Mental Illness in EthiopiaEthiopia is the second most populated country in Africa, with a population of over 100 million. With such a large population comes a prevalence of poverty as well as disease. In an estimate from 2014, around 30% of Ethiopia’s population was below the poverty line. According to statistics from this year, Ethiopia also makes it onto the list of the world’s poorest countries, ranking 7th poorest in the world in both GDP growth and GDP per capita. Along with this poverty comes a myriad of diseases. The top four causes of death in Ethiopia are, in order, neonatal diseases, diarrheal diseases, lower respiratory infections and tuberculosis. While these diseases are quite well-known, Ethiopia is also plagued by another type of disease: mental illness. Mental illness in Ethiopia may not be as recognized as the other diseases that plague Ethiopian citizens but mental illness can impact overall general health and the ability to provide for one’s family.

A Troubled Past

Despite the fact that an estimated 15% of Ethiopians suffer from mental illness and substance abuse disorders, for decades almost nothing was done to address or treat these issues. In the 1980s, there was only one psychiatric hospital in the entire country and such an insignificant number of psychiatrists, that it was almost impossible to find treatment. Moreover, the psychiatrists who did practice at the time were often not interested in developing new research and treatment techniques. Because of this, most cases of mental illness went untreated, leaving mental health sufferers to face both isolation and discrimination.

A Passionate Doctor

When Dr. Atalay Alem started his medical work, there was only one psychiatric hospital in the country. After his decades of work, spanning from the 1980s until modern day, his efforts to improve the psychiatric treatment of Ethiopians have had a massive payoff. He started as a medical doctor before receiving his degree in psychiatry. After that, he became a psychiatric professor at Addis Ababa University, where his research and his passion for better mental health services were instrumental in the expansion of Ethiopia’s mental health care. Alem was also a key founder of the graduate psychiatry program at Addis Ababa University, giving more Ethiopians a chance to make a difference in the field. Today, there are almost 90 psychiatrists practicing in Ethiopia. Apart from these psychiatrists, there are hundreds of psychiatric nurses as well. These nurses are part of what has made such widespread psychiatric care possible and their presence has aided in the addition of mental health services at most Ethiopian hospitals. For his efforts, Alem was awarded the Harvard Award in Psychiatric Epidemiology and Biostatistics in 2019.

A Positive Future

Though Ethiopia has a total of under 100 psychiatrists, the current number is a great improvement from just a few decades ago. Moreover, with the help of Alem and other passionate psychiatrists, research efforts continue to grow. Alem is currently working on a study that looks at the way severe mental illness impacts rural Ethiopian communities in order to evaluate how to improve treatment and maximize impact. The Ethiopian government is also invested in improving the diagnosis and treatment of mental illness. The government, starting seven years ago, created a mental health strategy to aid the country’s mentally ill and allocated government funds to the overall improvement of mental healthcare. These funds have gone toward improving health services, such as more adequate healthcare training and increased access to psychiatric medications. Part of the reason Ethiopia’s mental health treatment has improved so much is due to the partnership between the Ethiopian government and the World Health Organization. WHO was absolutely key in providing guidelines for how to implement these new mental health care strategies.

Though progress always takes time, with the help of doctors like Alem and partnerships with organizations like WHO, Ethiopian mental health care has better days ahead.

Lucia Kenig-Ziesler
Photo: Flickr

Eating Disorders' Global SpreadEating disorders are often presented as a western-world problem. Portrayals of eating disorders (EDs) to the general public suggest white, middle to upper-class females are the ones mostly affected. However, ED statistics demonstrate that all races, genders and ethnic groups are susceptible. As westernization continues, eating disorders’ global spread ignites.

Eating disorders cause approximately one death every 62 minutes. Medical professionals agree this number is likely higher because many ED cases are overlooked and not recorded as the cause of death. Out of all mental illnesses, “eating disorders have the highest mortality rate.” In developing countries where mental health resources are scarce, untreated people live dangerously exposed.

Increased Risk in Developing Countries

The long term health consequences associated with EDs are brutal. Typically, in countries where psychiatric help is unavailable, general healthcare services are lacking for those below the poverty line. Furthermore, in countries such as Saudi Arabia and the United Arab Emirates (UAE), mental illness is a serious taboo. Although sterilization is no longer a treatment for people experiencing mental health problems, there are still a lot of stigmas associated with them. They often lead to discrimination and prevent people from seeking help when needed. In these countries, psychiatric professionals able to help are nearly impossible to find.

