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Mental Health in India: Community-Based Care

Mental Health in IndiaIt is estimated that 13.7% of the people living in the Southeast Asia region suffer from mental health conditions. When zooming in on India, the number rises to 15%, showing the need for reform for mental health in India. Most people suffering remain untreated in the country’s current mental health infrastructure. This contributes to the high suicide rates in Southeast Asia. When individuals remain untreated, personal and interpersonal relationships are negatively impacted. Furthermore, there are documented consequences at the individual’s socioeconomic level.

Mental Health in India

India lacks a unified health infrastructure, leading to exorbitant prices and unequal access to mental health care. High treatment costs have a detrimental effect on vulnerable populations, pushing some families into poverty as they seek treatment. While the country provides free health care to the most impoverished 40% of its population, significant gaps in coverage remain. Many people are left to pay out of pocket for up to 50% of their healthcare needs, including prescriptions.

This inconsistency in healthcare contributes to the 55 million people who are pushed back into poverty every year in India. Despite these numbers, India, the most populated country in this region, spends less than 2% of its gross domestic product on health care. Low spending has resulted in a shortage of medical staff and resources. To combat this mental health epidemic, leaders are looking toward implementing more community-based care models.

Community-Based Care

Traditionally, institutionalization has been the mainstay in treating people with mental disorders. This was first thought to provide people with a safe place to heal while struggling with a mental disorder. However, new research has shown that it is not the most effective method. New understandings push public health leaders to advocate for and develop a new community-based care system. The care system will center the individual and their community at the core of treatment. The Southeast Asia Director of the World Health Organization (WHO), Ms. Saima Wazed, explains how “as our understanding of mental health has evolved, so too must our methods of care.”

As WHO Southeast Asia transitions to a community-based care model, it is emphasized that this shift will reduce the negative impacts of institutionalization. It will provide more community support for individuals with mental disorders. This new model of care will increase the number of people with access to mental health care and offer improved treatment outcomes. In March 2024, a three-day meeting was held in Bangkok, Thailand, to discuss how best to implement community-based care in the region.

Those working to create more awareness and implement community-based care are also fighting the deep stigma that surrounds mental health in India. Often fueled by misinformation, the stigma prevents many people from accessing the care they need for fear of social marginalization. This is contributing to an underutilization of available resources.

Final Words

India, having one of the highest percentages of individuals affected by mental health disorders, stands to gain the most from implementing community-based care as a pillar of mental health treatment. This new development from WHO Southeast Asia will aim to eliminate institutionalization as the region’s focal form of therapy and instead explore community as a highly researched alternative.

– Carlee Unger

Carlee is based in Pembroke, NC, USA and focuses on Global Health for The Borgen Project.

Photo: Flickr

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How Poverty in India Makes It Difficult to Seek Support

Poverty in IndiaAcross the globe, the discussion surrounding mental health has become more accepting in recent years. By reducing stigma and increasing access to potentially life-saving care, people are now more than ever encouraged to get the help they need. India is no exception to this. The Indian government launched the National Mental Health Program (NMHP) to improve mental health services in 1982 and aims to provide community-based mental health care.

A watershed moment in awareness for those struggling with their mental health in India was the Mental Health Care Act 2017. The act ensured that every person has the right to access mental health care and treatment from services run or funded by the government; this treatment must be of good quality, affordable and available without discrimination.

The Role of Poverty in India

These acts alone cannot overcome the exceptionally disadvantaged position impoverished individuals in India face. People experiencing poverty in India often reside in rural or underserved urban areas where mental health services are scarce or nonexistent. Even these government-run mental health facilities are limited and unevenly distributed around the country. According to a National Mental Health Survey (NMHS) conducted in 2015-16, about 70-80% of those suffering from mental disorders in India did not receive treatment, an unsettlingly high statistic.

Additionally, communities are unable to band together to support these individuals, with almost half of persons surveyed by the NMHS attributing mental health struggles to personal weakness. This deep-seated stigma surrounding mental health is prevalent in India, which leads struggling children and adults to blame themselves for disorders rather than seeking the help necessary. In these areas, school systems also tend to have less information to speak about mental health, unknowingly allowing deep-seated cultural beliefs and superstitions about mental health to persist to the detriment of struggling citizens.

In fact, the literacy rate in rural India stands at around 68.91%, compared to 84.11% in urban areas. This disparity limits the dissemination of mental health information. Even online means fail, with those in poverty-stricken areas only accounting for about 25% of the country’s total internet database, hindering access to online mental health resources and telehealth services.

