10 October, World Mental Health Day

Dr. Tedros Adhanom Ghebreyesus, Director-General of the World Health Organization in announcing the theme for World Mental Health Day 2020 “Mental Health for All: Greater Investment – Greater Access” stated, “The world is accepting the concept of universal health coverage. Mental health must be an integral part of UHC. Nobody should be denied access to mental health care because she or he is poor or lives in a remote place.”[1] In the wake of COVID 19, the need for universal access to mental health services has become even more urgent. His statement cuts to the heart of the global mental health response, much of the world’s population still do not have access to psychologists, psychiatrists, or any kind of treatment for psychological illness or substance use disorders. In Australia, mental health awareness during the past decade has grown significantly, as has funding for it. Yet globally mental ill-health is widely under-reported and underdiagnosed, particularly in lower-income countries.

In lower-income countries where mental health research is sometimes non-existent, lower numbers of mental ill-health are documented and therefore treated. However, the WHO estimated one in four people globally will suffer from a disabling mental illness or neurological disorder at some point in their lives[2] and estimated that 5% of the population are diagnosable for significant mental disability in any one year (WHO World Health Report 2019)[3]. This quite broad definition includes many forms; depression, anxiety, bipolar, eating disorders, and schizophrenia. 

In Cambodia during 2019 only approximately 60 psychiatrists[4] were available to treat a population of more than 15 million, hence the focus this year on greater investment and greater access. Further training of mental health professionals is desperately needed, in lower-income countries. As are health campaigns that teach people how to recognise and seek treatment for friends and family that are displaying mental instability and illness. In many parts of the world, one documented barrier to people seeking timely mental health care and treatment can be, when religious beliefs and methods are preferred over medical and community support. This can occur when the abnormal behaviour of others is perceived to be a spiritual problem instead of a mental illness. While traditional rituals and customs can greatly assist individuals in the healing process, when a person is presenting with severe symptoms the priority should be timely medical and community intervention. 

Most people use the terms of mental health and mental illness interchangeably. Yet the WHO definition refers to health as “a state of complete physical, mental and social well-being”[5] So we must consider mental health as the objective for all of us, mental illness is “generally characterized by some combination of abnormal thoughts, emotions, behaviour and relationships with others”[6]. This difference is extremely important. Many agree mental illness should be completely de-stigmatised because it is essentially another kind of health problem. Yet if you have never experienced severe mental illness in yourself or with people close to you, it is hard to grasp what destigmatising mental illness looks like in practice. Mental illness is by its very nature is relational because it affects thoughts, emotions, and behaviour. Where physical ill-health locates illness in a body, mental ill-health does not just affect a single mind/body. It affects relationships and affects not just the mind of the individual, but all the minds linked to this individual by chance or by choice. 

De-stigmatisation of mental illness thus requires a radical re-thinking of how we relate to others, and not just to those with a diagnosed condition. It calls for insight into the process of our minds while practicing compassion and patience when we encounter, what we consider to be abnormal thoughts, emotions, and behaviours in others. Yet the caveat here is that “abnormal” and “normal” behaviour are socially constructed at any given point in time. Thus, interrogating one’s understanding of what is considered normal and abnormal behaviour is an essential part of de-stigmatising mental ill-health and understanding how to respond compassionately when you meet someone who may be experiencing a mental illness or crisis. 

If you do experience a mental illness in your life, whether you receive timely adequate treatment and your basic human rights are respected, depends to a great extent on where you are located geographically. “The overall prevalence of mental illness is broadly similar in rural and urban Australia, but the suicide rate is considerably higher in rural areas, particularly among younger men, elderly men, and Indigenous people.”[7] This is why when considering how to improve access to mental illness treatment and support globally, greater investment providing mental health services in rural and remote areas is needed. 

While mortality by suicide is widely discussed in Australia and is being addressed through prevention programs and campaigns, what is lesser known that people with a mental illness have increased mortality from common conditions, including cancer, stroke, cardiovascular disease, respiratory diseases, and accidents[8]. Thus, we cannot speak of mental health without addressing the interconnected nature of mental health to so many other issues including physical health. Integrated mental health treatment acknowledges this interconnectedness and most mental health professionals are keenly aware that mental health is a spectrum of experience that changes over time, with environmental, relational, and societal factors playing a very large role in those experiencing a mental illness. The WHO rightly states: “An environment that respects and protects basic civil, political, socio-economic and cultural rights is fundamental to mental health. Without the security and freedom provided by these rights, it is difficult to maintain a high level of mental health.” [9] 

However, when you look at the multitude of mental health campaigns and mental health media coverage in Australia, the focus is largely on breaking the stigma and calling on individuals to look after specifically their own mental health. To the point that Mental Health Australia Ltd has called their current campaign for world mental health day “Look after your mental health, Australia”. There are indeed things we can do to support our mental health. Yet this approach ignores the fact that many who have a mental illness or face a mental health crisis are at the mercy of other larger systemic issues such as; poverty, racism, sexism, violence, civil unrest, rape culture, domestic violence, toxic masculinity, extreme weather conditions, water scarcity and the widespread destruction of whole ecosystems for the profit of few. It also ignores the fact that if one has experienced trauma as a result of dealing with any of these systemic issues then looking after one’s mental health is ultimately more challenging, and there can be insurmountable barriers that prevent people from taking a walk, meditating or any of the other well-meaning often touted advice for looking after your mental health. Mental illness can happen to anyone, but we also need to be aware of the role that privilege plays in how mental ill-health is perceived by others, how accessible treatment is, and in the length of recovery. 

