Just a few years after the most recent World Health Organization report on the global burden of disease, mental health has remained a low priority in most low-income and middle-income countries. Such nations instead prioritize the control and eradication of infectious, reproductive, maternal, and child health diseases. More modernized nations put the highest value on modifying risk factors of non-communicable diseases that add to early death such as cancer and heart disease even ahead of diseases that cause years lived-with-disability (YLD), such as mental disorders, dementia, and stroke.
But if mental health disorders are to be considered a distinct health domain with separate services and policy needs, then investment in mental health has only recently escalated to its present high priority. This is because of the recognition of the enormous health and economic impact caused by specific mental health disorders such as depression, anxiety, and substance use, and its premature morbidity and mortality of co-occurring diseases as diabetes, cardiovascular disease, and cancer, especially when mental health conditions go unrecognized and untreated.
With an estimated annual loss in productivity to the global economy of at least $1 trillion due to depression and anxiety alone, the cross-cutting nature of mental health issues has never been more important. Advocates of mental health services note the vital nature of integrating mental health services into general health systems, whether in the form of universal health coverage, maternal and child health, workplace or wellness programs, or in rescue and reconstruction efforts in war torn conflict zones and humanitarian settings.
To bring the problem into local focus, an estimated 1 in 5 adult New Yorkers had a mental illness in the past 12 months, with a rate of 5% of serious psychological distress that has remained stagnant. Compared to the estimated one-half million New Yorkers living with depression, those without depression were less likely to be employed (39·3% vs 62·5%) and three times more likely to report fair or poor general health (54·6% vs 19·0%). Less than 40% of adults with symptoms of depression received mental health treatment in the past 12 months, with foreign-born and poorer New Yorkers even less likely to receive support. Inequities exist beyond access to quality mental health treatment such as in highly segregated, impoverished, or under-resourced neighborhoods, and others in whom mental health issues are compounded by repeated exposure to violence, discrimination, and barriers to access mental health care. Changing the culture of mental health disorders is difficult but first steps appear to include reducing its stigmatization and encouraging earlier interventions, alleviating disparities in access mental health services through community partnership, while using data-driver programs to be more responsive to gaps in mental health services.