Mental_Health
Inequities in public health spending and focus are often seen among income level, race, and different diseases. However, there are also huge discrepancies in the funding and attention of different aspects of health. Particularly, mental health is lacking. Globally, 1 in 10 people suffer from a mental illness, and yet only a mere one percent of the global health workforce works in mental health. This puts the average mental health worker allegedly responsible for 10,000 people(based on world statistics). We know that the distribution of mental health professionals is not equal around the world. For example, in the U.S., though our mental health workforce is lacking and treating mental illness continues to be a huge public health challenge for us, we still have better access and generally more advanced treatment than millions of people suffering around the world.

One of the reasons for such low accessibility is the overall lack of funding in this area. It is estimated that only $2 per capita per year is spent on mental health in low and middle-income countries. Even higher income countries are not spending nearly enough with an average rate of 42 beds per 100,000 population. With a lack of funding, few countries have any programs in place to spread awareness of care or even to accept new patients. Less than half of countries surveyed by the World Health Organization have at least two functioning mental health promotion and prevention initiatives. Of countries that do have programs in place, most are focused on combating stigmas and largely on suicide prevention. There is a huge gap in care for women with mental illness pertaining to maternity or violence.

Along with a lack of funding comes a lack of professionals entering the field. Since 2011, the number of nurses entering into mental health professions has increased, but only by a slight 35 percent. This number also does not showcase the distribution of the new professionals entering the field- most in higher income countries. Furthermore, the countries where the largest inequities are seen are often the places where people are most susceptible to mental illness. In middle and low-income countries, there are often higher incidences of violence or more disastrous effects of natural disasters, which prove to be traumatic for the people who experience and deal with the consequences of such events. Thus, mental illness can easily manifest and often go untreated.

The World Health Organization has put into effect the Comprehensive Mental Health Action Plan 2013-2020, which aims at improving leadership, providing comprehensive care services, implementing promotion and prevention strategies, and strengthening information systems, evidence, and research as each pertains to mental illness. Hopefully, as the plan gains traction, we will start to see real progress in bridging the gaps in mental health care around the world. While higher-income countries in general have the resources, it is a matter of stepping back and refocusing to make quality and sustainable investments for long term success so that developing nations follow suit. Also, once more developed nations start to improve their care, they will be able to implement similar cost-effective programs in developing countries.

Emma Dowd

Sources: CBC , Economic Times, US News, WHO
Photo: Boston’s Children Hospital

Mincome

Alberta Canada is enacting poverty reduction measures that have been long talked about by many experts in the field. The proposed “mincome” program guarantees a minimum income to people who need it. The program would give between $900 and $1,450 per month to households currently receiving welfare. Unlike other programs aimed at boosting household incomes, the mincome program allocates the funds without set guidelines on how to spend it, allowing the process to be streamlined—an attractive idea in comparison to multiple binding and restricting programs for different allowances. The mincome would be implemented as a “negative income tax,” working as the reverse of a regular income tax, helping to boost those below a designated amount.

In a few Canadian towns and U.S. cities, similar programs have been piloted in the past. The results suggest that although, as expected, hours worked generally decreased as a result of the stipend, there were promising social benefits. Most common benefits seen were higher levels of educational attainment and fewer hospital visits, related specifically to mental health. The findings suggest that granting the poor a regulated guaranteed income alleviates high stress and gives children who often feel the need to help support their families in times of economic turbulence enough stability to stay in school and receive an education. These results have, or course, tremendous benefits for the country in the long-run. Higher educational attainment is associated with lower crime rates and higher workforce and political participation. Among many economists, particularly left-wing anti-poverty activists, the idea of a guaranteed income for those below the poverty line has been a popular topic for many years. However, the new findings have brought the idea back into light.

Still, critics remain. Most commonly, the fear is that the program will allow those who do nor work to continue doing so, comfortably. Also, the fact that the mincome would be funded by higher taxes could bring back the very problems that the policy is trying to eliminate. Still, many experts agree that the benefits outweigh the risks. While the program is still relatively new and therefore lacks the abundant research needed for fierce backing, if implemented in Alberta, more data can be collected to be analyzed for the potential for more widespread implementation. Although the program may seem only feasible for developed countries like Canada and the United States, similar programs have been tested in countries such as India and Malawi. Tailoring the program to fit the needs of the country and of the people could allow for widespread growth and poverty reduction. The program is still experimental, but if the data continues to support the policy, more and more political leaders could be convinced of program’s benefits and broader use.

