On World Mental Health Day, A Renewed Movement Towards Equitable Care

On October 10, countries across the globe celebrate World Mental Health Day, an occasion to raise awareness of the work done and desperately needed to make mental health care easily accessible for all. The World Federation for Mental Health chose ‘Mental Health in an Unequal World’ as this year’s theme, a decision highlighting the inequity of mental health care due to factors such as gender, sexual orientation, and income. 

In particular, the federation emphasizes that 75% to 90% of people in low and middle-income countries have no access to mental health services. The theme also reflects how COVID-19 put unequal health access on display and further accentuated or created mental health issues in people worldwide.

At its core, World Mental Health Day is a reminder of the weight mental health has for each person and the perils of ignoring it. “Mental health is deeply intertwined with nearly every societal issue we face and the global traumas they create,” says Dan Hoffmann, founding member and head of marketing for Project Healthy Minds, a non-profit working to end mental health stigma and close the treatment gap.  “The scourge of war, fear of gun violence, the pain of racial violence and inequities, the weight of attacks on the LGBTQ+ community—and so many more issues—have deep impacts on mental health. The pandemic has also created new mental health challenges and exacerbated others.”

In order to address these issues, individuals must have access to information about how mental health manifests and what treatments are available, says Dr. Charles Figley, the Tulane University Paul Henry Kurzweg, the Paul Henry Kurzweg, MD Chair in Disaster Mental Health at Tulane University and associate dean for research, director of the award-winning Traumatology Institute, and a professor in the school of social work. 

Global Entities and Leaders Must Aid In The Effort

World leaders and organizations are increasingly drawing attention to mental health as a sector of equal importance to physical health. Last month, Antonio Guterres, secretary-general of the United Nations, stated that “mental health and psychosocial support must be seen as integral, cross-cutting components in all our humanitarian, peacebuilding and development programmes.” In May 2021, the World Health Assembly pushed member states to increase mental health awareness and support, especially for vulnerable populations and through the utilization of innovative technologies. 

“Fundamentally, shattering stigma and increasing access to affordable mental health care for all are two keys to creating a more supportive world,” says Hoffmann.

In the wake of the pandemic, everyone from parents to healthcare workers reported poorer mental health. Speaking of the latter and their ongoing sacrifices, Rawan Hamadeh, project coordinator for Project HOPE, an organization focused on health initiatives such as mental health and resiliency training for health care workers, says, “health care workers need to be prioritized as our world addresses the importance of mental health. In addition to the above-average stress of their life-saving work, they are navigating the toll of a catastrophic pandemic that’s pushed them to super-human limits.”

An April 2021 study from BMJ Open demonstrates the tremendous mental health impact that Hamadeh discusses. Researchers looking at 262 healthcare workers in Egypt found that 98.5% experienced moderate to severe stress and 90.5% experienced varying degrees of anxiety. 

These numbers are reflective across demographics. Take teenagers, for example. An ongoing study from the Mental Health Foundation looking at the mental health of 2,395 British adolescents at the end of 2020 found that 27% of participants felt ‘nervous, anxious or on edge’ most or almost every day over the previous two weeks. Additionally, 32% of teenagers reported having poor sleep most or nearly every over the last two weeks. Instances of poor mental health increased for those with unemployed parents.

“There are so many stories around the world [of people] who struggle with mental health,” says Figley. “I have seen reports of more use of stress reduction procedures, yoga, meditation, exercise. It is possible to mobilize a population to focus on mental and spiritual tools, and it is happening throughout the world.”

Mental Health Challenges And Necessary Interventions Vary Worldwide

Each person’s experience varies tremendously based on their location, culture, and experiences—all of which must be considered when expanding mental health care. “Every culture of people has its own unique customs, values, and community norms. It’s critical that mental health be approached in ways that put local culture and customs first, offering mental health care in culturally competent ways,” says Hamadeh, adding that points to consider include:

• The level of stigma when it comes to seeking mental health services
• Accessibility to high-quality mental health services
• The abundance of alternative healing techniques
• Spirituality and religious rituals
• Presence or absence of family or social support mechanisms
• Frequency of gender-based violence

The global pandemic may impact most individuals’ mental health poorly around the world, but the circumstances, additional stressors, and supports they come at this widely shared experience with will be distinct. “Mental health is unique in that we feel the impacts of both local and global events,” says Hoffmann. “We feel the direct impact of events happening in our community—but mental health challenges can also be triggered by seeing traumatic events harm other communities around the world.” 

Humanitarian crises, in particular, can acutely impact a person’s mental health. While there are an immense amount of ongoing conflicts—societally or environmentally—that people are facing across the world, below are a few country-wide examples that illustrate the need for targeted interventions.

Afghanistan

On August 30th the United States officially withdrew its troops from Afghanistan after 20 years. Almost immediately, the Taliban overtook city after city, eventually reaching the capital of Kabul, abandoned hours before by the country’s president, Ashraf Ghani. Foreigners and locals alike fled the country but, for those who stayed or couldn’t find a way out, the Taliban’s return has brought an ongoing crisis.

Women must stay home and leave jobs and school or fear repercussion, people move through the day depressed, and there is little to no mental health support available, says Wais Aria, founder of the Tabish Social Health Education Organization, a non-profit working to expand human rights, education, and psycho-social health for Afghans.

He and his family were in Afghanistan to visit loved ones after moving to the United States a few years ago when the Taliban retook control. After harrowing days of attempting to board flights at the airport and Taliban members beating Aria with guns, they made it back to the United States. 

The residual trauma and long-term impact of events, such as displacement, may also be ongoing for individuals like Aria and his family who are no longer in Afghanistan. Aria speaks of the aid mental health professionals need to help people in Afghanistan and the importance of training individuals to support their family’s mental health struggles. 

Haiti  

On January 12, 2010, Haiti experienced a 7.0 magnitude earthquake, impacting an estimated three million Haitians or one-third of the country’s population and bringing years of distress and uncertainty. Eleven years later, on August 14, 2021, Haiti was hit by another massive earthquake, this time a 7.2 magnitude.

This natural disaster came shortly after the assassination of Haiti’s president Jovenel Moïse in his private residence on July 7. “People are trying to build resilience after getting hit by massive earthquake damaging whatever they were able to restore from previous earthquakes while trying to deal with the security situation and the political unrest,” explains Hamadeh.

Lebanon

On August 4, 2020, 2,750 tons of ammonium nitrate exploded, killing 217 people, injuring 7,000, and displacing another 300,000.

“In Lebanon, there is a huge need for mental health assistance, especially after the blast that hit the capital Beirut, paralyzing an already crumbled city,” says Hamadeh. “People in Lebanon are going through trauma after trauma, trying to survive the collapse of their government, the dire financial circumstances, COVID-19 and one of the biggest explosions in the world.”

Global Organizations Working To Improve Mental Health Worldwide

There is an incredible number of organizations working to improve mental health awareness and care. Below is far from an exhaustive list of some to check out whether you want to learn, donate, or get involved.

• World Health Organization
• World Federation of Mental Health 
• National Alliance on Mental Illness
• Project HOPE
• Project Healthy Minds
• Tabish Social Health Education Organization
• StrongMinds
• United For Global Mental Health
• Rethink Mental Illness