Global Mental Health, Time for Action

Baroness Murphy

Lord Crisp is leading a debate tomorrow on the global impact of the five leading chronic diseases — cancer, diabetes, heart disease, respiratory disease and mental illness, so called NCDs (non-communicable diseases, to distinguish them from communicable, ie infectious diseases). This follows on from a recent high level meeting of the UN at which the increasing problems of lifestyle related diseases, that is those caused largely through poor diet, smoking and lack of exercise were discussed with the aim of developing international agreements on how to tackle the problems not only in the developed world but also in low and middle income countries where these disorders now outstrip infectious diseases as causes of ill health and early death.

I shall talk tomorrow about mental ill health.  Mental illness and heart diseases alone account for almost 70 percent of lost economic output. Mental and neuro-psychiatic disorders like dementia and stroke are the largest source of burden of disease globally. Over 90% of the 24 million people suffering from schizophrenia live in low and middle-income countries, but less than half of them receive treatment, even in developed countries.

Countless millions go untreated and suffer misery and poverty, despite the availability of effective interventions and affordable delivery. A decade of reports calling for political action has been widely ignored. I was disappointed that mental health was scarcely given a mention at the UN meeting; it was not on the agenda and the final communiqué had barely 3 passing mentions.

We can guess why these disorders were ignored. The problems of stigma and mistreatment are similar to the experience of those with stigmatizing infectious diseases like HIV, and in some instances there are serious abuses of human rights. But we now have evidence based knowledge of effective treatments and delivery systems that can be adapted to meet the needs of different cultures. Indeed the best community based mental health systems have much to teach the developed world about recovery and social integration. Nevertheless, an enormous gap in treatment persists throughout world, particularly in the least developed countries. The time for global action has come and I hope our Government will begin to support the push for global action on mental health.





20 comments for “Global Mental Health, Time for Action

  1. MilesJSD
    05/10/2011 at 11:40 am

    I have some little experience, both as a misdiagnosed and iatrogenicly-injured patient and as a trustee member of a MIND management committee thereafter iving(because “John, you are about the only surviving ex-psychiatric patient we know who is still articulate and committee-capable”).

    I have also since scored distinction level in university-level Formal argumentation and Moral reasoning;
    from which arises in my own mind the following now-apposite piece of syllogistic argument, concerning the fitness-for-purpose of the Psychiatrist him/her-self:

    Premise #1: £200 per week is a sufficient living for one human being to maintain their-self healthy, citizenlike, and environmentally-supportive, in the Lifeplace as distinct from the Workplace (…)
    P2 Such human-being is personally-efficient, at ‘making ends meet’. (…)

    Sub-Conclusion #1: Therefore any-one having-to-have twice that one-human-being living is only 50% personally & lifeplace-efficient.
    Premise 3: A human being representing theirself to need five human livings per week is mind-functionally disordered (‘megalomaniacal’, ‘multiple-existential’, ‘delusionally-schizophrenic’)
    .i.e. both believing and acting as if the one human-being is actually 5 human beings.
    P4: A psychiatrist is only one human being, but by demanding £1000 per week income declares him/her-self to be five (5) human beings;

    Sub-C #2: Therefore the psychiatrist is delusionally-schizophrenic thinking her/him-self

    Sub-C #3: Therefore The psychiatrist is 4-times over ‘Unfit for Purpose’.

    (and I have a bit more to follow, concerning Fit-for-Purpose Models)

  2. MilesJSD
    05/10/2011 at 11:47 am

    testing from a dongle laptop,
    in case my submissions herefrom re ‘Fitness-for-Purpose’ are being lost

  3. Frank W. Summers III
    05/10/2011 at 12:41 pm

    Baroness Murphy,
    Your own background is medical and mine is humanist. Theology, political science, sociolgy, anthropology, history, literature and law all appear on my transcript with just a taste of microbiology and astrophysics and very little else on that side of the line. It seems to me that there has always to be a recognition of the two reasons to deal with what we choose to call mental illness. One of these reasons is for the benefit of society and the other is for the benefit of the patient. While most educated people scoff at rather than study such things this has been true where heresy, witchcraft and lycanthropy were used to label many of the same conditions. Those socieites so labeling also did very well and very badly in dealing with things from time to time.