Having talked to many people for a long time about mental health issues in very frank and personal terms, the most common thing I hear from those who have experienced mental illness at some point in their lives is that the kindness, patience, and compassion from others is what they needed most at that time. My own experience is the care of others saved me, along with medication. What most people need when they are experiencing a mental illness or crisis is a community of care that can assist with everyday tasks and checking in on sleep, personal hygiene, and making sure they are eating regularly. This can become burdensome if it is only one or two people doing the caring, which is why a community of support is needed. The other role a community of care assists with is deep listening, practicing non-judgment, and staying with the experience of the other in a calm way, no matter what arises for as long as they need. 

Here is what one friend would like me to share with you about her recent experiences. 

“Mental illness can affect anyone…I am suffering from severe depression, a few times I felt suicidal because I lost my job, friends, and my dignity. I’ve always been self-sufficient; I’ve always had more than enough so I always helped people in need. Now I feel helpless and I don’t recognise myself anymore…Most days I just want to sleep the whole day, sleep helps me not to think. Time freezes and it’s the only time I don’t think of my problems…I didn’t know this could happen to me…I live in a country that has a ‘survival of the fittest’ policy, so if I don’t have a job to support myself, I am on my own….What do I crave most at this time? Someone to be with me, to drag me back, to shine a candle into my darkness, to tell me ‘it’s ok not to be ok’ and tell me ‘it’s gonna be ok, I don’t have anything to give but you have my friendship’ because I feel so alone and I feel like I don’t have anyone.” 

I wanted you to hear her words directly because she expresses through her lived experience many of the themes mentioned in this article. Her words should remind us that though all the statistics, data, and talk of global mental health issues, there is an individual human in need of connection and support. Destigmatising mental illness is showing up and giving that support, in the same way we do for people who have a physical illness.

Another way is to observe your mind when you next encounter someone showing some combination of abnormal thoughts, emotions, behaviour, or relationships. Before you react, respond, or judge, simply look at the quality of your thoughts and your possible delusions. Practice compassion and kindness in the way you think about the other, in the way you respond, and in the way you assist. 

If you have never encountered mental illness before, here are some of my top things to remember:

• Mental health plans are wonderful things to share with friends and family when we are healthy, that way in a time of crisis friends and family will know our wishes or how they can be of assistance. 
• Do be there for your friends and family experiencing hardship, spend time with them, and listen to them. Check-in on them, don’t be offended if they don’t ever call you, they may not be able to. Rally a community of support around them. 
• Don’t post or share videos online of people who are acting strangely and who are possibly experiencing a psychotic episode. 
• If you meet someone or encounter someone with poor personal hygiene, be kind, do not be rude to them, or say anything. They may be aware of their situation but are struggling with doing basic life skills for themselves. There is no need to mention it to others after. All humans have a smell, even you. 
• If someone confides in you about how they are feeling, or is hearing voices or is having suicidal thoughts, urge them to seek professional help. Unless you have experienced this exact thing yourself, hold off from giving advice. Sit with them and listen, ask questions. Seek details and try to encourage them to see a professional. 
• If you have a friend or family member who is amid a crisis, don’t try to help them all on your own, seek help and support from others in a respectful way. Make sure you don’t put your mental health at risk in trying to assist them.

—Anastasia Freeman (MELF 2019-2020)

  [1] Dr. Ingrid Daniels (2020) “Message from the WFMH President” from https://wfmh.global/world-mental-health-day-2020/ (27/09/20)

[2] A product of NMH Communications. World Health Organization, Geneva, 2001. https://www.who.int/whr/2001/media_centre/press_release/en/ (7/10/20)

[3] World Health Statistics 2019: Monitoring health for the SDGs https://www.who.int/gho/publications/world_health_statistics/2019/en/ (7/10/20)

[4] “Mental health services in Cambodia: an overview” by Sarah J. Parry and Ewan Wilkinson https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7283113/ (7/10/20)

[5] https://www.who.int/news-room/fact-sheets/detail/mental-health-strengthening-our-response

[6] https://www.who.int/mental_health/management/en/

[7] https://www.ranzcp.org/practice-education/rural-psychiatry/mental-health-in-rural-areas (8/10/20)

[8] Tackling the Global Mental Health Challenge: A Psychosomatic Medicine/Consultation–Liaison Psychiatry Perspective by Amy M. Bauer, Ken Fielke, John Brayley, Mesfin Araya, Atalay Alem, Bernard L. Frankel, Gregory L. Fricchione. Pg 186 Psychosomatics 51:3, May-June 2010. http://psy.psychiatryonline.org

[9] https://www.who.int/news-room/fact-sheets/detail/mental-health-strengthening-our-response (8/10/20)

Messages to Anastasia Freeman c/- Siobhan Golden - MGA Intern