Daniela Strube is a Research Fellow in the Lowy Institute's G20 Studies Centre.
Bit of an irritating question, isn't it? However, American mental health expert Dr John Grohol suggests asking ourselves this confronting question when thinking about a health issue that's even more important than cancer in terms of prevalence, burden and untreated cases: mental illness.
You could argue that direct mortality from mental illness is lower than from cancer, and that's true. But in the US, for example, about one person every 15 minutes dies by suicide, and it is generally acknowledged that more than 90% of people who commit suicide worldwide have some form of psychiatric illness.
That's a lot of lost lives.
We have good grounds to assume (exhaustive data is hard to come by) that the situation in developing countries is both significantly worse and under-reported. More on this later.
Mental ill-health is, in many ways, the world's biggest health problem.
The numbers are staggering. Figures for advanced countries typically show that almost half of the population have experienced a mental health issue at some point in their lifetime. For developing countries, credible comprehensive data is simply unavailable, but if anything we should be worried that rates might be even higher.
Mental ill-health creates poverty, because education and work outcomes for people with mental health issues are known to be significantly lower. We also know that conflict is a significant determinant of psychological trauma and subsequent mental ill-health.
As an economist, I am also interested in the socio-economic impact.
Mental illness does not only impact on the individual, it also causes a large socio-economic burden. In addition to the direct costs related to the care as well as lost productivity and social barriers affecting the sufferer, it has indirect costs, for example in terms of the time devoted by caregivers. Mental ill-health is the indeed the biggest socio-economic problem among all non-communicable diseases.
Globally, it is estimated that mental ill-health accounts for more than one-third of lost global output due to illness. In the next 20 years, mental illness is projected to cost the global economy more than US$16 trillion. This equals about a quarter of the GDP of the whole world!
It is clear from these figures that this is an issue of far greater consequence than is commonly appreciated. This is even more the case when looking at the development dimension of mental illness.
Mental health is a story of severe inequality. As already mentioned, poverty is assumed to be a major cause of mental illness. But most importantly, the chances of receiving adequate treatment seem to depend largely on where a patient lives. Indonesia, for example, has only about 2.5 psychiatrists per million inhabitants. In low-income countries, this figure is even lower. Almost half the world's population live in countries with 0.2 or fewer psychiatrists per million people. This makes the availability of specialists 150 times lower than in high-income countries.
The underprovision of specialised health services leaves families in developing countries alone with the problem. In many cases, they lack knowledge about the condition of their affected husband, mother or child and they do not know that treatment is theoretically possible.
Often family members do substantial harm to mental illness sufferers when trying to help and care for their loved ones. These people are generally not mean or cruel; they are acting to the best of their knowledge and within their financial means and cultural belief systems.
People with mental health issues are often stigmatised as being possessed by spirits, or the illness is seen as a God-given destiny. To deal with the behavioural impacts of the condition, physical restraint and confinement including chaining and caging for years is a frequent practice. This can leave patients paralysed, distressed and severely emotionally and physically scarred.
Indonesia is the first developing or emerging country to set up a dedicated program to end the practice, known as 'pasung' in that country. The 'Free From Pasung' initiative pursues a human rights-based approach and aims to provide information to families, communities and health workers. Thousands of people have been freed and medically treated since the inception of the program in 2010. But Indonesia and indeed the whole world still faces an enormous challenge to address mental health appropriately.
What can be done?
The issue is complex, but, for the purpose of this article, let's focus on the basics. Knowledge about mental health is vital to remove stigma and raise awareness. Australia has a history of development initiatives addressing mental health, although the field is still in its infancy. It is important to ensure that, with the budget cuts currently being implemented in Australia's aid program, this line of work is not abandoned.
Mental ill-health is still largely a hidden problem, especially in the developing world. Sufferers in developing countries are often not visible and they have no lobby. Given the enormous scale of the problem and its socio-economic and development implications, Australia is well advised to assume responsibility in this area, particularly in our region.
As citizens, we can do our part. This is as simple as raising awareness in our families and communities. Stigma is still widespread in advanced countries too, and that includes Australia.
Image by Flickr user Andrea Estrella Reese.