    It is important that there be an admission that people like Van Gogh, John F. Kennedy, Silvia Plath, Mozart, Howard Hughes and countless others suffer from mental illness in part because society is bad and evil and makes them sick. Our total incapacity to admit this is scandalous and more extreme than ever before. On the other hand we cannot become perfect and their world would not be the same one for all mental deviants or a perfect one either.

    There are two poles I think in medical paradigms here. One is sports medicine, this is best for the individual. To the degree psychiatry can use this model the nonjudgemental doctor will ease the symptoms of the patient and help them on a philosophical path to high function but this will yield slow dividends in increasing conformity. The other path is epidemiology and here the social threat is most considered it is from this model that stigma, isolation, affront to civil liberties and powerful doctor guards have deliberately been adopted. There are few accidents here and one is reminded of Jesus quoting a quote he suspected others were going to quote to him. That quote was “Physician, heal thyself…”

  4. C Gardiner
    05/10/2011 at 1:14 pm

    In my experience, mental health diagnosis and treatment is still largely ineffective. I believe that’s because recovery is not so measurable or obvious as physical illness.
    I don’t bother consulting my GP anymore. They don’t bother checking my notes and are not bothered about my everyday environment. Repeat prescriptions are issued and I have not been recalled for years.

  5. Gar Howell
    05/10/2011 at 7:30 pm

    That is a very interesting post from Miles JSD, with an extraordinary sense of equality, which is hard to beat.

    Talking of money, I had a pal, who was the mentor of at least two law lords of the 90s, who based his life on self sacrifice, and hard work, for the cause of orphans. He was a monk, in every way but ordination, for 101 years.

    He earned a shoolmaster’s wage and pension, but only spent about £30/week on all his needs. He died in 2002, so that would still be only about £70/wk.

    I am getting down to that point, but only through growing most of veggies in the garden,and lacking the variety that would be nice in one’s diet!

    I can’t say that I have ever made any sacrifices for anybody but myself, and self preservation, which heaven knows is hard enough in a capitalist world where man predates man in such overt ways, and failing
    that goes to war.

    Well done Miles!

    • MilesJSD
      06/10/2011 at 2:50 am

      GH – thank you for your appreciation: evidently we are each committed to trying to live more sustain-worthily, as well as mind-healthily.

      A propos “self-sufficiency”, I have found that
      (i) potted herbs grow quite well, in a high-enough east-facing window; cut-and-come-again being the principle even for saved carrot, parsnip, turnip, beetroot tops (which ‘grow-on’ on a wet papertowel in a saucer);
      but especially (‘mandaatorily’) for such ‘stock-seed’ as garlic and onions (whilst in Moorhaven Big-House on the south-west edge of Dartmoor I was lucky enough to work on the dairy, sheep, pigs, arable, and double-dyke dry stone-walling farm, under Farmer Bartram, and in the great garden areas under lanscape-architect Owen Johnson, from each of whom I learned a few useful things, one being “Never eat your seed-stock” i.e. the garlic-cloves and onion-bulbs themselves).

      I also took the bold lone step of throwing away, into the high moorland bracken one Saturday afternoon off, my last packet of twenty ‘Players’ – and I didn’t look back !

      (I guess I could easily write a short book about my experiences, both the negative/negativising and the positive/positivising, some unbelievably shocking, but many quite humourously edifying, that have occurred inside and outside of the Human Development Intent and (therein ?) the psychiatric, community, and education systems –
      but ‘first things first’ seems to need to prevail –

  6. Gar Howell
    05/10/2011 at 9:03 pm

    I have not quite worked out the political leanings of the noble baroness, probably Cross bench, and it does not matter to me. It may seem foolish to introduce such a large concept as “imperialism” in to a discussion on health!

    I think that the settlements of most of China over the last 70 years has been based on very small agricultural units, for self sufficiency.

    Imperialism and globalism to are based on clearly defined pyramidal and political power structures in which the pecking order is clear. (Pyramids and pecking orders!)

    It has been so for 400 years since the first plantations in the USA, and more recently in Oz and NZ, a hierarchical system of land ownership, based on “Square” areas, 1sq mile 1/2sq mile, station sub station, sections subsections, plots etc, right down to a 200 sq yds.

