The Way Nations are failing to Incorporate people with mental illness into society

Martin Koehring

In opening The Economist’s summit on The International Crisis of melancholy in 2014, Kofi Annan, former UN secretary-general, said: “melancholy should become a global priority since it not only influences health and well-being but also reduces labor productivity and economic development. Calling the battle of melancholy a international crisis is no exaggeration whatsoever.” The urgency to deal with this growing social crisis hasn’t diminished since then. Yet, research from The Economist Intelligence Unit highlights major deficits in policies to incorporate the mentally ill in society.

October 10th has been World Mental Health Day, this season with a specific focus on mental health at work. Few diseases are more poorly known and much more subject to stigma and bias in relation to mental illness, and several inflict exactly the exact same size of influence  on both the afflicted and society too. Really, psychological disease (including substance use disorders) is among the top disease areas in terms of the global burden of disease, ahead of diabetes, HIV/AIDS and tuberculosis, for example (see chart 1 below). This has adverse financial consequences: in Europe, for example, the direct and indirect costs of mental illness on GDP are estimated annually at 3% to 4%.

Chart 1: Proof of global disease burden, 2015 (disability-adjusted life decades, DALYs)

Europe faces big “treatment gap” in emotional health

Though a consensus has emerged among health professionals, policymakers and patient advocates about the advantages of integrating the affected individuals into society and employment as opposed to sequestering them in associations, few countries have come close to realising the ideal. In 2014 study from the Economist Intelligence Unit, commissioned by Janssen, assessed the degree of commitment in 30 European countries–the EU28 and Switzerland and Norway–into integrating people who have mental illness in their communities.

Our study found that only one-quarter of all Europeans affected by mental illness get any treatment in any way, while just 10 percent of affected individuals receive “notionally adequate” care. Across Europe, initiatives to incorporate affected individuals into jobs and society tend to be weak and uneven. Germany, the United Kingdom and Denmark stand out among the best-performing Nations. But, understanding of the challenges and answers is hampered by a dearth of data.

At the core of the study is a benchmarking indicator comparing the degree of work in every one of the 30 countries on indicators connected with integrating affected individuals into society. The 18 indicators have been grouped into four different classes:

  • The environment for all those who have mental illness in developing a full life;
  • accessibility of victims from mental disorders to medical aid and services;
  • Opportunities, especially job-related, accessible to people who have mental disorders; along with
  • Governance of the machine, including human rights and efforts to combat stigma.

The analysis indicates that Germany leads Europe in relation to psychological health integration, so on the strength of its good health care system and ample social welfare provision. Not far behind are the UK and lots of Nordic states. The weakest states are mostly in Europe’s south-east (see chart 2 below).

Chart 2: Mental Health Integration Index results for Europe

The research found that real investment places apart countries severely addressing integration out of people producing “Potemkin coverages” that are far more façade than chemical. Overall state scores reveal a strong correlation with the proportion of GDP spent on psychological wellness.

In addition, the analysis throw a spotlight over the constraints–both regarding accessibility and comparability–of European information on emotional health integration. The Economist Intelligence Unit created qualitative data on integration efforts in large part because of the lack of quantitative data comparable across the 30 states under review.

Ultimately, the study concluded that Europe is only at the beginning of the trip from institution-based into community-centered care. It discovered that even deinstitutionalisation is currently in early phases; in 16 of the 30 countries more individuals continue to get care in long-stay hospitals or institutions than in the community. Moreover, statistics show that medical services for people who have mental disorders are poorly integrated, and that government-wide policy to organize clinical, social and employment services is a rarity.

Asia-Pacific Nations also struggle to integrate mentally ill into society

Chart 3: Mental Health Integration Indicator effects for Asia-Pacific

The indices for Europe and Asia-Pacific are, by design, identical within their classes and indicators. Regrettably, however, technological differences in scoring make direct comparisons between individual Asia-Pacific and European country results invalid. It is, nevertheless, possible to look at similarities and differences from the wider classes from the pieces of labour and, in doing this, shed light onto the global challenges of integrating those living with mental illness into the city.

The latest study found that countries across Asia-Pacific are giving more focus to mental disease but much remains to be done to achieve the ideal of community-based care and integration. In high–income Asian countries (Hong Kong, Japan, Singapore, South Korea and Taiwan) services for the mentally sick are comparatively wealthier and under-staffed. A rural-urban divide in maintenance hampers caution even in wealthy countries. And, like the findings for Europe, a scarcity of data undermines policymaking and standardisation of therapy.

New Zealand and Australia work well because of their long record of constant efforts to execute community-based care. This has led to not only the essential infrastructure, clinic and personnel but also a noticeable decrease in stigma against people living with mental disorder. But, both states are still working on weaknesses, such as access to look after socially-marginalised classes and rural dwellers.

High-income states (Hong Kong, Japan, Singapore, South Korea and Taiwan) have been attempting to execute community-based supply for individuals living with mental disease. However, such services are still comparatively under-developed and under-staffed. By way of example, Japan and South Korea have high levels of institutionalisation.

There is a distinct rural-urban divide in terms of service provision for individuals afflicted by mental disease, even in more affluent states. In Australia, for example, the number of psychiatrists per capita outside cities is just one-third of the figure for major urban areas, whereas per capita mental-health spending from the most remote areas is just 11 percent of the in major cities, even though the prevalence of mental disorder is exactly the exact same.

As we discovered for Europe, a lack of consistent data on mental illness discourages policymakers from taking activity and also prevents standardisation of therapy. Across much of Southeast Asia, as an example, surveys measuring prevalence of depression and stress cover only around 15% of the population, also in South Asia only around 5%.

Our studies show that a few countries in Europe and Asia-Pacific have observed noticeable progress in integrating people who have mental illness in their communities. However, since the world celebrates World Health Day, much remains to be done for depression and emotional health to actually become “a global priority”, as Mr Annan has required.

Martin Koehring

Before linking the EIU’s idea leadership group in 2014 he was Europe editor in The EIU’s Country Analysis group, covering politics, economics and business trends in Western Europe. Along with English and his native German, he also speaks Italian and French. Before joining The EIU in 2011, Martin was employed as a senior economist at the business intelligence provider Dun & Bradstreet.

Martin gained a bachelor of financial and social studies in international relations (First Class Honors) from Aberystwyth University and a master’s degree in EU international relations and diplomacy studies by the College of Europe. He’s also studied global health policy, international economics and macroeconomics at the University of London.

Martin is an expert public speaker. His media experience includes mentions or appearances in various outlets, including ABC News, BBC News, Bloomberg, Deutsche Welle TV, Retail Week, Sky News, The Guardian and Voice of America. He’s introduced EIU study to audiences across the world, such as in Brussels (on obesity in Europe), in Bucharest (on tuberculosis in Romania) and Belgrade (on modernising health care systems in the Balkan countries). He is also experienced in chairing events, such as roundtables on disturbance in the medical sector and constructing a new ecosystem of maintenance as well as sessions at The Economist Events’ recent seminars on obesity, food and sustainability.