Poorer nations asked to aid mentally ill

By MARIA CHENG, AP Medical WriterTue Sep 4, 5:19 AM ET
War, poverty and diseases such as AIDS are adding to mental health problems in poorer countries, which are generally ill-equipped to respond to depression, schizophrenia and other such ailments, according to health officials.
Experts say that has to change.
On Tuesday, health officials called for new strategies and more money to treat the mentally ill in the developing world in a special issue of the British medical journal, The Lancet. Unless mental health treatment becomes widely available, the futures of poor countries will be handicapped, the writers argue.
Among the simple solutions offered: training lay people to spot mental illness in their community. The ill people and their families can then be referred for treatment. India has already introduced such a program for schizophrenia in certain provinces.
"We're thinking outside the box. We're not thinking of more mental health specialists," said Dr. Vikram Patel, a professor of international mental health at London's School of Hygiene and Tropical Medicine and co-author of several of the papers in The Lancet.
Nirmala Srinivasan, head of Action For Mental Illness, a lobby group based in Bangalore, India, said only a small percentage of Indians who suffer from some form of mental illness — schizophrenia, depression, obsessive compulsive disorder, anxiety — get proper treatment.
"The main reason is that people can't access treatment," Srinivasan told The Associated Press, adding that "there is no treatment available" in rural areas.
Dr. N. Vijaya, head of the Institute of Mental Health, a 1,600-bed facility with programs for 400-500 more outpatients in the southern Indian city of Chennai, said awareness of mental health was increasing in India — leading more people to seek treatment.
She said nearly a third of her facility's patients have been "wandering mentally ill" rescued from the streets by police and private aid groups.
"Social workers help us in contacting their families later," she said.
In Brazil, mental health care rivaling that in developed nations is available for those who can afford it. The Lancet said Brazil's mental health care system has improved in the past several decades, but gaps remain.
Mentally ill adults in the teeming cities of Brazil, Latin America's largest nation, are frequently seen begging on street corners and sleeping under highway overpasses. In destitute rural communities, families living in poverty cope the best they can with mentally ill relatives, but often can't afford medication or special care.
In some poorer countries, people turn to chains or cages to restrain those with mental illness.
In African countries, doctors and nurses are often too overwhelmed with illnesses such as AIDS and malaria to care for those with mental health problems.
But mental health advocates argue that because psychiatric problems such as depression and psychoses often lead to physical problems, investing in treating mental illness could prevent other diseases. That can in turn aid the overall economy.
Treating mental illness can't be solved simply by sending in foreign doctors, experts said. Counseling for mental health problems must come from someone who speaks the language and understands the local culture.
In countries such as Zambia, where mental illness is believed to be a sign of witchcraft or being possessed by the devil, people who are sick are reluctant to seek help. When they do, or when others alert the authorities, they are often locked up in institutions.
"You can't just parachute into a system and expect to solve their complex mental health problems," said Cornelius Williams, who helps treat emotionally scarred former child soldiers in Uganda for UNICEF.
Dr. Richard Horton, The Lancet's editor, wrote in an accompanying commentary that the World Health Organization has not done enough to support nations' mental health needs. Although the agency pledged in 2001 to bring "new hope" to treating the mentally ill, "WHO has not backed its words with resources," Horton said.
WHO officials declined to comment.