    Wales was not “planted” in such a way and nor to my knowledge was Ireland; they were just conquered and occupied.

    With all this preamble, and it is a miles-ian preamble(!)I would say that such non egalitarian distribution of land has led to the impossibility of any real number of people owning just sufficient land to grow enough for themselves and their families, to know, what the right diet is, not to buy packaged food, to get plenty of exercise, not too much sugar, no cancer, due to all those things.

    There is no answer to lord Crisp’s conundrums. Few men CAN buy their own plots, and even fewer want to, and yet that is the way to sanity, a good diet, not too much beet/cane sugar,plenty of exercise, and loads of Olives falling off the trees in to our bags to be packed for market!

    The most extreme non conformists to responsibilities of state ie demonstrators and rioters, criminals, are all very close to the truth. They are anti-capitalist and anti-consumerist, but have not taken the final leap in to self sufficiency!

    Their philosophy is NOT quite complete, and in being in-complete, is a total disaster.

    They were going to carve up the forestry commission recently, though plans were abandoned due to public campaign against it.

    If planning law were emended to allow certain kinds of horticultural development on forestry areas, and even dwellings, on imperially based subsections and plots, a lot could be achieved.

    Frank knows, from being a Canadian, how the system failed in Canada, in the 1900s due to the shortness of the planting season. The plots bought for £10 were soon sold and people moved out as fast as they moved in.

    There must be ways of dividing up farm land to allow bona fide farm use.

    Meanwhile the Viscounts,Earls and dukes of these islands and some well place squirearchy too, continue to develop on a plantation basis, back in the old country of Britain, sprawling new towns, which are effectively controlled and taxed by the duchy itself. The tax takes the form of a land sale price on every house built.

    That is imperialism at work, now today.

    Compliance with the order and ever increasing laws of the mega-city or mega-metropolis is the thankless task of the psychiatrist and law enforcer, whether by pills or other punishment.

    The cost of rural homes in the UK is more than ten times what low income people can afford on mortgage. Not much hope for rioters of Tottenham eh? A number of Travellers from Dorset now live on horticultural plots with a home in Spain and Portugal. They are the lucky ones, along with Italian olive growers!

    • Frank W. Summers III
      07/10/2011 at 12:17 pm

      Gar Howell,
      If you click on “The Authors” at the top of the Home page of LOTB just below the banner image of Parliament it will bring up a very brief bio of peers who contribute regularly. I believe this always includes the answer to the question you imply in your post. Baroness Murphy is there listed as a Cross Bench Peer.

      • 07/10/2011 at 3:23 pm

        Gar Howell,
        Which Frank are you referiing to?
        If it is I of whom you write then many of my ancestors were Canadians until the period between 1765-1780. Some from families which had been there over a centure and others from families which had been there about eighty years. However since 1785 all those in my line who descended form Canadians have lived in or been associated with Nouvelle Acadie in Louisiana. I am Acadian American citizen… specificaly an Anglo-Acadian American citizen. I have visted Canada anumber of times but am not really at all Canadian as the identity did not really coincide very much with my ancestos tenure in those lands.
        If you are talking about someone else ignore this comment…

  7. MilesJSD
    06/10/2011 at 3:01 am

    and especially now since the People-and- Political-World is rapidly shifting away from being Anglophonic,
    our English thinking and planning, as well as our psychiatrists and other leaders, need to be made fit-for-Purpose & purposes.

    Let me submit that the following 7-fold holistic-living domains model is more-fit-for-Purpose & purposes

    [both inside psychiatric, medical, educational, environmental, governmental, community, religious, and small-group/individual workplaces;
    and in general outside thereof, namely genericly and individually throughout many various lifeplaces]

    than has been the 5-domains model of the United Nations’ and of Psychiatry’s and other Human-Development sectors’ very similar assessment model for the holistic human-lifestyle i.e.
    1 Physiological 2 Emotional 3 Mental 4 Social 5 Spiritual.

    (My) 7-fold Human Holistic Living Model:
    1 Physiologicals.
    2 Emotions.
    3 Mind-functionals.
    4 Environmentals (the Bio-, the Built-, the Peoples- (from intimately-friendly, through supportive, and ‘neutral’, to covertly or overtly hostile).
    5 Spiritual &/or Religious.
    6 Immediate individual sanctuary.
    7 Job-, Career-, and Workplace- (exigencies and skills ).