Perseverance

Because of India’s shortage of trained mental health professionals, telehealth services are absolutely vital yet inaccessible to those who need them. Despite the government’s attempts at change, their reach has been limited; however, this isn’t to say that all hope is lost. Mental health services are currently being integrated into primary health care to ensure that mental health assistance is accessible at a base level.

The Central Board of Secondary Education has made another example of the attempts to raise support. Schools are essential in shaping children’s foundational beliefs, which is why discussing mental health topics in the school curriculum and providing training for teachers to identify and support students with mental health issues is the best way to bring change to the country.

– Abby Collins

Abby is based in Westwood, MA, USA and focuses on Global Health for The Borgen Project.

Photo: Flickr

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Mental Health in Tonga

Mental Health in TongaAccording to the World Health Organization (WHO), as of 2022, one in every eight people globally suffers from mental health disorders and diseases. However, the effects are seen disproportionately, as developing countries face higher rates and poorer treatment options than more developed countries. A look into Tonga highlights this.

Causes

Mental health challenges that people in Tonga face mainly stem from difficulties or trauma, even from natural disasters. Tonga’s Prime Minister Hu’akavemeiliku Siaosi Sovaleni, in 2022, tells of the trauma people faced during the aftermath of the volcano and tsunami attacks on their motherland. Disasters have resulted in destroyed homes and infrastructure, leading to a significant toll on mental health.

Another major cause is substance usage and abuse. The Guardian, in 2022, talks about the drug crisis in Tonga, where between 20% to 70% of hospital admissions are because of drug usage and abuse. It further says that drugs have now become a major contributing factor to the onset of mental illnesses and the frequent relapse of individuals with chronic psychiatric disorders like schizophrenia and bipolar disorder.

Stigma

There is a great stigma around receiving mental health treatment in Tonga, a major reason why many who suffer from mental health conditions choose to keep the illness to themselves and don’t seek help. That’s because of Tongan traditional views of being possessed by spirits or cursed if one has a mental illness. Moreover, Tongan culture has a larger role in this in that family image is very important. Ali Latsu, in a Medium article, explains that Tongans rarely embrace an individualistic mindset, if at all. For Tongan parents, hearing their child confess to mental illness can feel like a veiled criticism of their parenting.

Services

Tonga lacks the extent of resources needed to support the growing population of people who are increasingly struggling with mental health challenges. Besides that, instead of resources increasing and progressing, they are decreasing and regressing. The Mental Health Atlas in 2020 found that the number of mental health workers per 100,000 population decreased from 21.62 in 2017 to 17.23 in 2020. Similarly, the number of community mental-based mental health services per 100,000 decreased from 5.67 in 2014 to just 3.83 in 2020. This downward trend is alarming.

Efforts

In 2022, the University of Auckland announced a groundbreaking partnership. This partnership involves researchers from the university, Te Poutoko Ora a Kiwa I Center for Pacific and Global Health and the Tonga Ministry of Health. The New Zealand Ministry of Health Polynesian Health Corridors supports it. The partnership aims to provide essential population-level insights into mental health and mental health services in Tonga. This information will offer much-needed insight and information to improve the mental health resources available in Tonga.

Furthermore, in March 2024, Tonga’s Minister for Mental Health, Matt Doocey, announced the launch of a new initiative to implement mental health and addiction peer support services in hospital emergency departments. The initiative aims to improve outcomes for individuals seeking crisis help while enabling clinical staff to concentrate on clinical work.

– Shreyan Singha

Shreyan is based in Coral Springs, FL, USA and focuses on Global Health for The Borgen Project.

Photo: Wikimedia Commons

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The Impact of Mental Health in Czechia

Mental Health in CzechiaThese days, the mental health landscape of Czechia is undergoing significant changes. Recognition of mental health issues has increased, and efforts to improve services and support are expanding. According to the World Health Organization (WHO), mental health disorders are very common worldwide: one in every eight people is suffering from a disorder. In the Czech Republic, trends are highly comparable to the worldwide situation, but specific problems and developments well deserve to be addressed.

Causes

These include socioeconomic conditions, lifestyle changes and the historical context. Approximately one-fifth of the population suffers from mental-health-related issues and problems, according to the National Institute of Mental Health in the Czech Republic. Depression, alcohol-related disorders and anxiety are the leading disorders reported or diagnosed in this area. Indeed, many more people could be silently suffering from these mental health disorders during times like this.

