Chair’s Column July 2012

Enormous unmet mental health needs are leading to increased uses of integrative approaches

Mental illness accounts for about one-third of the world’s disability due to all health problems in adults, reflecting marked societal and personal suffering and enormous socioeconomic costs. Critically, mental health care globally does not adequately address this crisis, calling for urgent change in the paradigm and practices of mental health care including basic reforms in education, clinician-training, and research. Serious mental health problems, including depression, bipolar disorder, schizophrenia, and drug and alcohol abuse occur in all countries and affect all age groups. Mental illness is often associated with poverty, wars and other humanitarian disasters, and often leads to suicide. It is estimated that 10-20 million people attempt suicide every year, and 1 million complete suicide. Major depressive disorder affects an estimated 121 million people worldwide and is one of the leading causes of disability on a global scale. By 2020 depression is expected to be the second leading contributor to all-cause disability worldwide second only to heart disease. Enormous psychological, social and occupational costs are associated with depressed mood. Maladaptive behaviours commonly seen in depression including over eating, smoking, excessive alcohol consumption and sedentary lifestyle, are important risk factors for many chronic physical illnesses that are responsible for approximately 60% of global mortality including cardiovascular disease, diabetes, cancer and respiratory illnesses. In the case of depression, this condition affects more than 21 million American children, adolescents and adults annually and is the leading cause of disability in the United States for individuals ages 15 to 44. Depression is the leading cause of approximately 30,000 suicides that take place in the U.S. annually where suicide is the third leading cause of death among individuals ages 15-24.

In spite of increased availability of antidepressants over the past few decades, questionable efficacy, unresolved safety issues and high treatment costs have resulted in an enormous unmet need for treatment of depressed mood. On average it takes almost 10 years for a depressed person to obtain treatment after symptoms begin, and over two-thirds of depressed individuals never receive minimally adequate care. Despite the magnitude of the impact of mental illness on global health, most countries do not regard mental illness as a high priority. In response to the urgent unmet need for improved mental health care on a global level the World Health Organization (WHO) recently called for integration of mental health services as an important priority in global development efforts and invited academic and research institutions, non-governmental organizations and global partnerships to implement more effective strategies. More than 85% of the world’s population lives in 153 low- and middle-income countries. Most of these allocate scarce financial resources to mental health care needs and have grossly inadequate professional mental health services. Approximately 4 out of 5 adults in the U.S. receive some kind of treatment for a mental health problem every year. The elderly, minorities, low income groups, the uninsured, and residents of rural areas are less likely to receive adequate mental health care and most people with serious mental health problems in the United States receive either no treatment or inadequate treatment for their disorders. In 2009, the last year for which data are available, total costs associated with treating mental illness in the U.S. including outpatient visits, hospitalizations, and ER treatment were approximately $80B, almost matching total treatment costs associated with heart disease and trauma. Heart disease was the only major medical condition for which total treatment costs significantly surpassed costs associated with mental illness. Each year 38.2% of the European Union population (approximately 165 million people) meet criteria for a psychiatric disorder however fewer than one third receive any treatment at all. The prevalence of mental illness in EU countries will probably continue to increase due to low treatment rates among the seriously mentally ill, delayed access to care and grossly inadequate treatment.

High prevalence rates and unmet treatment needs of serious mental illness in both developed and less developed countries illustrate the enormous global public health challenges posed by mental illness and the inadequacies of the conventional model of care, while underscoring the urgent need for more effective, safer, more affordable and more accessible treatments. Increasing acceptance of CAM treatments in developed countries is the result of both scientific advances and social trends. Conventional allopathic medicine is being influenced by increasing openness among conventionally trained physicians to non-Western healing practices in the context of growing patient demands for more meaningful and more personal contact with medical practitioners. These issues have led increasing numbers of individuals who see conventionally trained physicians to seek concurrent treatment from alternative practitioners, including Chinese medical practitioners, herbalists, homeopathic physicians, energy healers and others.