  8. Clive Arnold
    06/10/2011 at 9:47 am

    “Countless millions go untreated and suffer misery and poverty, despite the availability of effective interventions and affordable delivery”

    How can this be taken seriously when the welfare reform (cuts) bill is being pushed through? Poverty? Housing Benefit cuts, DLA changes to PIP-cuts, benefit sanctions because the people that should be entitled to disability related benefits/allowances are deemed fit for work by a corrupt assessment company, Support services SLASHED (kindly don’t use the “only in Labour wards” comment that crops up as I live in Hague’s constituency and have seen support services and the money they need to survive on cut to the bone and Hague doesn’t give a **** (and I could have been very crude with that last comment)

    Get out of your ivory tower and look at the ‘whole’ rather that pieces because disabled people are getting screwed over and those that run the country and pass the laws are so unconcerned as to be insultingly ignorant

  9. Gar Howell
    06/10/2011 at 1:11 pm

    If you could get the punctuation and paragraphing right Miles you would certainly stand a chance to be the modern literary equivalent of Havergold Brian who was said to have written a couple of hundred symphonies in his 80s and 90s.

    My own theory is that he was merely a collector of other people’s musical estate after they had died, but that he also had a clear understanding of the definition of symphony, ie it can be ten minutes long, provided other criteria are met! It is either the one or the other! 93 symphonies would not be too difficult to achieve at ten minutes a time!

  10. maude elwes
    06/10/2011 at 2:14 pm

    Our attitude and treatment of the mentally ll is akin to the Victorians. We would rather spend our tax payers money on war and foreign aid than help those who live a hell in our own State.

    Money is badly spend and these people are abandoned to live on the streets homeless.

    The only people who have made any effort to bring the psychologically ill and mentally disabled into real care, have been those in Totnes, Devon, and they are shunned by our departments of health. They have seen miracles.

    It is shameful that we can call ourselves a civilized society. This outfit is no more expensive than our shocking facilities and often far less expensive.

    Our mentally ill are often treated as guinea pigs.

  11. Gar Howell
    06/10/2011 at 6:13 pm

    It is obviously not civilization which is the cause of insanity/mental health problems! Even primitive tribal cultures had their lunatics, but it is surely far more prevalent in a civilized society which is separate from the soil that provides its food in nearly every way.

    We only ever hear of “consumer champions” but it is Anti-consumer champions that we should be looking for.

    Mental health or sickness, is a consumer product hard marketed and hard sold, and in view of various new deemed children’s diseases, from the cradle to the grave.

    you are so used to this kind of salesmanship that you do not think twice about the implications of the state providing “mental health” services, and the real meaning of it.

  12. Twm O'r Nant
    07/10/2011 at 8:05 am

    Countless millions go untreated and suffer misery and poverty, …………
    How can this be taken seriously when the welfare reform (cuts) bill is being pushed through?

    That’s the only way it can be taken seriously….
    unless of course there are psych prescribed pills which make normal dietary food unnecessary, and I sometimes wonder about that (and beer).

    Maude, in an ideal world, the state would spend nothing on any of them.

    The member for Totnes is a lady physician, with a forensic psychiatrist for a husband, which may explain that success. she is a capable woman, just in the wrong party.

    • maude elwes
      07/10/2011 at 12:28 pm

      @Twm O’r:

      The state spends around £150,000 to £160,000 per annum, per patient, kept in a mental health hospital.

      That is as much a Princess Diana spent on make up, Coiffeur and Couture, David Cameron’s school fees at Eton for five years, at todays rates, and more than a years stay at Champney’s Health Spa at Tring.

      Yet these hospitals stink, have little or old broken furniture, nurses and carers who cannot speak English or know their right hand from their left. I’d say that was poor value for tax payers money. Not to mention a calamity for the sick patients.

      Yet, not a thing is done to find out how or why these places are so horrendously shoddy, smell worse than an abattoir and where the inmates are treated far beneath the expectation of dogs at the local poodle parlour holiday home.

