO) Director-General Margaret Chan said in a foreword to a new report, entitled “Targeting people with mental health conditions as a vulnerable group,” stressing that they are marginalized in terms of development aid and government attention.

“We can measure the costs to individuals, families, societies, and economies. And the costs of these disorders, which tend to have an early onset and are chronically disabling, are enormous. Taking action makes good economic sense. These disorders interfere, in substantial ways, with the ability of children to learn and the ability of adults to function in families, at work, and in society at large.”

The report calls on development actors to recognize the group’s vulnerability, include them in all development initiatives, scale up services for mental health in primary care, provide social and disability benefits, and involve people themselves in designing development programmes.

It notes that almost 1 million people commit suicide every year, the third leading cause of death among young people. Depression is the leading cause of years lost due to disability worldwide.

According to the report, the majority of development and poverty alleviation programmes do not reach persons with mental or psychosocial disabilities. For example, between 75 and 85 per cent do not have access to any form of mental health treatment. Mental and psychosocial disabilities are associated with rates of unemployment as high as 90 per cent. Furthermore people are not provided with educational and vocational opportunities to meet their full potential.

“A greater attention from the development community is needed to reverse this situation,” WHO Assistant Director-General for Non-Communicable Diseases and Mental Health Ala Alwan said. “The lack of visibility, voice and power of people with mental and psychosocial disabilities means that an extra effort needs to be made to reach out to and involve them more directly in development programmes.”

An estimated one in four people globally will experience a mental health condition in their lifetime, WHO said, noting that mental health conditions are responsible for a great deal of mortality and disability, accounting for 8.8 and 16.6 per cent of the total burden of disease due to health conditions in low- and middle-income countries, respectively.

Depression will be the second highest cause of disease burden in middle-income countries and the third highest in low-income countries by 2030. “The challenge is enormous,” the agency said.

“We need to break down the barriers that continue to exclude persons with mental or psychosocial disabilities,” Sha Zukang, Under-Secretary-General of the UN Department of Economic and Social Affairs (UNDESA), which is working with WHO on the issue. “In order for them to have access to better opportunities and to benefit from the fruits of development, they must also be involved in the design of policies and programmes related to development.”

The report notes that the group is subjected to high levels of stigma and discrimination, due to widely held misconceptions about the causes and nature of mental health conditions; experiences high levels of physical and sexual abuse, including in prisons and hospitals; and often encounters restrictions in the exercise of their political and civil rights.

The majority of people with mental health conditions in low- and middle-income countries are not able to access essential health and social care. People with severe mental and psychosocial disabilities are also much less likely to receive treatment for physical illnesses. The exclusion of children with mental and psychosocial disabilities from education causes further marginalization.

“Mental health has long been neglected in human development and quality of life initiatives,” the report declares. “Successful and sustainable development policies and programmes require a renewed focus on mental health issues, through improved recognition of the links between development programmes and mental and emotional well-being, and the inclusion of persons with mental and psychosocial disabilities to achieve development for all.”


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