Emma Dowd

Sources: National Post, PRI, The Star
Photo: The Globe and Mail

south-korea
With thousands of students vying for acceptance into top colleges, adolescent suicide rates in South Korea increasingly mirror rising scholastic pressure. These uncompromising education standards, as many suggest, continue to compromise happiness nationwide.

The bodies of two 16-year-old girls were found on a cement sidewalk in early March. A note reading, “We hate school,” was found following their jump from the multistory Daejeon hospital building.

Less recently, at the Korea Advanced Institute of Science and Technology (KAIST), students grappled with the loss of four peers and one professor to suicide. As the region’s most prestigious institution, test anxiety and copious amounts of schoolwork are part of the daily routine.

“Day after day we are cornered into an unrelenting competition that smothers and suffocates us. We couldn’t even spare 30 minutes for our troubled classmates because of all our homework,” the KAIST student council said. “We no longer have the ability to laugh freely.”

These grim narratives dominate headlines in South Korea – a country where the number of teen suicides has increased by 57 percent since 2001.

While secondary schools hold candlelight vigils and Seoul subway stations install barriers to prevent commuters from jumping, some are questioning the actual education system itself and its effects on adolescent suicide rates in South Korea.

For a typical high school student, class begins at eight in the morning and finishes at four in the afternoon. From there, however, military-style cram sessions at private institutions can last until 11 at night.

This pressure hits its peak in November, when students from around South Korea gather to take a single college entrance exam – the “suneung.” While mothers pray at churches or temples and the South Korean Air Force lands all planes, adolescents hunker over booklets and answer sheets for the nine hour test.

The “suneung” determines which university, if any, the student will attend. Most strive for the so-called SKY schools – Seoul National, Korea or Yonsei universities.

“To get admitted there decides what you can do in life and who you can marry. It determines your future,” Young Hwan Kim, a 17-year-old at Shinil High School said.

This race to success contrasts sharply with pre-World War II conditions. Though now an economic powerhouse, South Korea was once one of the poorest countries in the world, with only $64 per capita income.

Severely undereducated, only five percent of the population had attended secondary school or pursued advanced degrees.

Investment in infrastructure and human capital, in addition to foreign aid from both Japan and the U.S., pushed the country to its contemporary state. An unyielding focus was also placed on education, perhaps to make up for South Korea’s lack of tangible resources.

“We don’t have enough natural resources; the only resources we have [are] human resources,” said Kim Mee Suk, a researcher at the Korea Institute for Health and Social Affairs.

Now, in response to this mindset, roughly 75 percent of students attend a university – something many call the “Korean education miracle.”

This blessing, however, has also been a curse.

While overall suicide rates in developed countries are falling, adolescent suicide rates in South Korea continue to climb. A February survey released by the Korea Health Promotion Foundation even found that just over half of the country’s teens had suicidal thoughts this year.

Inchae Ryu, a 17-year-old student also at Shinil High School, spends 12 hours per day studying. Hunkered down in the library, clad in a navy uniform and green tie, he looks over notes for an extra English class he attends twice a week.

“I have no time to think about my future or my dreams,” Ryu said.

While attempting to stimulate the economy today, South Korean officials have blatantly disregarded what may happen in the future. In addition to overall drops in mental health, many parents are choosing not to have children because private tutors and lessons cost too much.

If this pattern continues, both in terms of diminished family size and augmented suicide rates, the country may face a deficit in that highly valued human capital. Numbers aside, South Korea may be facing an entire generation of unhappy citizens as well.

“It’s kind of alarming actually. If young students [are] not happy, we cannot guarantee their happiness when they grow up, so our future will be really dark,” Kim said.

Lauren Stepp

Sources: Aljazeera, NPR, The New York Times, The Wall Street Journal
Photo: Flickr

mental health
The connection between poverty and mental health is not surprising. The severe emotional strain and stresses associated with making ends meet, poor nutrition and unfavorable living conditions can be extremely high. Depression can be up to two times more prevalent among low-income groups and people with the lowest socioeconomic status are eight times more at risk for schizophrenia.