      I didn’t really grasp the point you were making! Unless, it is that the mentally ill should be at home with their family. Unfortunately, this is not possible or practical in many cases. If you try that, you end up with the women in the attic, akin to Mrs Rochester, the character in the Jane Eyre novel.

  13. Twm O'r Nant
    07/10/2011 at 5:49 pm

    If you try that, you end up with the women in the attic, akin to Mrs Rochester, the character in the Jane Eyre novel.

    Which was of course common practice by husbands stuck with liability wives, and others besides.
    I understood that in recent years many people run their own little private enterprises for the same purpose, but have half a dozen or a dozen patients in their care, who can mingle normally with the local community, suppressed
    by drugs.

    cancer, diabetes, heart disease, respiratory disease

    I am really rather more interested in the prevention of these other diseases, which would be far more rewarding to discuss.

    Dia-betes: too much-sugar!
    Respiratory disease; too many fags
    Cancers 3rd most common cause of death intestinal;bad diet

  14. baronessmurphy
    08/10/2011 at 8:36 am

    Certainly some unpredicted comments there. Milesjsd I also like your idealism, which comes through many of your posts and don’t be discouraged by Gar Howell criticising your written language, we can always understand the underlying message.
    Clive Arnold, it is exactly because people with mental health problems make up a large proportion of those on disability benefits (about 40%) that I want to see a much fairer system with better regular assessments to suit the needs of people with fluctuating conditions but on this occasion I was talking about global international problems not local issues. C Gardiner, I am sorry to hear you did not get the right help from your doctor; hope you were able to contact a local voluntary organisation or support group who might be able to point a way forward. Frank W Summers lll thanks for pointing out I’m a crossbencher.

  15. Gar Howell
    08/10/2011 at 8:51 am

    Apologies Frank not the same. UK orphans were sent to Canada in 1918 to populate the prairies their parents/adoptive on a small land holding basis, of probably 20acres. The plots were too small and were soon vacated to be replaced today by the vast mechanised gadgets, 12 of which produce all of the bread flour for the UK in a year.

    Is it any surprise there are all these diseases if one machine can produce all the bread for 4m people for a year? Nobody gets any exercice earning their bread!

    The UK govt officials were not unwise to think of populating Canada in such a way but they took no account of the skills of the
    lot holders, which were inadequate for the task.

    Oz/NZ/Ca were split up like this(they attempted to do the same with parts of Afric
    which was very foolish):

    6400 (10sq miles) Station (sheep etc)
    640acres(1sq ml) sub-station
    320 acres 1/2 sq mile
    40 plot

    What I am saying is that there should be an opportunity for poor Brits to return to the soil, in numbers, which they do not have because all the rural houses are taken by investment greedy second home owners.

    There is no policy of providing plots with the right to dwell, and which could provide
    food and a healthy existence to poor people.

    all the above problems would be reduced… the cancers, the ill health, diabetes, heart disease, if, not new towns, but not self sufficient villages were permitted by planning law in the UK itself.

    They would have to be designated as for unemployed people, and designated for horticultural occupants only, as many are for agricultural occupants only even today.

    Whilst the Dukes/Marquises/viscounts/Earls make themselves big capital from their taxing new town residents, NO workable land goes with it.

    What I am saying is that NEW villages should be built where the lands is designated as above, and where ALL the houses have ten acres to work with, and support themselves.

    The dukes and marquises would have a different way of selling their fertile acres, but since the existing conversion factor to
    horticultural land from agriculture is about three, they would still make a handsome profit.

    In the last hundred years or so, I can only find two or three examples of this having been done in the UK, but there is Findhorn and similar communal projects.

    There is a vast amount of paternalism in agricultural development at the beginning of the 20thC before anybody could have become aware of the vast machinery which makes every man and woman indolent today.

    It is that indolence which goes a very long way indeed to cause cancers, M-h disease, heartfailure, diabetes…..

    • Frank W. Summers III
      08/10/2011 at 4:18 pm

      Gar Howell,

      I appreciate you r apology (not exactly necessary but certainly nice) placed in a fulsome and fairly eloquent clarifying comment. I have been called thing both less flattering and even less accurate than a Canadian many times and without apology. Perhaps if and when it occurs you will let me know if I misdefine you and we shall call it even..

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