This reflection on the Out of the Shadows conference was written by Daniela Muhleisen, one of our members and a student liaison to the Harvard Global Health Institute. It was originally posted on the Harvard Global Health Institute's website.
The World Bank and the World Health Organization hosted a conference this April with the goal of making mental health a major part of the global development agenda. The conference aimed to increase worldwide awareness for mental illness and to engage and convince finance ministers and governmental organizations to scale up funds for mental health care services. With help from the Harvard Global Health Institute, members of the Harvard Global Mental Health Coalition were able to attend this conference and to present our our video on mental health at the conference.
Two weeks later, I reflect on this meeting, and I want to share, besides my gratitude, some thoughts. First, I will look at the financial rhetoric surrounding mental health at the conference, and then I will look at the arguments presented based on human rights and activism.
The Financial Burden of Mental Illness
The productivity lost from mental illnesses are estimated to be in the trillions of dollars. In 2010, this number was predicted to be around $2.5 trillion, and it is expected only to increase in the future. Even more alarming is the fact that over half of this devastating financial burden falls upon low and middle income countries. Mental health is a leading cause of years lived with disability around the world, yet in many nations’ agendas, it remains the last of priorities.
The World Bank projects that one dollar spent on mental health care leads to a four dollar return in the nation’s economy ($1 investment=$4 return). Yet we also have to look beyond cost-effectiveness. World Bank analysts use the term “extended cost-effectiveness” when analyzing the distribution of costs and benefits as well as value of financial insurance. Ultimately, with extended cost-effectiveness, it becomes evident that allocating money towards universal public finance leads to more equitable allocations of resources across income groups and that the lowest income groups end up benefiting the most. Thus, public financing and scaling up of resources is not only affordable but increases the protection of the lowest income groups in a nation.
If 10% of GDP were spent on health care and then 10% of health care was spent on mental health care, a nation’s allocation towards mental health resources would only make up 1% of the nation’s GDP. This is already an incredibly low number. Unfortunately, the reality is much worse: most countries spend just 3% of their GDP on health and around 1-5% of this health budget on mental health, making mental health care spending add up to around only 0.1% of a nation’s GDP.
World Bank President, Jim Yong Kim, delivers opening remarks at the Out of the Shadows conference in Washington, D.C on April 13, 2016. Also pictured (L-R): John Prideaux, U.S. Editor, The Economist; Margaret Chan, Director-General, World Health Organization, and Arthur Kleinman, Harvard University.
The Human Rights Perspective
As much as it is necessary to look beyond cost-effectiveness, we must also be able to look beyond this extended cost-effectiveness. Mental health is a human right; mental health care should similarly be treated as such. At the conference, many financial analysts and health leaders compared mental health advocacy to the beginning of a new ACT UP movement to show its relevance in terms of human rights. Though it is essential for world leaders to view mental health as the human right that it is, I think that some key distinctions must be made when comparing mental health to HIV/AIDS. These distinctions are also necessary to understand how mental health advocacy can grow in the future.
First of all, HIV/AIDS activism is not over, and neither is HIV/AIDS. In calling mental health the “new” ACT UP, we forget that millions of people all over the world do not have access to HIV/AIDS treatment and that this is still a global epidemic. Additionally, I believe that this is a difficult comparison to make because of the nature of mental illness itself. Many of the mental health activists today are “recovered.” As powerful as their stories are, they are often set in the past tense: “I suffered.” We do not always hear the stories of those who are suffering. Thus, these stories seem less urgent, and the burden of disease becomes something of the past. But it is very much something of our present. For financial leaders, I wonder how “cost-effective” a story of recovery is to their budget plans. Aside from this, ACT UP’s powerful art and demonstrations had a huge influence on mass media, an influence that I still think mental health activism is lacking. And most importantly, I think that the rhetoric behind the two differs drastically. When looking at HIV/AIDS, ACT UP presented the CDC and FDA with specific “asks.” For example, “drugs into bodies” cannot readily be transposed into mental health activism, especially when we start to look at the anti-psychiatry movement which revolves around the opposite rhetoric. When we say “mental health treatment” or “allocations for mental health,” what do we mean? What are our wants? What exactly, if any, are our needs — and who is making them?
(L-R) Sreeja Kalapurakkel, Sara Surani, Daniela Muhleisen, Dr. Vikram Patel, Nick Seymour, and Laura Kanji. (Other members of the Harvard Global Mental Health Coalition at the conference not mentioned are Brendan Eappen and Marek Kowalski)
I think that we are still very far from being able to consider mental health activism the new ACT UP. I wish this weren’t the case. I wish this for two reasons: I wish that the HIV/AIDS epidemic in our world was over; and I wish that mental health activism had the vitality, the power, and the impact that ACT UP had in the eighties and nineties. But I do think that there is hope, and that mental health activism is finding new ways to gain power. This conference was considered historic. It is sad to think that it has taken until 2016 for mental health to be addressed in this light, but it is also empowering. I am glad that the World Bank and the World Health Organization understand that this is an issue worth addressing.
This conference was a starting point. It is a starting point, and we have long ways to go on from here. We must develop specific “asks” and find a bridge between anti-psychiatry movements and mental health care providers. We must create a foundational coalition between patient and government, and make sure that the voices that are not being heard are somehow listened to. This means, of course, that we have to reduce stigma, and that we have to promote policy reform that makes treatment, and whatever treatment means, affordable and accessible to all. $1=$4 return might mean everything to someone making a nation’s financial budget; for those of us who are not, let’s focus on the fact that every single one of us is affected by mental illness. I don’t know how many numbers it’s going to take for the world to find a call to action.
There is no health without mental health. We need your help.