The economic transformation after the fall of communism also contributed to this factor here. As a result of rapid changes in society, increased stress levels have been created among people, which can further give way to mental health complications. Additionally, poverty strongly correlates with mental health challenges, where those in lower economic strata experience higher rates of mental health disorders and face significant barriers in accessing mental health care.

Stigma

Despite increasing mental health awareness worldwide, stigma remains a significant barrier in Czechia. According to a report by the European Union Agency for Fundamental Rights, many individuals with mental health problems in Czechia experience discrimination, particularly in employment and interpersonal relations. Cultural factors and historical contexts contribute to feelings of isolation, making it challenging for people to seek support and discuss their mental health openly.

Services

Czechia had made plans to develop and improve its mental health services, although gaps still exist. The Mental Health Atlas of WHO in 2020 indicated that approximately 30 mental health professionals per 100,000 population in the Czech Republic. The government has responded by initiating various programs to strengthen the mental health infrastructure, such as the integration of mental health services at the primary care health services and expansion at the community level.

Recent initiatives in Czechia’s mental health care include efforts to improve access to services for children and adolescents, enhance mental health education and reduce stigma. International cooperation has also facilitated the exchange of best practices, contributing to the development of mental health services in the country.

Czechia is at a critical stage in managing mental health, with significant strides being made in reducing stigma, enhancing services, and integrating mental health into broader healthcare.

– Ansha Gupta

Ansha is based in Apex, NC, USA and focuses on Global Health for The Borgen Project.

Photo: Flickr

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Improving Child Mental Health in Ethiopia

Improving Child Mental Health in EthiopiaEthiopia, a landlocked country in East Africa, is the continent’s second-most populous nation with an estimated 129 million people. Despite its large population, poverty is pervasive, with 68.7% of its residents classified as multidimensionally poor, according to the Oxford Poverty and Human Development Initiative. The impact on children is particularly severe, with an estimated 13 million living in poverty and two million in extreme conditions, lacking necessities such as housing, sanitation, clothing, food and education. Additionally, mental health in Ethiopia remains a significant concern, with a noticeable lack of resources and awareness compounding the challenges faced by those living in poverty. The United Nations (U.N.) emphasizes that “…it is most threatening and harmful to children, leaving them unable to enjoy their rights, to reach their full potential and to participate as full members of the society.”

Mental Health in Ethiopia

Childhood and adolescence are crucial phases for physical and mental development and poverty could hinder a child’s ability to focus on studies and connect with peers. In sub-Saharan Africa, the prevalence of depression among 10 to 19-year-olds is about 27%, significantly higher than in Europe and other high-income countries. In 2023, around 24.68% of Ethiopian children experienced mental health issues. The stark disparity in mental health prevalence between regions stems from differences in socioeconomic status, living conditions and public childcare resources. High-income countries, with more advanced childcare systems, provide minimally adequate care for depression to approximately one out of every five individuals, contrasting sharply with one out of 27 in lower-middle-income countries like Ethiopia.

Tackling the Root Source

In Ethiopia, the lack of a defined mental health system for children stems not just from inadequate resources but also from a pervasive lack of awareness. Many Ethiopians hold traditional views on mental disorders, encapsulated in the phrase “Lij Bedilu Yadgal,” which translates to “children will grow by their chance or luck.” This perspective aligns with the belief that mental health issues are spiritual and best treated through cultural or religious practices. Combined with the challenges posed by poverty, this has led to significant gaps in child psychiatric services within the health care system. Addressing these issues requires a focus on community mental health care to enhance awareness, reduce stigma, support recovery and foster social inclusion.

A New Direction

Recently, Ethiopia’s Federal Ministry of Health has initiated new mental health initiatives, including the Enrichment Center Ethiopia’s Support the Care-givers Intervention Program (SCI). This innovative program brings together a team of professionals and volunteers from around the globe to assist infants and children in meeting critical developmental needs. Despite scarce resources, SCI focuses on children aged 0 to 6, aiming to elevate caregiving knowledge by training mothers, social workers, teachers, teaching assistants and childcare staff in orphanages. The training encompasses four weeks of comprehensive sessions in eight different groups, covering essential caregiving skills such as attachment and secure base, insightfulness, reflective functioning and dialogue, emotional regulation and empathy. This approach is designed to enhance the early developmental environment for Ethiopia’s children, particularly in settings where traditional support structures may be lacking.

So far, the Enrichment Center Ethiopia’s training program has educated more than 400 caregivers, with overwhelmingly positive outcomes. Participants report reduced instances of violence, enhanced family dynamics, deeper emotional bonds with children and increased job satisfaction. Leveraging local resources and manpower, ECE’s experience serves as an inspiring model for other communities, demonstrating a cost-effective approach to raising awareness and improving mental health care for young children.

