Minding Asia’s mental health

Asian governments are developing their mental health policies, but there is more work to be done to improve the quality of life for the mentally ill, Harry Minas writes.

Throughout Asia, mental disorders are common and disabling. They result in productivity losses at a scale that has a negative impact on national economies.

In low and middle-income countries, less than 20 per cent of people living with a common mental disorder like depression or anxiety have access to any kind of skilled mental health treatment and care.

People living with mental disorders are among the most vulnerable and marginalised groups in Asian societies. More often than not, their daily lives – and the lives of their families – are characterised by poverty, social and economic exclusion, neglect, and abuse of their human rights.

Until very recently the only services available were distant, often dilapidated, and poorly staffed and equipped mental hospitals and social protection centres. These institutions frequently contribute to rather than relieve suffering, dysfunction, and stigma.

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Gradually, governments have accepted that the wholesale neglect of the rights of people with mental disorders cannot be allowed to continue. They have turned their attention to the development of mental health laws and policies. In Asia, most of this progress has occurred in the last five years.

Several factors have contributed to the scale and pace of policy development, including policy-relevant evidence, effective policy advocacy, and enabling UN instruments and programs.

Studies have demonstrated that mental disorders are a major contributor to the total burden of disease globally, particularly through years lived with disability, but also through premature mortality. This is particularly the case with depression and anxiety because of their high prevalence.

Economic studies have also revealed the massive burden on national economies of lost productivity attributable to a high prevalence of mental disorders. Many studies in low- and middle-income countries have demonstrated that effective, affordable treatments can be provided in low-resource settings. In addition, economic modelling has shown that investment in mental health services produces substantial economic, social and health returns.

Effective policy advocacy has come from multiple quarters. The Mental Health Department of the World Health Organization (WHO) has been one of the most effective players. At national and local levels WHO advocacy has been amplified by demands for improved and more accessible mental health services by active and influential mental health professionals, often in collaboration with mental health consumer and other civil society organisations.

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Adoption by governments of key UN instruments and agendas has created an enabling policy environment. The most important of these have been the Convention on the Rights of Persons with Disabilities and the Sustainable Development Agenda, both of which pay attention to mental health and impose clear obligations on countries.

Despite the level of policy activity, serious problems remain. For example, in their reporting to the WHO, most countries have stated that their mental health laws comply with international human rights instruments.

However, the reality is quite different. The neglect and abuse of persons with mental disorders are common and frequently severe. In most places, effective, accessible and affordable mental health services, and human rights protections, are not available.

While mental health laws and policies are essential, many countries frequently fail to enforce laws or effectively implement their own policies. Effective policy implementation requires improvements in governance arrangements, implementation planning, the distribution of state resources, and mental health system design, monitoring and evaluation.

There are substantial problems in all these areas. In many low- and middle-income countries in the region, implementation failure is the norm rather than the exception. When it does occur, implementation is often partial, providing limited benefit to people with mental disorders and their families, while perpetuating negative social and economic impacts at community and national levels.

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Can Australia do more to support the development of effective, equitable and better integrated mental health systems in the poorer countries of our region?

Australian organisations have the capacity to provide assistance in mental health policy development and implementation, mental health service design and management, integration of mental health into other critically important development activities, and strengthening of research capacity.

Many institutions and individuals have deep, long-term collaborative connections with relevant ministries, teaching and research institutions, international agencies such as the WHO and the United Nations Children’s Fund (UNICEF), multilateral and bilateral development agencies, and with local and international NGOs and civil society organisations. While these positive relationships provide a platform for sustained and coherent technical assistance for development, much of the work being done in the region is reliant on short-term and unpredictable project funding, and is fragmented and disconnected.

The mental health of populations in our region is a vitally important health, social and economic issue. It demands more systematic and effective deployment of Australia’s substantial mental health capabilities.

Over the last half-century, Asia has made substantial strides in improving the physical wellbeing of populations. With support from countries like Australia, it’s time for the region to do the same for mental health.