Addressing rise in mental health disorders

Studies have shown that the prevailing economic recession and violent crimes in the country, and indeed the world are responsible for rise in mental health disorders.

Mental health refers to a broad array of activities directly or indirectly related to the mental well-being component included in the World Health Organisation (WHO)’s definition of health: “A state of complete physical, mental and social well-being, and not merely the absence of disease.”

Mental health is related to the promotion of well-being, the prevention of mental disorders, and the treatment and rehabilitation of people affected by mental disorders.

Mental disorders include: depression, bipolar affective disorder, schizophrenia and other psychoses, dementia, intellectual disabilities and developmental disorders including autism.

According to the WHO, common mental disorders are increasing worldwide. Between 1990 and 2013, the number of people suffering from depression and/or anxiety increased by nearly 50 per cent, from 416 million to 615 million. Close to 10 per cent of the world’s population is affected, and mental disorders account for 30 per cent of the global non-fatal disease burden.

Humanitarian emergencies and ongoing conflict add further to the need for scale-up of treatment options. WHO estimates that, during emergencies, as many as one in five people are affected by depression and anxiety.

Two consultant psychiatrists – former Chief Medical Director of Lagos State University Teaching Hospital (LASUTH) Ikeja, Dr. Femi Olugbile; and Senior Lecturer, Department of Psychiatry, College of Medicine, University of Lagos (CMUL), Dr. Erinfolami Adebayo Rasheed – identified a positive relationship between economic recession and mental health disorders.

The psychiatrists said some key factor seem to make people more vulnerable to mental health disorders: being unemployed, having a precarious work situation, facing debts and economic strain, and having a pre-existing mental illness.

Olugbile said there is no clear statistics showing an increased trend but plenty of anecdotal and sensational stories, especially pertaining to suicide, referencing the recent sad story of a banker in Lekki, Lagos. However, he said, it is true that a properly confirmed upward trend in suicide could act as a ‘litmus test’ of increased mental illness in a society, since there is a clear link between suicide and depression (as well as a number of other mental health conditions).

On the prevalence of mental illness in Nigeria, the psychiatrist said mental illness (like ‘physical illness’) exists in a large number of varieties, each with different characteristics, different treatment modalities, and different implications for the individual, now and in the future.

Olugbile said the lifetime prevalence of mental illness that is the number, out of a hundred citizens, that would be expected to have at least one episode of mental illness in their lifetimes is variously quoted from seven per cent to 15 per cent in Nigeria.

To address the issues, medical experts on the occasion of the World Mental Day (on October 10, 2016), canvassed greater awareness and understanding of Psychological First Aid and how it can be used following crisis events to support people in distress.

The theme of this year’s World Mental Health Day is Psychological First Aid. World Mental Health Day provides an opportunity for people and organisations working on mental health issues to talk about their work, and what needs to be done to make mental health care a reality for people worldwide.

Also, the World Health Organisation (WHO) has confirmed that economic crisis is expected to produce secondary mental health effects that may increase suicide and alcohol death rates.

The United Nations (U.N.) apex health body, however, recommended that the mental health effects of economic crisis could be offset by instituting social welfare, active labour market programmes, family support projects, increasing alcohol prices, debt relief programmes, and accessible and responsive primary care services.

According to a new study published July 29, 2016 in Community Mental Health Journal, experiencing financial difficulties and worrying about debt at university increases the risk of mental health conditions such as depression and alcohol dependency.

The research from the University of Southampton and Solent National Health Service (NHS) Trust, United Kingdom (U.K.), found that symptoms of anxiety and alcohol dependence worsened over time for those who were struggling to pay the bills. Those who were more stressed about their debt had worsening levels of stress, anxiety and depression.

Additionally, mental health issues and alcohol dependency predicted higher levels of financial stress and vice versa, suggesting the possibility of a ‘vicious cycle’ occurring.

A systematic literature review of mental health outcomes in times of economic recession published February 2016, in the journal BMC Public Health found that depression, anxiety, frustration, fear, disappointment and anger are some of the negative emotions that 44 percent of Greeks feel as a result of the economic crisis.

The researchers concluded: “On the basis of a thorough analysis of the selected investigations, we conclude that periods of economic recession are possibly associated with a higher prevalence of mental health problems, including common mental disorders, substance disorders, and ultimately suicidal behaviour.”

Olugbile said through the pathway of increased stress on the individual, there is increase likelihood that more individuals will reach their ‘threshold’ for various illnesses that they may be innately genetically or constitutionally susceptible to (including even physical illness such as hypertension) but which they might not have succumbed to in the absence of a ‘precipitant’ such as the increased stress occasioned by such circumstances.

On the connection between economic conditions and rise in suicides, the psychiatrist said: “Most of the evidence locally is anecdotal and comes from sensational stories about students, professionals and even rural dwellers being reported in the press. The assumption of an upward trend is a reasonable one to make, but it needs to be backed up by properly conducted research. One million people die annually all over the world from suicide. WHO statistics (2012) ranks Nigeria 102 among the list of nations in the incidence of suicide among the population, with an annual figure of 6.5 for every 100,000 in the population, and a strong male preponderance. Obviously a lot of work needs to be done to deal with that, as well as heading off any upward trend.”

Erinfolami told The Guardian: “It is plausible that the actual economic crunch increased the population’s psychological distress. This period correlates with higher prevalence of common mental disorders, substance disorders, and ultimately suicidal behaviour. It is also that in order to cope with psychosocial stress people might turn to substance misuse.”

The psychiatrist said some key factor seem to make people more vulnerable to the effects of the hardship: being unemployed, having a precarious work situation, facing debts and economic strain, and having a pre-existing mental illness.

Erinfolami said economic crunch might also have a severe and long-term impact on mental health in children and young people, especially if they face stress within the family as a result of economic hardship or parental unemployment.

He, however, said there no statistics or local studies to buttress this point but economic hardship as indicated by income and available funds for medications had been implicated or associated with relapse of existing mental health issues as well as emergence of new illnesses by many local studies.

The psychiatrists said scaling up mental health services will contribute to achievement of one of the targets of the Sustainable Development Goals, endorsed at the United Nations General Assembly in 2015: by 2030, to reduce by one third premature mortality from non-communicable diseases through prevention and treatment and promote mental health and well-being.

According to a new WHO-led study which estimates, for the first time, both the health and economic benefits of investing in treatment of the most common forms of mental illness globally, every US$ 1 invested in scaling up treatment for depression and anxiety leads to a return of US$ 4 in better health and ability to work. The study, published in The Lancet Psychiatry, provides a strong argument for greater investment in mental health services in countries of all income levels.

The new study calculated treatment costs and health outcomes in 36 low-, middle- and high-income countries for the 15 years from 2016-2030. The estimated costs of scaling up treatment, primarily psychosocial counselling and antidepressant medication, amounted to US$ 147 billion. Yet the returns far outweigh the costs. A five per cent improvement in labour force participation and productivity is valued at US$ 399 billion, and improved health adds another US$ 310 billion in returns.

However, current investment in mental health services is far lower than what is needed. According to WHO’s “Mental Health Atlas 2014” survey, governments spend on average three per cent of their health budgets on mental health, ranging from less than one per cent in low-income countries to five per cent in high-income countries.

“Despite hundreds of millions of people around the world living with mental disorders, mental health has remained in the shadows,” said Jim Yong Kim, President of the World Bank Group. “This is not just a public health issue — it is a development issue. We need to act now because the lost productivity is something the global economy simply cannot afford.”