Mental Health Systems
HIV & Mental Health
Teaching & Capacity Building
Our Institutions
Kushinga - Mental Health in Zimbabwe
Mental, neurological, and substance use disorders account for 13% of the global burden of disease worldwide, greater than the burdens due to cardiovascular disease and cancer (Collins et al., 2011), yet up to 98% of people with mental disorders in low-income countries do not receive treatment (Eaton et al., 2011; Fulton et al., 2011). Given the psychosocial challenges associated with Zimbabwe's political and economic environment, the prevalence of depression and other common mental disorders may be even greater than that of other low-income countries. Common mental disorders, including anxiety and depression, often strike people in the middle of their lives, their key productive and child-raising years. People whose mental disorders go untreated are often unable to work or care for children and may be resource drains on their families, trapping the family in poverty and further limiting an already crippled economy (Lund et al., 2011).
Why is it critical to address mental health in low-income countries?
-Disease burden: Mental health accounts for 13% of the global burden of disease (Collins), taking a greater toll on human life and productivity than heart disease or cancer. The aggregate years lived with disability (YDLs) from mental disorders is currently around 22.7%, higher than any other disease, including HIV/AIDS and tuberculosis.
-Economic burden: Existing data suggest that the impact of untreated mental disorders on a country's economy is massive and is larger than the economic burdens caused by other non-communicable diseases. In South Africa, having depression reduced personal income by $4798 per person per year (Lund, 2013). In Nigeria, people earned $463 less per year if they had severe mental illness (Esan, 2012). Household survey data from Ghana estimated that poor mental health caused 6.8% loss to GDP due to lack of productivity, a greater GDP loss than that due to malaria (Canavan, 2013).
-Lack of attention: Stigma, misunderstanding of mental disorders and their treatments, and lack of knowledge of the magnitude of the global burden have led to low investment in mental health worldwide. Despite the burden of mental disorders, less than 2% of health spending in low and middle-income countries goes to their treatment and prevention. Because of the chronic underinvestment, development of mental health programs could have substantial impact because they would be pioneering efforts that fill a gap in service delivery and international attention.
-The relationship between mental health and HIV/AIDS: Lifesaving antiretroviral therapy for people with HIV is contingent on compliance with a strict medication regime. Studies show that many HIV-positive individuals struggle to take their medication regularly due to depression and psychosocial issues. Basic treatment for depression could help improve antiretroviral adherence among people living with HIV, thus increasing the cost-effectiveness and enhancing the delivery of major HIV prevention programs.
-Impact on other global health investments: Investing in mental health would not only increase the effectiveness of investment in HIV treatment, but also other global health programs. Studies have shown that people with mental illness are less likely to adhere to medication regimes, present for appointments and other treatments, or lead healthy lifestyles, and they have a higher risk of developing chronic diseases. Increasingly, donors are investing in global health interventions that rely on long-term behavior changes. The success of programs such as hypertension or diabetes treatments, directly observed treatment (DOTS) for TB, and prevention of mother to child transmission of HIV (PMTCT) hinges on people altering their lifestyles and behavior. It is inefficient to spend on these interventions while ignoring mental health. Mental health spending would be particularly high-impact because it would have positive spillover effects on other interventions.
-Cost-effectiveness of treatments and interventions: Data on the clinical and cost-effectiveness of treatments for mental disorders suggest that many treatments, particularly those that use well-established psychotropic drugs and are integrated with primary care, are feasible, effective, and cost-effective in low-income countries.