Global mental health report condemns Life Esidimeni tragedy

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Exactly a year after the start of the arbitration hearings that sought justice for the families of the dead Life Esidimeni patients, the esteemed Lancet Commission on Mental Health has released a global mental health report condemning the local disaster.

“In 2016, a tragic case occurred in South Africa when the Gauteng Health Department stopped funding a large 2,000-bed facility and allowed the dis-charge of vulnerable people with psychosocial disability into unlicensed community residential facilities, leading to the death of over 140 people,” Health-e News reports that report noted.

Penned by the Lancet Commission on Mental Health, the report highlighted that people living with mental illnesses still routinely suffer “gross human rights violations” including “torture”. According to the report, mental disorders are rising in every single country in the world and will cost the world’s economy $16 trillion by 2030.

10 October marks World Mental Health Day, and the report notes that young people bear “the brunt of the burden of mental ill health”. Half of all mental illness starts by the age of 14 with most cases undetected and untreated, according to the World Health Organisation’s (WHO).

Globally, “depression is one of the leading causes of illness and disability among adolescents” with suicide being the third leading cause of death in 15 to 19-year-olds, noted the WHO. Among 15 to 29-year-olds, suicide jumps to second place. More than 90% of these suicides occur in in low- or middle-income countries.

Health-e News reports that according to the South African Depression and Anxiety Group (SADAG), almost one in five teens have considered suicide and they have had reports of suicides in children as young as six years old. “The youth are not equipped with enough coping skills or support structures to handle the kind of problems that they have to deal with every day,” said SADAG’s Cassey Chambers. The organisation is particularly concerned about the upcoming matric and university examinations, a time where suicide attempts are at their highest.

Health-e News says along with highlighting mental illness in young people, the Lancet report recommended governments be held accountable and approach mental health from a human rights basis. “The Commission calls out the shameful and shocking treatment of people with mental ill health around the world,” said Dr Richard Horton, editor-in-chief of The Lancet.

While the Commission’s report recommended “a wholescale shift to community-based care”, it should not be implemented in the negligent and torturous manner of the Life Esidimeni move. Professor Vikram Patel, of the Harvard Medical School and joint lead editor, said that mental health “is the foundation of human capability that makes each life worthwhile and meaningful”.

“Anyone who cares about poverty, education, social cohesion or economic progress should work to improve mental health, putting the vast knowledge we have on promotion, prevention and care into action,” said Patel.


The team of 28 global experts say that there is a “collective failure to respond to this global health crisis” which “results in monumental loss of human capabilities and avoidable suffering.” The Guardian quotes the commission as saying that the burden of mental ill-health is rising everywhere in spite of advances in the understanding of the causes and options for treatment. “The quality of mental health services is routinely worse than the quality of those for physical health,” says their report.

When it comes to mental health, says the commission, every country is a developing country. “Government investment and development assistance for mental health remain pitifully small,” says the report. The high cost of $16tn by 2030 is estimated from previous World Bank data on the loss to the global economy of people of working age with mental health problems. In some countries, people with mental disorders are abused and incarcerated, it says. “Human rights violations and abuses persist in many countries, with large numbers of people locked away in mental institutions or prisons, or living on the streets, often without legal protection,” it says.

The Guardian quotes Patel as saying that mental ill-health caused “colossal human suffering” and was responsible for substantial numbers of deaths that are attributed to other causes. “Mental health problems kill more young people than any other cause around the world,” he said.

Suicides are attributed to deaths from injuries. Opioid deaths are considered to be drug misuse. “We are treating mental illness as a risk factor,” said Patel. “A lot of global health priority setting has historically been around diseases that kill.” The commission estimates that 13.5 million deaths every year could be averted if the underlying mental ill-health problems were addressed.

The Guardian reports that in many countries there is no expectation of help. Surveys in India and China, which have a third of the global population, suggest that more than 80% of people with any mental health or substance use disorder did not seek treatment. And when they do seek help, the quality is poor.

Human rights violations occur most often against people with mental health disorders such as schizophrenia and learning disabilities. “Tens of thousands of people with mental disorders are chained in their own homes, or in prayer camps and traditional healing facilities,” says the report. When people are freed, it may be without warning or proper

According to The Guardian, the commission recommends a much higher priority for mental health and parity with physical healthcare, as well as the integration of mental health care into routine primary care.

Executive Summary
A decade on from the 2007 Lancet Series on global mental health, which sought to transform the way policy makers thought about global health, a Lancet Commission aims to seize the opportunity offered by the Sustainable Development Goals to consider future directions for global mental health. The Commission proposes that the global mental agenda should be expanded from a focus on reducing the treatment gap to improving the mental health of whole populations and reducing the global burden of mental disorders by addressing gaps in prevention and quality of care. The Commission outlines a blueprint for action to promote mental wellbeing, prevent mental health problems, and enable recovery from mental disorders.

Health-e News report
The Guardian report
The Lancet Commission articles

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