One in four people worldwide are affected by mental disorders; and one in two people worldwide are poor. Often these are the same people.
A village in Madhya Pradesh: India has one third of the world's poor. Photo by Carmine Pariante.
World Mental Health Day (by World Health Organization (WHO), 10 October) and World Mind Matters Day (by World Psychiatric Association (WPA), 4th of September) are important opportunities to raise awareness of mental health problems and of their unbelievable human and economic costs. The aim of these initiatives is heroic: promoting dignity and social justice for people with mental disorders and disability, and mobilizing efforts to support mental health. But how can we guarantee equity of access to opportunities and services, if the starting point for people with mental disorders can be so drastically low: if poverty is where a lot of mental disorders start?
People who fall behind are at higher risk of developing all types of mental disorders. On average, people who are poor are twice more likely to experience depression or anxiety than more affluent people; and up to five times more likely if they are poor children or adolescents. The risk for severe mental illnesses, like schizophrenia, is even more accentuated by socioeconomic differences, with poor people being up to four times more likely to develop these disorders than affluent people. A variety of factors mediates this increased risk, since most correlates of poverty are on the causal pathways to mental illness: debt, unemployment, victimisation, social isolation, urban environment, exposure to violence, poor physical heath, and the experience of fleeing one's country for war or persecution, to name a few. The exact mechanisms underlying these pathways are still to be clarified, but they are likely to include the effects of increased subjective and objective levels of stress on brain function, psychological processes and social interaction.
Poverty does not only affect mental health of the current generation but also that of people yet to be born. Women from disadvantaged backgrounds are more likely to experience severe stress, depression and other mental disorders during pregnancy and after giving birth, a profoundly delicate time when the mother-infant relationship is most vulnerable. In turn, these upheavals may influence the mental and psychosocial development of the child, resulting in increased mental health problems and thus potentially perpetuating a trans-generational cycle of poverty and poor mental health. Indeed, children of mothers with severe depression in the perinatal period are at higher risk of becoming adolescents and young adults who themselves suffer from depression and other mental health problems. Their children may suffer too, one day.
And of course there is the headline-making issue of refugees. One in every 122 people worldwide are now refugees, internally displaced, or seeking asylum: if this were the population of a country, it would be the world's 24th largest-ironically, right next to the United Kingdom. The exposure to trauma, war, loss and poverty is an explosive combination: the rates of post-traumatic stress disorder-a mental disorder where the suffering comes from intrusive memories and images of the traumatic experience, high anxiety, emotional numbing and increased suicidal thoughts-is ten times higher in refugees, and 15 times higher if the refugees are children. In refugees camps there is very little assistance for physical health, let alone mental health: and it is not only about East Africa and the Mediterranean sea, but also Central America and Mexico, the Horn of Africa, and countries like Bangladesh and Myanmar. The world is simply unequipped to deal with this mental health emergency.
Both Word Mental Health Day and World Mind Matters Day focus our attention to the most urgent priorities. The theme for Word Mental Health Day 2015 is Dignity-or, rather, lack of. The WHO statement could not be clearer: the dignity of many people with mental disorders worldwide is not respected, as they are frequently locked up in institutions, subjected to abuse and neglect, and deprived of the basic rights that we all enjoy: the right to make decisions for ourselves, to have general and mental health care, to access education and employment opportunities, and to participate fully in society. The WPA statement on social inclusion, launched as part of World Mind Matters Day, is equally clear in its recommendations-ever so important in the current financial climate. For example, it recommends implementing programmes for mental health promotion and prevention, at a time when the budget for mental health is shrinking everywhere. And it recommends including a mental health impact assessment when implementing economic reform strategies and programmes, at a time when austerity policies and welfare reforms are affecting the poorest families the most.
So, long may these two celebratory days live, to defend and support the importance of mental health, and may them become one entire week, one entire month, one entire year: until when the battle is won, poverty eradicated, and mental health truly considered equal to physical health.