Looking Ahead

Ethiopia’s challenges with widespread poverty and inadequate mental health resources, especially for children, require ongoing attention and intervention. Initiatives by the Federal Ministry of Health and programs like the Enrichment Center Ethiopia’s caregiver training are making strides in addressing these ongoing issues. By focusing on enhancing caregiving practices and providing support, these programs aim to improve the mental health and well-being of Ethiopian children. Continued dedication to these ongoing efforts could be vital in creating a healthier and more resilient future for the country’s youth.

– Kewe Chen

Kewe is based in Memphis, TN, USA and focuses on Good News for The Borgen Project.

Photo: Flickr

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Addressing Mental Health in Nicaragua: 3 Promising Programs  

Mental Health in NicaraguaMental health is a significant global health concern, and many countries are striving to find effective solutions. According to the 2022 World Mental Health Report, about one in eight people in the world live with a mental disorder. Creating a positive mental health environment has been a complex journey for the citizens of Nicaragua, as they have faced many external hardships, including political regimes and natural disasters.

Mental Health in Nicaragua

In Nicaragua, there is a severe lack of health care professionals for those suffering from mental health issues. According to the World Health Organization’s (WHO) Mental Health Atlas in 2020, there were only 250 mental health professionals in the entire country. That means for every 100,000 people, there are less than four mental health professionals. Medical professionals are necessary for Nicaraguan citizens to attend to their health needs. Without their care, the citizens must manage their health issues on their own.

The lack of those professionals is only one part of the problem. The places where those people go to get the help they need are also an issue. There are only five mental health outpatient facilities attached to a hospital in the country and only one main mental hospital which had a total number of 1, 179 admissions, according to WHO. This severe lack of resources for those dealing with mental health in Nicaragua can lead to many people not receiving the help they need.

Within the population of Nicaragua, approximately 24.9% live in poverty, according to the World Food Programme (WFP). Since there are few medical professionals and places, those who live in poverty and suffer from mental health have almost nowhere to go.

This difficult reality is still prevalent in Nicaragua, even so, the country is working towards fostering positive mental health. Education and outreach are two of the key factors when it comes to changing the mental health crisis. Here are three programs that are reworking mental health in Nicaragua:

ANDEPSI

Due to the lack of mental health professionals in Nicaragua, The Nicaraguan Association for the Development of Psychology (ANDEPSI) has set out to change this issue. ANDEPSI started in 2016 and has continued to promote mental health to the citizens of Nicaragua. Psychology professionals in Nicaragua are better equipped to address mental health issues through the dedication of ANDEPSI to enhancing their training. Education is the first step, as ANDEPSI works with both students in university and senior professionals, updating both groups on advancements in mental health. This leads to better-equipped workers handling mental health challenges.

The association educates those within this field and those in the community through regular educational events in the media. Through this level of outreach, the ANDEPSI is promoting a well-rounded education of professionals that trickles down to the individuals affected by mental health in Nicaragua. More educated professionals can result in those who live in poverty getting the help they need closer to them rather than travelling to one of those five outpatient facilities. The group has made small but meaningful progress such as creating alliances with national universities, joining the International Union of Psychological Science, and has organized meetings to discuss climate change action in the country, according to the American Psychological Association (APA).

The Mental Health Innovation Network

The Mental Health Innovation Network (MHIN) is conducting a research project focusing on improving Nicaragua’s mental health literacy. The project’s approach includes educating teachers who will then educate students and developing an “innovative tech platform to support youth self-education on mental health.” This allows both students and teachers to learn more about the reality of mental health and decrease the surrounding stigma. The group conducted their initial research which showed promising program results such as lower psychological distress scores among students. Researchers within the group also reported that “90% of intervention teachers and students were very satisfied with the curriculum and felt it was important to continue to offer it in school programming.”

The project plans to implement a variety of resources beyond the education curriculum, such as a platform to discuss these issues. Platforms like this help educate and encourage those who face these issues to get the help they need. The Ministry of Education plans to continue this form of education and the research group is looking to work with policymakers to increase the program’s outreach.

CISWH

The Center for Innovation in Social Work and Health (CISWH) has gone a different route regarding mental health in Nicaragua, through social work trips. In 2022, the CISWH trip partnered with many Nicaraguan companies and organizations, such as the National Autonomous University of Nicaragua FAREM-Estelí (UNAN-FAREM). The Superemos Foundation, based in Estelí, conducted psychosocial seminars as part of its community development work through health and social services.