Yet this problem does not receive adequate attention in many places, partly due to the societal stigmas sometimes associated with mental health issues. Only two percent of national health budgets is dedicated to mental health and up to 31 percent of countries do not have a mental health budget at all.

In India, a string of farmer suicides have been making headlines. Driven to depression by rising debt, small farmers who are unable to make a profit with the scarcity of rainfall and falling prices of crops commit suicide. According to a CNN report, in 2013, 11,722 farmers killed themselves across India. The suicides plunge families further into financial insecurity and hopelessness. Government interventions are crucial to curb these disturbing losses of life. Policies pertaining to land reform, industrialization, agriculture, poverty alleviation, availability of financing and compensation to farmers are all going to be needed to alleviate the burdens on small farmers.

Stigma and isolation complicate matters in treating mental health issues. People who suffer from mental health issues are often discriminated against or are discouraged from seeking treatment.

In some parts of the world, mental problems can be regarded as a sign of an evil spirit. Sufferers are seen by traditional or spiritual healers and are not treated by counselors or psychiatrists. Decades of superstitions and beliefs are hard to overcome, particularly when dealing with a delicate problem.

Many organizations and projects are trying out methods to provide mental healthcare to affected populations, including projects like the Zimbabwe based Friendship Bench Project, which provides counseling sessions, the international Programme for Improving Mental Health Care, which researches on methods to scale up delivery of mental healthcare and India based Sangath, which trains lay people in counseling and works with other nongovernmental and governmental organizations to evaluate and launch models for mental healthcare. Dr. Vikram Patel, co-founder of Sangath, was recently named one of TIME’s 100 most influential people. This might aid in bringing more attention to this urgent issue.

While the Millennium Development Goals can go a long way towards alleviating poverty, which will reduce many of the stressors, mental health issues need to be given importance as a public health issue and duly addressed.

Mithila Rajagopal

Sources: CNN, Prime, Sangath, SciDev, Times of India, World Health Organization
Photo: Flickr

international youth day
On Aug. 12,  the U.N. hosted an International Youth Day event at its headquarters in New York City. The event focused on the importance of addressing the mental health concerns of youth around the world, thus making them less susceptible to homelessness, crime and conflict situations.

The theme of this year’s International Youth Day was “Mental Health Matters.” The half-day event in New York City brought together young people, youth organizations, U.N. Member State representatives, civil society and U.N. entities for a series of presentations including panelists and young artist performances.

This event marked the official launch of the U.N. Department of Economic and Social Affairs publication, Social Inclusion of Youth with Mental Health Conditions.

The report reveals “one-fifth of the young people around the world experience a mental health condition, with risks especially great during the transition from childhood to adulthood.”

The U.N. seeks to banish the stigma that plagues those suffering from mental illness. U.N. Secretary-General Ban Ki-moon warned in his opening remarks that failing to address access to mental health services makes affected youth “more vulnerable to poverty, violence, and social exclusion, and negatively impacting society as a whole.”

International Youth Day was marked overseas at a U.N. peacekeeping mission in Somalia, where the mental health of the young is of particular concern. Somali youth face violence and crime on a daily basis, and many are forced to join military groups or survive on the streets.

A traumatic childhood, like that experienced by youth in Somalia, breeds mental illness. According to Philippe Lazzarini, the U.N. Resident and Humanitarian Coordinator in Somalia, “We must be clear that what we need is nothing less than a paradigm shift in policies and attitudes towards the role of youth in order to empower and place them at the core of the development agenda.”

The population of those 25 years of age or younger is growing in countries like the Democratic Republic of Congo, where young people are 70 percent of the civilian body. It is especially important for countries like the DRC to focus on mental health because the youth “are not only the Congo of tomorrow, but also the Congo of today,” said a U.N. representative from the country.

The World Health Organization recommends a range of specific actions that should be integrated into national development plans in order to break the cycle of debilitating mental illness. These strategies include supporting access to school for children with mental disabilities, integrating mental health issues into broader health policies and creating employment for those suffering from mental illness.

