Tuesday, October 12, 2010

It’s a mistake to ignore mental illness

Sunday Nation 10 October 2010

Today is World Mental Health Day. With the possible scrapping of Moi Day as a public holiday, it is to be hoped that Kenyans will today join the global community in marking a day dedicated to reducing suffering due to illnesses of the mind.

This year’s theme is: “Mental health and chronic physical illnesses: The need for continued and integrated care”. The focus of this year’s World Mental Health Day is on the interplay between mental health and chronic illnesses such as diabetes, cancer, heart disease, respiratory diseases, and obesity.

Globally, the burden of mental illness is well understood to be higher than that of the more “glamorous” diseases like HIV/Aids, tuberculosis and malaria.

However, due to the immediate and more visible morbidity and mortality of infectious diseases, lots of resources are being spent on them, often neglecting chronic illnesses that have a bigger impact on quality of life and productivity.

For instance, in 2003, it was estimated that mental and neurological disorders alone contributed up to 13 per cent of Disability-Adjusted Life-Years (DALYs), and this was projected to rise over 15 per cent by 2020.

Depression alone accounts for a huge burden of disease, greater than HIV/Aids, TB and malaria combined.

In Kenya, recent research has shown that up to half of patients who visit our public hospitals suffer from some degree of depression.

The violent nature of our political and social interactions has played a huge role in increasing the unrecognised burden of mental illness, and previous studies on survivors of Mau Mau concentration camps, ethnic violence in the Rift Valley and sexual and gender-based violence have demonstrated very high rates of trauma-related mental disorders.

The World Health Organisation estimates that four chronic diseases – cardiovascular, diabetes, cancer and respiratory illness – are responsible for 60 per cent of the world’s deaths, with over 80 per cent of these deaths happening in the poorest nations in the world, including Kenya.

Untreated mental illness increases the risk of these chronic physical conditions, makes it more difficult to manage them and worsens the outcomes after treatment.

Conversely, most of these chronic conditions increase the risk of many mental illnesses, including depression, anxiety disorders and substance use disorders.

As the world shifts focus from infectious diseases to chronic physical illnesses, there is a risk that mental disorders will continue being ignored as governments prioritise and rationalise their health budgets.

This will be a huge mistake. Instead of seeking to reinvent the wheel, we can learn from the experience of the HIV/Aids pandemic.

Initial efforts at control of this infection focused on scaring people about the consequences of getting HIV and Aids, and most campaigns carried pictures of emaciated individuals said to be dying of Aids.

This evolved to an emphasis on anti-retroviral treatment and other approaches aimed at reducing suffering among those infected with HIV.

It is only with the later involvement of mental health specialists that the huge burden of mental illnesses among many people living with HIV/Aids is being recognised. Today, many funding agencies expect to see a mental health component in every HIV/Aids proposal if it is to be successful.

It is our hope that mental health services will be integrated into any chronic disease management programmes that our government develops.

Dr Lukoye Atwoli is a consultant psychiatrist and lecturer at Moi University’s School of Medicine www.lukoyeatwoli.com

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