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The Mental Health Treatment Gap: Why it Exists and What Is Being Done

A reflection on our unfair approach towards mental health issues in developing countries, and what we can do to fix it


By: Semini Beragama Jathunga



Introduction

You may have heard the saying, “If you see someone without a smile, give them one of yours.” It’s hard to argue against it—after all, what is there to lose? While sharing a smile is certainly a simple effort to make someone’s day, we shouldn’t let our attitudes towards mental health become too superficial. The truth is, when we think about mental health issues, we are often preoccupied with the mental well-being of people who have similar lifestyles and are in similar social situations as us—because we think they’re easier to relate to. A global consequence of this style of thinking has been the prevalent mental health treatment gap that has become drastically observable in low-income regions of the world, such as in Sub-Saharan Africa. People whose lifestyles are different from ours, such as people in developing countries, are often overlooked in our conversations about prioritizing mental health. As a result, there is a lack of funding and attention that goes specifically into mental health resources in developing countries (1).


The Treatment Gap

Only about 10% of total global mental health resources are available in developing countries, with the other 90% predominantly concentrated in high-income countries (1). This leaves about 76-85% of individuals with severe mental health disorders in the developing world with little to no access to mental health resources (1). Consequently, there is a large mental health treatment gap where people who need help just don’t have access to it. Sub-Saharan Africa has some of the highest rates of malaria and AIDS in the world, and the 48 countries comprising it contribute the greatest proportion of least-developed countries in the world (2). While difficult economic conditions and barriers to physical health and well-being tend to get attention, the debilitating effects that they have on mental health are often disregarded. Childhood is a difficult period of personal growth and social development, and many children in these parts of the world are also burdened with additional emotional and social stresses (2). These undesirable environmental influences tend to play a large role in increasing a child’s susceptibility to mental health issues at early stages in life (3).


Due to the prevalence of infectious diseases mentioned above, many other existing barriers to mental well-being do not receive as much attention as they should. Certain neurological conditions in children, such as epilepsy, that do not get as much attention often go untreated—the psychiatric consequences of which could be exceedingly detrimental (3). Children in urban settlements are exposed to toxins that could potentially lead to neurodevelopmental problems (3). The lack of attention paid to child abuse, neglect, and trauma introduce yet another set of barriers (3). We are often accustomed to seeing mental health as a “shadow” that is second to supposedly “larger” global health crises like infectious diseases. Mental illness can affect anyone regardless of their social and economic status, and it is simply unfair to deprioritize someone’s mental health due to the other challenges they must endure.


Ongoing Initiatives and Plans

Educational institutes around the world, including the University of Toronto, have been addressing the issue by collaborating with countries in Sub-Saharan Africa, such as Ethiopia, to provide better training to primary care providers who directly interact with children who may be suffering from mental health burdens (3). This way, primary care providers are better equipped to be of greater help. The World Health Organization has put forth the Mental Health Gap Action Plan (mhGAP), which aims to pay special attention to delivering and increasing accessibility to mental health resources in low- and middle-income countries (3). With adequate funding and care, this programme hopes to provide the necessary treatment that is needed to help more and more people lead healthier lives (3). We need more programs and initiatives that are specific to this cause, and we need more support and recognition of the efforts that are already present. National health policies need to be put into place that address these ongoing difficulties (3). At an individual level, fighting for change can mean a simple change in your own attitude. Mental health resources should be a right, and no one’s mental health struggles should be second to their additional burdens and challenges.


References

1. The “treatment gap” in global mental health reconsidered: sociotherapy for collective trauma in Rwanda. European Journal of Psychotraumatolgy.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4654767/


2. Prevalence of Child Mental Health Problems in Sub-Saharan Africa. JAMA Pediatrics.

https://jamanetwork.com/journals/jamapediatrics/fullarticle/1107721


3. Child and adolescent mental health in sub-Saharan Africa: a perspective from clinicians and researchers. BJPsych International.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5619623/

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