The seminars, focused on trauma and mental health, educated many community members such as the Estelí Department of Public Defense and medical personnel from the University. CISWH travelled to other parts of the country to conduct seminars on other issues, including the environment.

Along with mental health, the group pushes for environmental activism. They met with La Mariposa, a school and hotel that uses its profits to fund rural community projects. Those on the trip learned about La Mariposa’s current plan to improve access to clean water. By educating people on these issues in communities, it brings awareness and potential help within these programs. For those living in poverty, community outreach is one of the many ways they can receive training and education on issues such as mental health and the environment.

This form of outreach allows citizens to engage with each other and get educated on global issues. In the future, CISWH plans to continue this outreach remotely as it trains UNAN-FAREM students in social and psychology.

The Path Forward

Mental health in Nicaragua is a critical and complex issue with deeply intertwined with the country’s socio-political landscape. Through these organizations, it is clear that the solutions to the mental health crisis start with educating those on the front lines. Medical professionals and students alike must be kept informed and updated on the various aspects of mental health care. Community outreach goes hand in hand with that as it empowers the citizens to receive education on this topic.

Mental health and poverty are two sides of the same coin. When a person is mentally sound, they can reach for better opportunities to work out of poverty. This boosts the economy as well since if more people are working then the economy is bound to grow. By engaging with people, the country can alleviate mental health and open the door for more conversations regarding it.

While mental health is still an ongoing issue in Nicaragua, suicide-related deaths have been improving since 2018 and stands at 4.35 deaths per 100,000. There has also been an increase in community-based mental health services from 2017 to 2020. As Nicaragua continues to navigate its country’s challenges, addressing these mental health issues needs to be a priority to ensure the well-being and resilience of its population.

– Tess Curran

Tess is based in Boston, MA, USA and focuses on Technology and Global Health for TheBorgen Project.

Photo: Wikipedia Commons

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Partners in Health Aids Poverty Reduction Through Health Care

Partners in HealthPartners in Health (PIH) is a nonprofit global health organization committed to providing better health care to people struggling with extreme poverty across 11 countries. PIH strives to build relationships with sister organizations in countries where poverty is a major issue, aiming to improve health care access. It achieves this through two main approaches: delivering the benefits of modern medical science to those most in need and serving as an antidote to despair.

Poor health care and overall health significantly contribute to poverty in a country’s population. Many people living in poverty cannot afford treatment, leading to untreated illnesses and long-term health issues. However, stronger health care systems enable developing countries to enhance the overall status of their health services. Providing better health care means the population is healthier, can work, attend school and thrive rather than survive. Additionally, improving health care in developing nations boosts the economy, as a healthier population is more productive, contributes more effectively to the workforce and stimulates economic growth.

Global Reach and Mental Health Initiatives

PIH operates in countries across four continents, including Haiti, Rwanda, Peru, Mexico, Malawi, Liberia, Sierra Leone, Lesotho, Kazakhstan and the United States (U.S.). The organization strengthens public health systems to ensure patients receive necessary care in their homes, local clinics or regional hospitals. Globally, PIH employs approximately 18,000 staff members, 99% of whom are from the countries where it serves.

PIH has established the Cross-Site Mental Health Program as one of its initiatives to support mental health development in the countries where it operates. Unlike many other NGOs, PIH strongly emphasizes community-based, primary care and hospital-linked mental health systems. This program addresses severe mental health conditions in areas that typically have little support for mental health.

Vision and Strategy for Mental Health Care

Many factors contribute to mental health issues, with some of the primary ones being homelessness or lack of home security, unemployment or unreliable income and family breakdowns, often due to the separation of families. While numerous other factors can affect mental health, many people living in poverty experience at least one of these issues. PIH aims to make the greatest impact on these individuals.

Partners in Health (PIH) aims to enhance the lives of poorer communities globally by increasing mental and psychological support in developing countries. Through its PIH Mental Health Value Chain, the organization strives to ensure that people receive the treatment they need, enabling them to lead better lives and escape poverty. The PIH model is built on four key pillars designed to improve mental health care in developing nations and enhance lives through better health care. The key pillars are as follows:

  • Clinical care and training. Mental health requires professionals trained to address such issues. Therefore, this pillar offers the necessary supervision and mentorship to support mental health initiatives.
  • Program management. This approach ensures that resources are directed in the most efficient ways to optimize their use.
  • Meaningful data collection. Research is essential for gaining a better understanding of issues in developing nations through monitoring and evaluation.
  • Shared learning. The Cross-Site Mental Health Learning Collaborative enhances understanding of mental health issues through both in-person and technological interactions.