Assembly President John Ashe summed up the objective of this year’s International Youth Day, urging, “We should be especially focused on addressing the needs of youth with mental health conditions, many of whom experience discrimination on a daily basis. We must work together to ensure that young people with mental health conditions can lead full and healthy lives.”

Grace Flaherty

Sources: World Health Organization, United Nations, UN DESA
Photo: Idealist Careers

IQ
It has been fairly well documented that a lack of food leads not only to health issues but also to problems in concentration that can affect daily tasks as well as education. What is not always discussed, however, is how a lack of food security affects IQ, a person’s mental bandwidth.

Eldar Shafir, a psychologist at Princeton University, conducted a study while visiting 464 farmers in 54 villages in Tamil Nadu in southern India before and after harvest. The farmers were given two tests to document their cognitive ability.

Due to the nature of farming in the areas studied, farmers often experience a surge of money flow around harvest time and then experience extreme hardship when it runs out prior to the next year’s harvest. The team led by Shafir found that the farmers had a more difficult time being able to pay back loans and pawned more belongings due to lack of money in the period leading up to the harvest than afterwards.

The farmers scored significantly lower on the tests before the harvest when money was tight, demonstrating that worry and stress were most likely affecting their ability to think clearly. This translated into a 13-point drop in IQ. Recognizing that people in general only have a certain amount of “mental bandwidth,””stress can decrease this bandwidth and leave little room for other cognitive abilities. In addition, it can contribute to poor decision-making among those who do not have food security.

When people are constantly worried about how much food they have or how they will afford to pay for the food they need for their families, the ability to think about other things diminishes. It is not that these people are any less smart; poverty takes up so much mental space that people’s abilities to make good long-term decisions for their families decrease dramatically because more fundamental needs take precedence.

Recognition of this is important for poverty initiatives and government programs around the globe. A person who is struggling with adequate food availability may not be able to fill out an outstanding amount of paper work for assistance or even a job application. In addition, hungry students are generally not able to concentrate in class and therefore may experience poor classroom performance. This could create a situation in which a child becomes disheartened by his or her performance and drops out of school as a result. In the long term, that student may be distrustful of education, a mindset they can pass on to their children.

The study concludes that food security must be a top priority for all aid work because it connects to so many other issues. Recognizing the significant impact of food security on a person’s mental capabilities is a first step in helping development agencies better adjust their programs to be more effective in the long run.

– Andrea Blinkhorn 

Sources: Princeton University, New Scientist
Photo: Ideorg

poverty and education interlinked
It is a well-documented fact that children from low-income households are significantly less likely to be successful than their middle and upper class counterparts. Studies have repeatedly shown a link between poverty and education. Family income is one of the strongest predictors available for measuring success, both in the classroom and later in life.

With fewer resources and less of a focus on education at home, children growing up in poverty are behind from the very beginning. Household stresses from living in poverty build up in the child, making it extremely difficult to concentrate on education.

Even if they are going to school regularly, children in poverty often fail to get an adequate education due to the stress of destitution. Since they have such a difficult time in the classroom, the kids fall into the poverty trap, in which their lack of education prevents any rise on the social ladder.

Until recently, it was unclear exactly what biological process made that the case. However, recent studies have pointed towards working memory as the key psychological factor linking poverty and education, specifically in academic achievement.

 

Working Memory Links Poverty and Education

 

Working memory is a “temporary storage mechanism” that lets us hold information and facts in our head for short-term usage and manipulation. The process of using working memory is central for reading, problem-solving and learning new languages.

A number of studies have shown that children with the best working memories also tend to have the highest test scores and the best grades. Children in poverty consistently have a less developed working memory than those above the poverty line.

With a dearth of educational resources in poor countries, an underdeveloped working memory often goes unnoticed and untreated.

This means that in addition to dealing with stress at home, children in poverty also have trouble remembering basic facts and instructions at school. Unable to stay on task, and struggling to keep up, their failure at school only adds to their stress level.

What’s more, a study published in the Development Science journal showed that, “Stress in early childhood negatively affects a child’s working memory in adulthood.”

The problems for children in poverty become even bigger problems in their adult lives. While a poor working memory for a child only means bad grades, it spells unemployment and crushing poverty for an adult.