In circumstances where someone living with an ED is not able to access medical assistance, the lack of access to treatment has persistent ramifications on a person’s body, such as experiencing pain caused by blocked intestines, muscle deterioration, cardiac pain, tooth decay or swollen jaw.

People living long-term with an ED have higher mortality rates. Living with an ED in a developing country is often a death sentence. Causes of death can include stomach ruptures, esophagus tears, kidney failure and cardiac arrest. To see reduced ED fatality rates, countries need psychiatric and medical resources. The number of countries that cannot provide these services advances the global spread of eating disorders.

Why Eating Disorders Occur in Impoverished Countries

The expansion and acceptance of Western culture are largely responsible for increasing ED cases around the world. Multiple studies evaluated the extent to which Westernization affects the elevated rate of eating disorder populations.

On the islands of Fiji, researchers conducted an observational study of EDs. The results of the study showed the impact of Western media. In the past, Fijians valued heavier body types as the image of beauty. When TV became commonly available in Fijian society during the late 1900s, ED rates were less than 1%. Three years later, a survey found 15% of teenage girls in Fiji vomited to keep their weight down.

An article published by the University of Columbia in the Journal of Eating Disorders analyzed Asia’s reaction to Westernization. The findings disprove the notion that eating disorders occur only in Western cultures. The article concludes by expanding the concept to all developing countries. These results strongly suggest that “eating disorders are not culture-bound or culture-specific, but rather culture-reactive.”

Westernization influences nearly every country in the world. Urbanization, population growth and newly introduced media further perpetuate eating disorders’ global spread. The most vulnerable countries are those that have little protection against virtually any form of addiction.

Outreach Combating Eating Disorders’ Global Spread

Eating disorder communities and organizations reach beyond their home countries. Outreach projects, such as international conferences, online training and collaboration between countries’ healthcare services, help protect people who are living with an ED and deprived of treatment. 

Originally the national charity Beat was solely based in the U.K. Now, Beat partners with international efforts in providing ED relief. The charity’s most well-known contribution is its international helpline service. Beat responded quickly to the 2020 coronavirus pandemic, seeing helpline calls escalate by 30%. In response, Beat offers an online training course to recruit more volunteers.

The International Association of Eating Disorders Professionals Foundation (IAEDP Foundation) plays a role in halting eating disorders’ global spread. The IAEDP Foundation provides high-quality ED education to international multidisciplinary groups. Core courses and certifications are available in a home study format. The goal is to improve ED knowledge amongst medical professionals so people living with EDs have more opportunities for support. 

The Austrian Society on Eating Disorders (ASED) dedicates itself to establishing a network of occupational groups with ED experience. As an international network, ASED creates guidelines catered specifically to each country’s culture. ASED encourages countries to begin scientific research in ED detection, treatment and prevention. By fostering international co-operation and education, ASED hopes to expand ED resources.

Hope for the Future

Eating disorders are complex and threatening illnesses. In the Western world, health checkups and residential treatment options, in addition to emotional and nutritional therapy, encourage recovery. However, even with these resources, ED recovery can take years; if unsuccessful, EDs may result in death. For those living in highly impoverished countries, years easily turn into lifetime struggles with EDs that could end one’s life abruptly. Luckily, outreach programs enhance efforts to bring awareness and ultimately decrease ED casualty rates. Without these promising efforts, eating disorders’ global spread would continue to permeate communities around the world.

Grace Elise Van Valkenburg

Photo: U.N. 


Mental Health in Africa
Africa still has a long way to go in terms of mental health awareness and care. Mental health is highly stigmatized and there are not enough mental health facilities or resources for the people. In Africa, the average number of psychiatrists is 0.05/100,000 population, while in Europe it is 9/100,000 population. Here are five challenges to mental health in Africa.

