Mental disorders, health inequalities and ethics: A global perspective

Abstract

The global burden of neuropsychiatry diseases and related mental health conditions is enormous, underappreciated and under resourced, particularly in the developing nations. The absence of adequate and quality mental health infrastructure and workforce is increasingly recognized. The ethical implications of inequalities in mental health for people and nations are profound and must be addressed in efforts to fulfil key bioethics principles of medicine and public health: respect for individuals, justice, beneficence, and non-malfeasance. Stigma and discrimination against people living with mental disorders affects their education, employment, access to care and hampers their capacity to contribute to society. Mental health well-being is closely associated to several Millennium Development Goals and economic development sectors including education, labour force participation, and productivity. Limited access to mental health care increases patient and family suffering. Unmet mental health needs have a negative effect on poverty reduction initiatives and economic development. Untreated mental conditions contribute to economic loss because they increase school and work absenteeism and dropout rates, healthcare expenditure, and unemployment. Addressing unmet mental health needs will require development of better mental health infrastructure and workforce and overall integration of mental and physical health services with primary care, especially in the developing nations.

Trauma is a public health issue

“…Further, mental health resources are often inequitably distributed among countries, regions, and within communities. Such inequities can occur in access to care, use and outcomes of care, and by geographic region, race/ethnicity, gender, sexual orientation, and socioeconomic status (Ngui, Khasakhala, Ndetei, & Roberts, 2010). Governments must invest more of their health budgets toward these inequities in order to adequately address mental health and trauma-focused prevention and early intervention.…”

“…Much attention around the world has focused on the benefits of integrating mental health care into primary care and other settings where people receive services (Ngui et al, 2010; Patel & Prince, 2010; World Health Organization, 2001). Such integration of physical and mental health care is especially important for trauma-exposed populations, as they often seek help in primary care rather than mental health settings (U.S. Department of Veterans Affairs, 2002).…”

Global challenges and ethics in protecting and promoting the interests of psychiatrically ill patients

“…A comprehensive MEDLINE and PsycINFO literature search revealed three key themes, in the analysis of the authors. The first of these, identical to an issue that Ngui and Roberts (2010) discuss, concerns the gross underfunding and limited access of culturally appropriate mental health care in most low-and middle-income countries. They note that there is an important 'treatment gap'.…”

“…Ngui, Khasakhala, Ndetei, & Roberts (2010) underscore the vital importance of mental health to general health and framed the issues -such as inequalities in access and in outcomes, burden, stigma, discrimination -encountered in the provision of mental health care in developing nations. A key insight of the article is the observation that widespread mental illness is not only a cause of suffering in economically developing nations but that endemic lack of treatment for mental illness becomes a threat to the economic strengthening of these countries.…”

Mental Health in a Social Context

“…In particular, health systems in LAMICs are characterized by an inequality in the distribution and allocation of mental healthcare resources [56,[78][79][80]. According to the WHO, health inequalities can be defined as 'differences in health status or in the distribution of health determinants between different population groups' [81]. A complex series of problems affect people confronted by unmet mental and behavioral healthcare, including continued unnecessary suffering and premature deaths, work instability, limited or lack of treatment for people suffering from these conditions, substance abuse and poverty [82].…”