The answer must come well before adulthood. With properly trained educators, an underdeveloped working memory can be easily spotted and rectified before it becomes a larger problem.

The lack of a proper education makes up a major part of the poverty trap — a phenomenon in which people living in poverty cannot rise up due to scarce resources, depression, lack of opportunity and other issues. The poverty trap can start before the child ever enters the classroom, and it has long-term psychological consequences.

Even from early childhood, poverty can create both a biological obstacle and an inescapable trap that collectively reduces the likelihood for academic and monetary success.

– Sam Hillestad

Sources: PsyBlog, PNAS

Poverty and Depression
In 2003, psychiatrists Vikram Patel and Arthur Kleinman suggested that there is a correlation between poverty and depression, as well as other common mental illness, in developing countries. They argued that the “experience of insecurity and hopelessness, rapid social change and the risks of violence and physical ill-health” explain why impoverished people are so vulnerable to mental illnesses such as depression.

In the United States, as of 2011, 30.9 percent of people in poverty are depressed. While this isn’t a global statistic, it does illuminate the relationship between the global depression phenomenon and global stressors, such as insecurity, violence, etc. These external factors are crucial to the development of depression, but so are internal or hereditary ones; a combination of the two is what neuroscientists now believe causes the neurological disorder.

Studies of the neurology of depression center around the neurotransmitter serotonin, a chemical messenger found in the brain associated with feelings of well-being, mood regulation, memory and cognition. Neurons release serotonin into the synaptic cleft, the space in-between neurons, and receptors on adjacent neurons receive it.

Different receptors have specialized effects. The two most important serotonin receptors in depression research are 5-hydroxytryptamine receptor 1A (5HT1A) and 2A (5HT2A.) The former is associated with increased activity, while the latter is associated with decreased activity.

One theory is that depression is caused by an uneven ratio of 5HT1A to 5HT2A receptors, with an excess of 5HT2A. This is an hereditary occurrence that leaves one more prone to depression, though not necessarily depressed. If there is insecurity, violence, etc. in this person’s environment, however, he or she is likely to develop symptoms of depression.

Another theory suggests that people suffering from depression naturally produce less serotonin than those who do not. This is, again, genetic and will only ever make one vulnerable to depression; it’s most likely a combination of genetic predisposition and external influences from one’s environment that cause this mental illness.

To counteract genetic predispositions to depression, neurologists, commonly use an antidepressant medication called selective serotonin re-uptake inhibitor (SSRI) drugs. They block what is called re-uptake, a process during which neurotransmitter transporters limit the amount of a neurotransmitter – in this case serotonin – in the synaptic cleft by taking it from receptors and driving it to other areas of the brain. Blocking re-uptake increases one’s serotonin levels where it counts, in the synaptic cleft where neurons communicate.

The effects of this medication may seem counter intuitive.

“Regardless of the emotion being happy or sad it would seem SSRI drugs dampens the experienced intensity of the emotion,” said Albert Gjedde, a neuroscientist who studies antidepressant SSRI drugs. “People in treatment with SSRI dugs describe it as if the peak of their emotions are cut away.”

Drugs such as SSRIs can help people with innate biases toward depression, but until poverty and its consequences are reduced, there will always be those at risk. Neuroscientists and philanthropists must work in tandem to mitigate the effects of depression and, eventually, to annihilate it.

Adam Kaminski

Sources: The Atlantic, ScienceNordic
Photo: Salon

Childhood Poverty
Over the years, numerous studies have demonstrated the damaging effects of childhood poverty on development. Recent testing helps to unravel how growing up poor causes psychological problems.

The human brain grows the most during the first few years of life. It has been discovered that children from poorer homes are more likely to have psychological disorders in their adult lives. To explain the correlation between poverty and psychological problems, one theory suggests that exposure to high amounts of stress during this early critical time permanently hinders an individual’s ability to cope with stress.

Testing done by Professor K. Luan Phan supports this notion. During her study, scientists examined the brain function of 24-year-old individuals, whose family situations had already been recorded 15 years prior. The participants were asked to try and control negative emotions while looking at a series of pictures.

The ability to suppress and manage feelings is key to helping individuals deal with the stress of life.