Health Care Improvements in Haiti

By improving health care related to mental illnesses, developing nations can boost morale and begin to reduce poverty levels, as poverty and mental health issues are often interconnected. People experiencing poverty are typically more at risk of mental health issues, so addressing mental health can also help decrease poverty. An example of Partners in Health’s (PIH) efforts to provide better mental health care is its work in Haiti, a developing Caribbean island nation with a long history of economic and political turmoil, natural disasters and postcolonial exploitation.

PIH and its partners have developed a more reliable health care system in Haiti, previously unavailable in the country. The program has integrated mental health into primary care through a task-sharing model in collaboration with the Ministry of Health (MOH). As a result, psychologists, social workers, nurses, physicians and community health workers have become more common in the country, enhancing health care provision. This improvement means that people living in poverty have better access to care and increased chances of recovery. An enhanced health care system benefits developing countries in four main ways: it boosts productivity, reduces absenteeism from work and school, decreases poverty and improves quality of life.

Looking Ahead

As Partners in Health (PIH) expands its efforts to provide health care and mental health services in impoverished regions, the organization continues to make a significant impact on global health outcomes. By collaborating with local entities and enhancing health care infrastructure, PIH is fostering resilience and a better quality of life for communities in need. Moving forward, its work in improving health care access and mental health support promises to contribute to the economic and social development of the countries it serves, leading to more sustainable and healthier futures.

– Lachlan Wellington

Lachlan is based in Fareham, UK and focuses on Technology and Global Health for The Borgen Project.

Photo: Flickr

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Poverty and Mental Health in Hong Kong

Mental Health in Hong KongDespite being one of the freest and most developed economies in the world, Hong Kong is a city characterized by high levels of inequality, with a significant portion of the population living in poverty. Not coincidentally, the city also faces prevalent mental health challenges, which are both a cause of poverty and a consequence. It was estimated that every one in seven people in Hong Kong experience a common mental disorder at any given time and 74% of mental health sufferers do not seek any professional help.

Even more concerning is the state of mental health of youth in the city: A 2023 survey estimates that about one in five participants experienced at least one mental health issue in the past 12 months, a rate significantly higher than the global average. In addition, more than half of the sufferers experience more than one mental disorder.

The Risk of a Vicious Cycle

Poverty and mental health in Hong Kong are deeply interconnected. Studies focusing on the city found that in comparison to their higher-income peers, working adults and children in low-income groups face poorer mental health and lower self-esteem. Research also suggests that poverty contributes to poor mental well-being by causing material deprivation. At the same time, income poverty does not directly correlate with mental health.

Besides the direct relationship between poverty, deprivation and mental disorders, lower-income individuals are also more vulnerable to other risk factors for mental disorders, such as the pressure to overwork. A 2016 survey found that workers in Hong Kong work an average of 50.1 hours per week, 35% higher than the global average among 71 other cities. As a result, 25% of Hong Kong workers suffer symptoms of depression and anxiety, 2.5 times above the global average. Another contributor to mental health problems is housing conditions and limited living space, an issue almost only faced by low-income individuals.

While low-income populations are more vulnerable to mental health problems, the symptoms of mental illnesses and the social stigma attached to them make it harder for sufferers to lift themselves out of poverty. Such a two-way relationship between poverty and mental health can lead to a self-perpetuating vicious cycle for low-income individuals, leading to chronic, intergenerational poverty.

Government Initiatives

In December 2023, in response to the city’s mental health crisis, the government launched a 24-hour mental health support hotline that coordinates the resources of about 20 related organizations. Earlier in the year, the Hospital Authority (HA) also promised to enhance support for patients with severe mental disorders by increasing the ratio between case manager and patient, exploring new treatments and reducing patient waiting time.

Grassroot Organizations

Nongovernmental organizations (NGOs) also play a crucial role in addressing Hong Kong’s mental health crisis. Mind HK, for example, provides free talking therapies and check-in services for individuals with mild to moderate mental health problems. The organization also engages in campaigns and events to raise awareness of mental well-being, as well as training sessions that educate people on mental health literacy. In 2022 alone, more than 6000 participants joined the nonprofit’s training sessions.

KELLY support group, on the other hand, focuses on the mental health of youth and adolescents. The organization organizes programs that promote peer support around emotional well-being and provides referral services to match youth with partnering organizations for counseling services and other support.

