Rural transformation, mental wellness and love

by Saboto Caesar

Minister of Agriculture and Rural Transformation

Sunday 29th October, I attended Sunday morning Independence Day worship at two Churches. In a relatively short 20-minute drive, I counted eight persons at different intervals who were walking on the road exhibiting signs of being mentally unwell. It dawned on me that we in SVG are not isolated from the impacts of mental unwellness that many mental health experts predicted would follow the Covid-19 pandemic.

The Director of the Pan American Health Organization (PAHO), Dr Jarbas Barbosa, in June of this year urged leaders and decision makers to ensure that mental health is placed at the top of political agendas and integrated into all sectors and policies, in order to address worsening mental health in the Americas due to the COVID-19 pandemic. I wish to quote Dr Barbosa extensively.

“The mental health of the population of the Americas has been severely impacted by the COVID-19 pandemic.

“While mental health has historically represented a significant source of disability and mortality in the Americas, accounting for nearly one-third of all years lived with a disability, the COVID-19 pandemic further increased the risk-factors for mental health issues, including unemployment, financial insecurity, and grief and loss.

“Despite the high level of mental health issues in the Region, the vast majority of those with a condition do not receive the care they need. In 2020, more than 80% of people with a severe mental health condition, including psychosis, did not receive medical treatment.”

The PAHO Director highlighted that this lack of access to care is due to a variety of factors that pre-date the pandemic, including: low investment, only 3% of countries’ health budgets are allocated to mental health; a reliance on long-stay hospitalization when the majority of mental health problems can be resolved in the community; a chronic shortage of trained mental health personnel; and reduced access to services for those living in vulnerable situations

To address these issues, in May 2022 PAHO established the High-Level Commission on Mental Health and COVID-19. The Commission, which is made up of 17 experts from government, civil society, academia and those with lived experience of mental health conditions, was tasked with providing guidance to PAHO and its Member States on how to advance mental health in the Region during and after the pandemic.

The Commission’s report, A New Agenda for Mental Health in the Region of the Americas, provides countries with ten recommendations to improve mental health care:

1. Elevate mental health at the national and supranational levels.
2. Integrate mental health into all policies.
3. Increase the quantity and improve the quality of financing for mental health.
4. Ensure the human rights of people living with mental health conditions.
5. Promote and protect mental health across the life course.
6. Improve and expand community-based mental health services and care.
7. Strengthen suicide prevention.
8. Adopt a gender transformative approach to mental health.
9. Address racism and racial discrimination as a key determinant of mental health.
10. Improve mental health data and research.

“Investing in mental health is crucial to promote equitable and sustainable human development for all to live with well-being and dignity,” Dr. Epsy Campbell Barr, Chair of the Commission and former Vice-President of Costa Rica, said. “We must remember that the mental health burden is not a private struggle but a public health crisis that warrants urgent and immediate action.

“Today, we don’t just launch a report; we launch a beacon of hope, a roadmap for change in how we view, treat, and prioritize mental health in the Americas. It is now in our hands to shift how we approach mental health, especially in a global crisis that has profoundly affected it,” added Dr. Nestor Mendez, Co-Chair of the Commission and Assistant Director General of the Organization of American States (OAS).

Mental Health in the Americas

Nearly one-third of all years lived with disability (YLDs) and one-fifth of disability adjusted life years (DALYs) are due to mental, neurological and substance abuse conditions and suicide.

Depressive and anxiety disorders are the third and fourth leading causes of disability.

Alcohol is responsible for 5.5% of all deaths in the Americas.

The Americas has the second highest level of alcohol consumption in the world.

Suicide claims the lives of nearly 100,000 people each year.

The regional age-adjusted suicide rate increased by 17% between 2000 – 2019.

8 out of 10 individuals with a severe mental health condition do not receive treatment.

In 2020, during the COVID-19 pandemic, major depressive disorders increased by 35% and anxiety disorders by 32%.

65% of countries reported disruptions to essential mental health and substance use services in 2020. This number has decreased to 14% in early 2023.”

In conclusion, whilst the world has been consumed by the COVID-19 global pandemic, another pandemic has gone unrecognized that effects far more people of the world, it is the global mental health crisis.

The first thing we must address is a willingness to talk about the issue, but we must also change our attitude towards the many families and friends that are struggling.  We don’t look down upon anyone suffering arthritis or diabetes, so why do we if a person is depressed or has a crisis of confidence?

It’s time we change our attitude to mental health illness.

Historically, anyone who might admit to struggling with a mental health condition like depression or anxiety would fear being stigmatized as having a weakness of character. A fear of having ‘my private business potentially getting out there and causing friends, family, or my employer to feel differently about me’ also causes people to not seek treatment. This area is covered extensively in Employment Law.

Like any illness, mental health conditions worsen when untreated. People often begin to self-medicate, leading to addictions to alcohol and drugs to escape their pain. This leads to bad outcomes and the vicious circles of mental health illness and addictions that can ruin families and cause violence and crime.

There are so many types of mental health illnesses that have root causes in trauma from one time or another in our lives. These traumas can look differently to different people, but they are wounds of a kind that can have lifelong consequences if left untreated.

It is recommended that:

1. Family members and communities provide greater support.
2. More young persons enter career paths that will address solving issues arising from mental unwellness.
3. We continue our active quest to attract trained medical experts in the field of mental health. Our youth entering the medical profession should request scholarships for the training necessary to become psychiatrists, psychologists, counselors and mental health nurses. Our region must find mechanisms to attract foreign professionals to support and train professional service providers the current international standards.

Let us all pledge to be a voice for mental health wellness.