From the tests, researchers were able to conclude that the individuals who were the most impoverished at 9 years old scored the lowest on the exams as 24-year-olds. Even if the subject’s living conditions improved over the years, childhood poverty proved the dominating factor for test performance.

The findings connect childhood poverty to a lower ability to control one’s emotions. This connection supports the notion that the high-stress situation of living in poverty as a child directly affects an individual’s ability to handle strains in their adult life.

Other research done by the Washington University School of Medicine helps to explain the phenomena in a more anatomical sense. Their study showed that the psychological effects of childhood poverty are likely connected to smaller brain volumes in areas associated with emotion processing and memory. The researchers examined brain scans of children between the ages of 6 to 12, whose family history had been previously recorded.

From the scans, scientists found that the stress of poverty physically changes a child’s brain; those living in impoverished homes had smaller volumes of white and cortical gray matter. These white and gray areas are associated with the part of the brain that is associated with communication, as well as sensory and emotions. A small amount of matter in this area of the brain suggests that those functions are hampered.

So, childhood poverty has a visible effect on the brain, which reflects an impairment of emotion processing.

Though both studies are still in the testing phase, the connection drawn between childhood poverty and its lasting effects on mental development is alarming. According to UNICEF, over 22,000 children die everyday because of poverty.

Seeing the permanent damage poverty causes to childhood development highlights its severity and the critical need to address it.

Kathleen Egan

Sources: Spring, US News, Global Issues
Photo: Portside

special olympics
Rhoda Kaittany knew something more needed to be done to help her son. They lived in Nandi, a county in Kenya where children dealing with intellectual disabilities, including her child, lacked the resources to overcome their handicaps.

Working alone, she set out to organize everything required to bring a Special Olympics program to her county. During this process, she discovered children with intellectual disabilities growing up isolated from the world. In one case, a boy had been kept rope-tethered in a sheep’s pen to keep him from straying into danger.

Kenya’s situation is typical for poor countries. In fact, the majority of people dealing with developmental disabilities reside in developing countries. As Kaittany’s discoveries show, these people are often excluded from societies which lack the means to accommodate their special needs. The governments of developing countries are often too poor to devote the necessary social, health and educational resources to assisting the intellectually disabled. Moreover, few eligible families with disabled children receive government benefits in low-income countries. Lacking these resources, the disabled get stuck in poverty more often than those without disabilities.

Kaittany saw how desperate the problem had become in Kenya, one of the world’s poorest countries and home to an estimated 3.9 million people living with intellectual disabilities. She knew that the Special Olympics were part of the solution.

The Special Olympics is defined as a “global, grassroots movement dedicated to empowering the lives of people with intellectual disabilities.” The movement empowers lives first by promoting fitness through sports. A study conducted in The Netherlands found that children with intellectual disabilities tend to have less aerobic endurance and physical strength than other children. Since other research papers have suggested that improved physical fitness leads to improved cognitive and physical development in all children, it is imperative that the intellectually disabled find more opportunities to improve their fitness.

But the Special Olympics does more that just promote exercise. The organization provides health screenings, youth programs and public awareness campaigns for a population typically marginalized. It also believes in the potential of sports to educate in addition to promoting fitness. For example, in Botswana, the organization taught its athletes, who as a group were at a greater risk for contracting infectious diseases, about HIV/AIDS.

Globally, about 190 Special Olympics competitions take place every day—or 70,000 per year. The number is impressive, yet the movement strives to do more. The goal? Reach 200 million disabled people around the world through Special Olympics programs. For example, a relatively new program, the Global Football Initiative, is using the world’s most popular sport—soccer—to bring the organization closer to its goal. Through this program, Special Olympics athletes train with the support of professional clubs: the Italian Inter-Milan and the English Manchester United, for example.

So whether it is developing the bodies and minds of people living with disabilities or teaching communities how to help these individuals, the Special Olympics can play a crucial role in developing countries—as Rhoda Kaittany’s efforts have shown.

– Ryan Yanke

Sources:

Sources: USAID, Journal of Intellectual Disability Research 1, Journal of Intellectual Disability Research 2, Special Olympics, World Bank, KAIH
Photo: Special Olympics