Mental health disorders: the borders and burden of the problem

Mental health disorders (MHDs) affect one of every four people at some stage during their lifetime: this type of illnesses is not just someone else’s’ problem (World Health Organization, 20011).
These disorders are among the major causes of global burden of disability (Vigo et al., 2016). This was a fact already in 1996, when the first Global Burden of Disease was published (Murray and Lopez, 19961), which estimated that depression alone caused more disabilities than HIV or nutritional problems, two priorities of the United States health-related international programs (Murray and Lopez, 19961; Bolton, 2014).

Nowadays, many international health systems have increased awareness of mental disorders (World Health Organization, 2001) and the global impact of the problem is known (World Health Organization, 2018):

  • about 300 million people suffer from depression
  • about 60 million people have bipolar affective disorders
  • about 23 million have schizophrenia or other psychoses.

Unfortunately, it seems that these numbers have grown together with population growth and ageing (Whiteford et al., 2013). Moreover, in our society, there are individuals with a higher risk of experiencing MHDs: these vulnerable groups include minority groups, those living conflicts, natural disasters or discrimination, older people, prisoners, and the young unemployed resulting from the global financial crisis (World Health Organization, 2013).

Currently, no universal definition of what constitutes an MHD has been validated (Bolton, 2014). However, it is possible to distinguish two large groups of MHDs: the first includes uncommon disorders with a genetic basis (e.g. schizophrenia) that cause severe dysfunction and have a large impact on individuals and their families, but a relatively small impact on public health and global development; the second group, referred to as common mental disorders (CMDs; e.g. depression, anxiety, and post-traumatic stress disorder), comprise mental health problems mostly conditioned by events and environment, which may constitute a greater global social issue due to their high prevalence related to extreme conditions especially in low-income countries (Bolton, 2014).
In general, MHDs are complex health problems that require multidimensional, high-quality and effective care, as inadequate approaches can affect improvement and recovery (Moran et al., 2013).
To have a clear idea of the burden of these disorders, it must be underlined that MHD patients (and, among them, not just those with severe disorders), experience considerable and continued deterioration of their quality of life, with major consequences on psychological functioning (Mendlowicz and Stein 2000; World Health Organization, 20013). Additionally, these patients face higher rates of comorbidities and mortality, with data clearly indicating that people with major depression have a 40% to 60% higher chance of dying prematurely than the general population (World Health Organization, 2013).

MHDs not only have a massive social impact, but also are a very high economic burden (World Health Organization, 2001). In particular, the economic load of MHDs, due to health and social service needs, reduced productivity, impact on caregivers, premature mortality and levels of public safety, is very high (World Health Organization, 2001). Moreover, the World Health Organization (WHO) estimates indicate that MHDs often lead families into poverty (Funk et al, 2010), while growth projections indicate a global economic cost of mental disorders of $US 6 trillion in 2030 (Shearer et al., 2016).
Nevertheless, this high burden of mental health is not paralleled by an adequate proportion of healthcare budgets allocated to prevent and cure MHDs: in 2005, such budgets ranged between 2% in low-income countries and 7% in high-income countries (Saxena et al., 2007; Shearer et al., 2016). Another important data regards the rates of treatments meeting the minimal standard for adequacy, which are generally lower in lower-income countries, with the exception of USA (18%) (Wang, 2007).

But why is mental health still often underrated and what is the risk for these patients?
In general, mental health remains a low priority due to the wrong attitude that MHDs are less critical than physical issues, a stigmatization of these kind of disorders, together with a lack of recognition of the uniqueness of each MHD (Bolton, 20142a,b,c). In middle- and low-income countries, MHDs seem to be even more unrecognised, also due to poor general resources (e.g. mental health services far from the urban area) and lack of dedicated policies (World Health Organization, 2011; Bolton, 2014).

Mental health is essential to the overall well-being of any individual and, in general, of society (World Health Organization, 2001) and even if MHDs are major problems, especially CMDs, they are manageable through effective treatments that can significantly reduce suffering and improve functioning of patients, families and the entire community (Bolton, 2014).
According to the WHO, several important actions need to be implemented from a public health perspective, which should include, among others: guaranteeing widespread access to cost-effective services and adequate care and protection of human rights, supervising the mental health status especially of “vulnerable” subjects (e.g. children), promoting healthy lifestyles and enhancing research in MHD aetiology and treatment, as well as monitoring and evaluation of mental health systems (World Health Organization, 2001).


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