Final Remark

While the interconnections of poverty and mental health in Hong Kong are associated with the risk of a vicious cycle for sufferers of mental disorders, from a positive perspective, addressing the mental health crisis in the city also contributes to poverty elimination in the long term. Hong Kong’s ongoing initiatives protect not only the mental wellness of its residents but also social equity and economic development.

– Wangruoxi Liang

Wangruoxi Liang is based in Ann Arbor, MI, USA and focuses on Global Health for The Borgen Project.

Photo: Flickr

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Mental Health in Tajikistan: The Living With Dignity Project

Mental Health in TajikistanIn 2018, International Alert, an organization attempting to tackle community violence in societies with a history of conflict and extreme poverty, embarked on the Living with Dignity project, an effort to tackle economic insecurity and reduce domestic abuse, hoping to improve mental health in Tajikistan.

Poverty and Gender Inequality in Tajikistan

Declaring its independence from the Soviet Union in 1991, Tajikistan had a deadly civil war from 1992 to 1997, which greatly deepened social, economic and political inequalities already largely prevalent in the country.

Despite recent successful efforts to decrease poverty, Tajikistan is still the poorest country in Central Asia. As of 2019, approximately 26% of inhabitants lived in poverty, calculated based on income compared to the costs of basic necessities, with higher poverty rates in rural areas. In addition, around 6% of the population falls below the international poverty line. The Living with Dignity project has found that this widespread economic insecurity has profoundly negative consequences for mental health in Tajikistan.

Another key issue in the country is gender inequality. UNICEF reported a significantly higher rate of female suicide than male suicide, which by global standards is unusual, prompting questions as to the causes of this unique case. While official government figures report that approximately 31% of women from the ages of 15-49 have experienced forms of physical and emotional domestic abuse, research by International Alert indicates that the real figure could be greater than 60%. One key cause of this propensity to violence within many households is economic insecurity and the stresses it places upon families. The high rates of abuse have massively detrimental effects on mental health in Tajikistan.

Living With Dignity

International Alert’s Living with Dignity program focussed on transforming violent familial behavior through communication and reflection workshops, which provided a space for family members to understand each other’s experiences and needs better, according to the International Alert report. It found that a key cause of discord within the family was economic insecurity. So a key tenet of the project was the economic empowerment of women who generally have very little say in household financial management. The program also made use of gender sensitivity training and professional mental health services to challenge the patriarchal norms that dominated these areas and explore how they harm women’s mental health.

Economic Empowerment

International Alert found an increase in economic independence for women to be highly important in improving mental health, with participants reporting that they felt more heard in decision-making within the household. Moreover, an upturn in women’s participation in work led to greater economic security, which massively affects mental well-being. Throughout the Living with Dignity project, there was a 32% increase in families having enough food and money to support their needs. Moreover, at the beginning of the project 42% of women reported going to bed hungry at least once a week, while by the end of the project, that number was down to just 8%, according to the International Alert report. Many participants stated that an increase in economic stability was the key change in improving their mental health, given it made many women feel more valued and respected by their families.

Effects on Domestic Abuse

International Alert reports a 24% decrease in women feeling fearful in their household every week throughout the program. According to interviews conducted, this was largely brought about by an increase in respect between family members, fewer instances of domestic violence, greater economic independence of women and thus greater mobility. International Alert also found an increase in women feeling comfortable sharing their opinion on matters of household finance by 22%, and a 38% increase in women believing they now had more of a say in decision-making, both of which correlated strongly with improved psychological and emotional wellbeing.

Throughout the project, there was also a marked decrease in specific instances of violence and the amount of individuals who felt the use of violence in the home was acceptable. The gender sensitization training aimed to encourage families to deal with disputes in non-violent, diplomatic ways, which produces more comfortable home environments for women, facilitating better mental health outcomes.

The Living with Dignity project, then, has had a positive effect on the lives of many of these women, improving mental health in Tajikistan through tackling patriarchal, often abusive, norms and promoting both women’s safety and economic independence. Programs like this show that, by tackling global poverty we can reduce domestic violence and improve mental health outcomes.

– Billy Jardine

Billy is based in Liverpool, UK and focuses on Global Health for The Borgen Project.

Photo: Unsplash

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Mood Over Matter: Mental Health in Malta 

Mental Health in MaltaMalta, the small island state at the heart of the Mediterranean Sea, faces an epidemic of undiagnosed mental health problems. As many as 120,000 of its citizens struggle with some form of mental illness. An article from Lovin Malta interviewed several Maltese individuals who shared their mental health struggles. Two interviewees described living with anxiety and stress, self-diagnosing as suffering from Post-Traumatic Stress Disorder (PTSD). Another two detailed their difficulties with neurodivergence—one with suspected Asperger’s syndrome and the other with inattentive ADHD—conditions that significantly impact mental well-being.

