From Developing World Bioethics
As I write this on October 10, 2020 World Mental Health Day is upon us once again. The global picture of the suffering that mental health problems visit upon humanity remains as grim today as it does in every other year. Neuropsychiatric disorders remain stubbornly the third leading global cause of disability-adjusted life-years. Reliable access to mental health care, when it is needed, remains a significant problem even in the global north, but those problems pale into insignificance when compared against the situation in much of the global south. According to WHO data about 75% of people with mental health problems in the global south receive no treatment for their illness.1 The disruption of health services, courtesy of the global response to COVID-19, has resulted in already unreliable and insufficient access to health care under ‘normal’ circumstances turning into no access for many. That has impacted patients seeking relief from mental illness-related suffering disproportionately. The disregard for the suffering mental illness causes in the global south is also reflected in global health aid allocations to this problem. As far as global health aid is concerned, only about 1% of international development assistance for health is earmarked for mental health. Considering the much higher contribution to disability-adjusted life years impact that mental illnesses make, this does raise questions of distributive resource allocation justice.
Human Rights Watch recently released a landmark report that shines a light on how countries in the global south respond to patients with mental illness related needs. They often put them in chains or shackle them in confined spaces. The human rights group quotes ‘Paul’, a patient who has been chained in a ‘faith healing’ institution in Kenya: ‘I’ve been chained for five years. The chain is so heavy. It doesn’t feel right; it makes me sad. I stay in a small room with seven men. I’m not allowed to wear clothes, only underwear. I have to go to the toilet in a bucket. I eat porridge in the morning and if I’m lucky, I find bread at night, but not every night…. It’s not how a human being is supposed to be. A human being should be free.’2 – Whatever ‘Paul’s' mental health issues may be, he is right. If he is a service user who does require permanent care, this surely isn’t the type of care that he is owed. Unsurprisingly, one explanation for the abuse that ‘Paul’ is subjected to has to do with the fact that ‘in many countries around the world, there is a widespread belief that mental health conditions are the result of possession by evil spirits or the devil, having sinned, displaying immoral behaviour, or having a lack of faith. Therefore, people first consult faith or traditional healers and often only seek medical advice as a last resort.’3
I reported in an Editorial in this journal last year about questionable research in such ‘faith healing’ institutions.4 The research was undertaken with the best of intentions,it aimed to reduce the number of people with mental health issues living in chains in such ‘healing’ outfits. The researchers tried to show that other methods, involving actual professional care, are superior to mere praying while-in-chains. While they were able to show that, apparently little has changed since then. Human Rights Watch reports that shackling occurs today in at least 60 countries across Asia, Africa, Europe, the Middle East, and the Americas.
I would urge bioethics researchers to focus at least some of their valuable attention on the plight of the global south’s mentally ill people and their need to access professional health care. It’s unlikely to capture as much public attention as the much-discussed question of how to allocate a prospective COVID-19 vaccine, but it’s arguably of greater importance.