5 Challenges to Mental Health in Africa

  1. Poverty: There is a strong correlation between different mental illnesses and the socioeconomic status of patients. According to The Conversation, when people are stressed about searching for basic resources for survival like food and stable sources of income, this stress affects their mental health. Furthermore, the healthcare expenses are high, making them inaccessible to some. People with mental health problems may also have more trouble with functioning effectively which can harm their financial resources as well.
  2. War and Conflict: Various African countries endure tribal wars and terrorist groups. These wars affect the population’s mental health — especially the victims. Commonwealth Health reported that more than half “of refugees have mental health problems from post-traumatic stress disorder to chronic mental illness.”
  3. Insufficient Resources: Most African countries spend less than 1% of their budget on mental health. Additionally, mental health is not a popular subject; therefore, there are few higher education facilities teaching about it. The stigma around it prevents graduates from enrolling in mental health-related programs. As a result of this shortage, the Mental Health Innovation Network states that “90% of people with mental illnesses have no access to treatment, especially in poor and in rural areas.”
  4. Lack of Awareness: Mental illness is a taboo topic in some African cultures. A study done by BioMed Central in Northern Nigeria found that at least 34.3% of respondents believed that drug and alcohol abuse was “a major cause of mental illness.” Commonwealth Health reports that the widespread stigma makes families hide their members who are suffering from mental illness because of the discrimination they have to endure.
  5. Other Diseases: Many African countries are still fighting a number of deadly communicable diseases such as HIV/AIDS, cholera, malaria and tuberculosis. As a result, the governments of these nations prioritize helping people survive these illnesses. A mere 3% of Nigeria’s health budget is invested in mental health: the other 97% goes to other health departments. This means that people with functional mental disorders are usually unnoticed and have difficulties accessing appropriate professional help.

Despite all the issues, progress is steadily being made. In Burundi, lay community counselors started screening people and encouraging dialogue about mental health. They emphasized educating parents about better ways to discipline children without causing trauma. Additionally, cognitive behavioral therapy has been helping people in Sub-Saharan Africa to deal with depression. Crisis assistance hotlines were also put in place to help those struggling with suicidal thoughts and other urgent crises. All these intervention alternatives highly depend on the community counselors to integrate the strategies with their respective cultures in order to provide relevant solutions.

Many African nations are trying to invest more in mental health and encourage people to seek professional help. Moving forward, countries must continue to support mental health research and intervention measures, prioritizing both the mental and physical health of Africans.

Renova Uwingabire
Photo: Flickr

Mental Illness in Developing CountriesMental illness has become a major health issue in the world today.  Approximately 450 million people currently suffer from some sort of mental illness or brain condition worldwide. Individuals living in developing countries, which often lack proper medical care, are extremely susceptible to mental illness.

War, poverty and diseases such as AIDS and polio are major concerns regarding mental illness in developing countries.  These countries are generally too overwhelmed by communicable diseases and ill-equipped to respond to depression, schizophrenia and other mental health problems.

Former United Nations secretary-general Kofi Annan believes that it is time to make mental health a priority and to allot resources for treatment, developing policies, and implementing reforms to address the growing problem of mental illness, especially in developing countries.

In a special issue of a British medical journal, The Lancet, health officials called for new strategies and more money to treat mental illness in developing countries.  The authors of the journal argued that, without implementing measures to promote positive mental health, the future of these countries will be limited.

At the turn of the century, the World Health Organization (WHO) published a collection of papers titled “Mental Health: New Understanding, New Hope” that highlighted the importance of mental health.

“The WHO is making a simple statement: mental health – neglected for far too long – is crucial to the overall well-being of individuals, societies and countries and must be universally regarded in a new light,” former director general of the WHO Gro Harlem Brundtland said.

The WHO conducted a program, titled Project Atlas, to catalog mental health resources around the world.  The program found that almost half the countries in the world have no explicit mental health policy and nearly one-third have no program for coping with rising brain-related disabilities.

The results for Project Atlas are as follows:

  • 41 percent of countries have no mental health policy
  • 25 percent have no legislation on mental health
  • 28 percent have no separate budget for mental health
  • 41 percent do not have treatment facilities for severe mental disorders in primary care

Depression, the most common form of mental illness, has seen an uptick of 18 percent between 2005 and 2015 bringing the total number of people with depression to a staggering  300 million worldwide.

Like most people with mental illnesses, those who suffer from depression often do not seek treatment. Almost 50 percent of people with depression or depression symptoms (such as loss of interest in activities once enjoyed, persistent sadness and problems with everyday activities) do not seek help.

Though there is still a lot of work to do to fight mental illness, especially mental illness in developing countries, some areas have already implemented strategies to fight these diseases. One of the poorest areas of India, with the help of mostly locally recruited mental health workers, showed the efficiency of community-based rehabilitation to manage severe brain-related disabilities. Other countries such as Chile have also implemented effective strategies to help fight mental illness.

