Depression is the third largest contributor to the global burden of disease.
For a very long time, mental health carried the stigma of weakness. Talking about emotions and private issues, material failures and intellectual disappointments, KRA drops and pink slips is not what people in the jet set era are supposed to do, at least in front of strangers (the caregivers, so to speak). But it turns out that not doing precisely all of that, and more, led to a downward spiral. The overall burden of mental health exceeds the burden of cardiovascular disease and cancer combined – 13%.
Sample the statistics: depression is the third largest contributor to the global burden of disease; every 7 seconds someone develops dementia that costs the world up to $609 billion (in 2009); by 2020, it is estimated that 1.5 million people will die each year by suicide and between 15 and 30 million will attempt it. (For comparison, India receives around 2 million cases of TB each year.)
The tragedy is not only that there is no cure for many of these diseases, but even for which there are effective treatments, they do not reach the needy. For example, in most low-income countries, there is no treatment for Parkinson’s disease in primary care. (If you are wondering if Parkinson’s disease is prevalent in India, read it. Indians get it at an earlier age.)
Let me admit that, on a metaphysical level, the debate is inconclusive about whether depression is even a disease. At the scientific level, data are still emerging on the actual functioning of these drugs; on a commercial level (due to direct-to-consumer advertising from pharmaceutical companies), antidepressants have been so oversold that people are even taking them for eating disorders, alcoholism, and premature ejaculation!
But the truth lies between the two. Certainly, a person who is different (someone who has a rational reaction to a crazy world), cannot be considered to have a mental illness!
In a representative article published today in Nature, Grand Challenges in Global Mental Health, a consortium of researchers from around the world uses 25 grand mental health challenges to set global and national priorities. The challenges encompass several broad themes. First, the results highlight the need for research that uses a life-course approach. “This approach recognizes that many MNS disorders begin or manifest early in life, and is also attentive to risk factors and disorders affecting children and older adults. Efforts to develop mental capital – the cognitive and emotional resources that influence an individual’s ability to contribute to society and enjoy a high quality of life – could also mitigate the risk of disorders such as depression, substance use disorders, bipolar disorder and dementia.”
Second, the challenges recognize that the suffering caused by mental and neurological disorders extends beyond the patient to family members and communities. Thus, system-wide changes are crucial, as well as attention to social exclusion and discrimination.
Third, the challenges emphasize that all care and treatment interventions must be evidence-based to provide planners, clinicians, and decision-makers with effective care packages.
It’s a comprehensive list that can very well set a country’s national agenda if it were to take the increase in mental health problems seriously.
For India, which has been preoccupied with infectious diseases for too long and which is only just beginning to realize the challenges of non-communicable diseases (cardiovascular, diabetes, etc.) what do you think Health Minister Ghulam Nabi will say Azad faced with these alarming projections? Yes Minister, who calls MSM (men who have sex with men) a disease?
“People have gone crazy.”