The mental health issues in Malta are as varied as in any other part of the world. Maltese people face similar challenges to those in more developed countries, not due to a lack of humanity or civility, but because of limited access to essential services and an unstable economy. Despite these challenges, “0.7% of all deaths among Maltese residents in 2017 were deaths by suicide” and the country ranks 40th globally in terms of national happiness.

Factors Affecting Mental Health Decline

Over the past decade, Malta has experienced a significant influx of migrant workers from within the EU and beyond. This population increase places pressure on society, particularly on the healthcare system, straining those responsible for its operation. This cultural shift forces the host nation to adapt inclusively to reflect the values of all its inhabitants. While this progression is often seen positively, it can be overwhelming for some, especially those already in a fragile mental state. The result is a society where some embrace change, while others feel abandoned by their culture.

Ironically, the push towards a more egalitarian society has disproportionately affected the vulnerable. As women increasingly enter the workforce, traditional care roles are diminishing, leaving the elderly and infirm to rely more on state support.

Until recently, the Maltese government did not prioritize open discourse about mental health. A lack of political will, consensus and leadership hampered efforts to address the issue, according to Health Policy.

Need for Change: Positive Developments

Significant improvements have been made in Malta’s approach to mental health over the past decade, building on reforms from the early 1990s. In 2012, Malta appointed its first Mental Health Commissioner, marking a turning point, Health Policy reports. Increased pressure from public bodies and media figures has helped to destigmatize mental health issues, prompting more open discussions.

Previously, Malta had the highest average length of stay for inpatients with mental and behavioral disorders in the EU. In 2013, the average stay was 57 days, which decreased to around 40.5 days by 2019. The number of hospitalized patients per 100,000 population also dropped from 144 to 89.7 during the same period, according to Health Policy.

The health care system now favors community hostel care or independent living arrangements over prolonged hospital stays, allowing patients to maintain their autonomy and human identity.

NGO Involvement

Several organizations are spearheading initiatives to combat mental health issues in Malta. These include the Mental Health Association Malta (MHAM), the Malta Federation of Organizations Persons with Disability (MFOPD) and the Malta Health Network (MHN).

Founded in 1982, MHAM supports caregivers of the mentally ill, educates the public to reduce ignorance and stigma and advocates for legislative changes to benefit caregivers and support workers.

Founded in 1970, MFOPD supports 41 member organizations and works on initiatives to reduce stigma, enhance societal understanding and improve integration and services for persons with disabilities. It advocates for the rights and needs of persons with disabilities, engages in lobbying efforts, and participates in relevant government structures and European events.

Established in 2007, MHN is an organization that focuses on promoting health-related interests for patients and the community in Malta. It collaborates with governmental, non-governmental, and not-for-profit organizations as well as patient representative groups to enhance health services and patient advocacy.

In February 2024, the organization launched a “To be seen and to be heard” (Arani u Ismagħni) campaign seeking to empower patients and equip them with skills of self-management and professional communication.

Future Directions

While Malta has made observable progress, the WHO is keen to draw attention to the work still to be done. Reducing poverty from its current rate of 9.2% to zero is crucial, but, according to WHO, so, too, is improving staff communication with patients and spreading information about mental health issues. 

Financial hardship and mental distress are interconnected. Studies suggest both poverty and mental health issues are still stigmatized, with some believing mental health is a middle-class issue. Research in Glasgow, however, indicates higher rates of mental health issues in deprived areas, though suicide rates are higher in affluent areas. This disparity highlights structural differences in access to resources, with the affluent having better access to mental health services, while the impoverished often face desperation and neglect.

It is challenges such as the above that an organization like MHA seeks to overcome; by combating the stigma that mentally ill people and their caregivers face in Malta and ensuring mental health services are both well-staffed and well-funded.

In September 2017, the MFOPD initiated a campaign comprising a series of educational modules that sought to assist those living with intellectual disabilities to engage in an independent lifestyle. The project’s mission statement was “Enhancing Social and Economic Inclusion Through Independent Living” and it reached 360 people by the project’s end.

– Thomas Johnston

Thomas is based in Dungannon, County Tyrone, Northern Ireland and focuses on Good News and Global Health for The Borgen Project.

Photo: Flickr