The renewed global focus on mental health is encouraging, where mental illness in developing countries still remains a major problem. Through the implementation of new strategies as well as the development of positive policies regarding mental health, there is evidence that mental healthcare is gaining importance and is becoming more accessible in developing countries.

Drew Hazzard

Photo: Pixabay

Global Mental Illness
Mental illness has recently become one of the top priorities of the World Health Organization (WHO). Though most renowned for contributions to the prevention and treatment of physical disabilities, the WHO has embarked on a lengthy Mental Health Action Plan that addresses global mental illness exclusively.

The action plan, initiated in 2013 and meant to see completion in 2020, outlines four encompassing goals:

  1. Enable more effective governance concerning mental health.
  2. Improve global access to social care services.
  3. Establish prevention/promotion strategies.
  4. Strengthen research surrounding global mental illness.

More specifically, the WHO seeks to achieve these goals by promoting human rights for the mentally ill, increasing access to health care for all groups of people around the globe and supporting research as well as research-backed treatment methods. On May 29, 2017, the organization endorsed an action plan specific to dementia, in concordance with the 2013-2020 Mental Health Action Plan, which included objectives such as risk-reduction and improved care systems. Additionally, the WHO initiated a year-long global campaign against depression, highlighted on World Health Day of 2017.

While mental health is a universal concern, the WHO has pointed to low-income regions in particular as at-risk. Not only is there a strong correlation between mental illness and poverty, but poorer populations are less likely to have access to adequate health care and information concerning treatment. Often, they receive little to no protection against discrimination. Therefore, the WHO has particularly emphasized mental health care implementation in developing nations.

The scope and intensity of the WHO’s global mental illness action plan mirror the severity of the issue. Behavioral health disorders are on the trajectory to surpass all other diseases as a major cause of disability by 2020. Each year, approximately $2.5 trillion is lost in the global economy to mental illness; this number is expected to increase to $6 trillion in a little over a decade. Approximately one in every four people in the world suffers from mental illness.

Fortunately, there is strong evidence that efforts to address global mental illness can aid both prevention and treatment tremendously. For example, enabling health care systems to detect behavioral abnormalities in children could have an enormous impact, as early diagnosis makes a substantial difference in the treatment of mental disease. By employing effective strategies that maximize global impact, the 2013-2020 Mental Health Action Plan is certainly a promising step in the right direction.

Kailey Dubinsky

Photo: Flickr

The Movement for Global Mental Health (MGMH) is a coalition of individuals and institutions aimed in eliminating the treatment gap for people living with mental disorders worldwide. It is the Movement’s mission to have full and effective participation in society of people with disabilities, including those with mental illnesses. The organization is based on two fundamental principles: scientific evidence and human rights.

The movement began in 2007, stemming from a Call for Action produced in the Lancet series, groups of articles addressing important topics of health that are often neglected by mainstream medical publications. Through a joint effort with partners, MGMH has formed into a space where members are able to discuss ideas and implement activities and programs to assist those with mental illnesses. MGMH aims to improve the availability, accessibility and quality mental health services for people all over the world.

Currently, members consist of over 200 institutions and 10,000 individuals, many of whom are family members of those affected by mental disorders, as well as health care providers, researchers and activists.

MGMH mainly focuses on low- and middle-income countries (LAMI), where people with mental disorders face the most amount of discrimination at all levels in society. Overcoming these social barriers to receive help often poses greater difficulty then dealing with the mental disorder on a personal level.

Although laws are widely in place to protect those with mental illnesses, they are still seen as one of the most vulnerable and marginalized populations. Thus, the MGMH website serves as a platform to share resources, advocacy articles and personal experiences of human rights violations.

The Movement seeks to emulate HIV/AIDS campaigns that have been successful in mobilizing global resources for people in LAMI countries. These types of movements were specific in the call for action and set clear guidelines in how to provide resources for testing and decrease the stigma associated with HIV/AIDS. MGMH hopes to mimic their successes by collaborating with human rights organizations, non-profits and universities to provide higher quality treatment for people with mental disorders, while protecting their basic human rights and increasing research in developing countries.

– Leeda Jewayni

Sources: British Journal of Psychiatry, Movement for Global Mental Health
Photo: Patch

On October 10, 2013, the United Nations and the World Health Organization, among other prominent international organizations, observed World Mental Health Day. Chances are that it wasn’t on your calendar.

When thinking of global health issues, many people include HIV, malaria, cholera, and malnutrition on the list of the most urgent diseases to address. However, despite its extremely dire outcomes, mental illness is often overlooked. The emphasis on communicable diseases often overshadows the recognition of non-communicable diseases.

In the mission to eradicate extreme poverty, increasing global health plays a prominent role. Although mental illness accounts for nearly 14 percent of the global problem of disease, it is often dismissed as too difficult to attend to, specifically in the developing world.

The World Health Organization predicts that by 2030, 14 percent will increase to 20 percent. Unlike many communicable diseases, which are easily recognized by certain symptoms, mental health issues are far more difficult both to diagnose and to properly treat. In poorer countries, the technology and the proper, individualized care is not widely available to deal with these issues.

Mental illness is so ignored in the developing world that a large number of patients in need do not retrieve the proper – or any – treatment. What is called the “treatment gap,” or the gap between the number of people with disorders and the number that actually obtain evidence-based treatment, is as high as 70 to 80 percent in developing countries.

“We don’t think of mental illness as a problem in developing nations,” said Vikram Patel, a psychiatrist at the London School of Hygiene & Tropical Medicine. “And yet it’s even more of a problem in these countries.” Patel is recognized as a leader in the crusade to improve global mental health, calling the current conditions in treatment for mental illness a human rights crisis.

Why has there been no outrage? To put it simply, because many people do not recognize how important and urgent the issue is. In the constant attention given to increasing global health, the threat of mental illness cannot continue to be ignored. The global community has been turning a blind eye on the mental health issues in developing countries, and new measures need to be taken.

– Sonia Aviv

Sources:  Global PostReutersAmeriCares
Photo: Urban Times

Indonesia Seeks to End Shackling of Mentally IllFor many Indonesians, having a mental health condition can be like a prison sentence — literally. “Pasung,” or shackling, is still a common practice in many areas of the country, particularly in rural areas with little capacity for medical treatment. Those who are seen as suffering from mental illness are sometimes bound and held captive behind their home, or inside a small room. Those who engage in “pasung” believe that they need to restrict the mentally ill from attacking or hurting themselves or others. However, shackling has been banned as a solution for mental illness in Indonesia since 1977.

As a member of a Parliamentary Health Commission, Nova Rianti Yusuf claims that “pasung” persists because people “cannot afford mental health care and [try] to escape the stigma associated with mental illness.” Unfortunately for many of those individuals who are shackled, there was often no official diagnosis before they were victimized.

Indonesia is working to centralize its mental health system in order to better serve its large population, which is the fourth largest out of all the countries in the world. A psychiatrist known simply as Asmarahadi, who works at a state mental hospital in Jakarta, claims that conditions have drastically improved over the past decade. The old problems, like a lack of infrastructure and medication, have faded away. New problems remain, but they seem less impossible to solve: Asmarahadi explains that nowadays, “treatment failure is usually caused by a lack of patients’ compliance and family support.” And as far as “pasung” goes, the director of mental health at the Health Ministry, Diah Setia Utami, lists ending the practice as one of her priorities for 2013.

Jake Simon

Source: IRIN News

Mental Illness Affected More By Poverty Than War
The citizens of Afghanistan have now weathered a 12-year war in the country and, as U.S. and as NATO forces prepare to pull out by the end of 2014, a new study confirms that poverty and vulnerability are more significant to the development of mental illness and anxiety than exposure to war.

The study, focusing on war and mental health in Afghanistan, says that war is undoubtedly an identifiable precursor to mental illness, but that poverty and vulnerability are actually “stronger and probably more persistent risk factors that have not received deserved attention in policy decisions,” said Dr. Jean-Francois Trani.

The study elaborates on the origins of mental illness and political violence, saying that unemployment and lack of access to resources contribute to the absence of one’s place in a social hierarchy, which leads to mental anguish that, in turn, can cause young people to act violently towards any government or institutions of authority.

The study calls these social and cultural predetermined factors “social exclusion mechanisms,” and maintains that these factors were in place before war began, but are exacerbated by military conflict. The researchers recommend that policymakers take into account all factors of these at-risk groups to create a more stable and self-sufficient Afghanistan.

Christina Kindlon

Source: Washington University in Saint Louis
Photo: Trends Updates