Ananda Galappatti is a medical anthropologist who has worked primarily with mental health and community services in the context of conflict, disaster and poverty in Sri Lanka. He is currently Director of Strategy at The Good Practice Group and an advisory board member of the Mental Health Innovation Network. His project in Sri Lanka received a Grand Challenges Canada grant through the Global Mental Health program.
The arguments put forward by the #FundaMentalSDG campaign make it hard to deny the relevance of mental health to the post-2015 global development agenda. It is now widely acknowledged that mental health conditions contribute a significant proportion of the global burden of disease (Whiteford et al, 2013), and that this burden falls disproportionately on the poorest people and countries in the world. Along with improved accounting for the human costs of psychosocial disability, there has also been growing recognition of the economic costs associated with mental health conditions, such as those due to cost of care or due to lost productivity (Bloom et al, 2011). It is encouraging to see the response to the #FundaMentalSDG campaign, given that the concerns of people with psychosocial disabilities have been too long been neglected. The challenge, it seems, is whether the cause of mental health can gather enough momentum within the current process to formulate the UN Sustainable Development Goals in secure robust language and (very importantly) dedicated outcome indicators to ensure that it remains on the world’s agenda for the next 15 years.
Having worked for nearly two decades with community services for people affected by crisis and poverty in Sri Lanka, I do not need to be convinced of the importance of mental health within mainstream development policy and practice. Whether working in the context of the major 2004 tsunami disaster, the 30 year ethnic war or the chronic deprivation in rural villages, it was always clear that mental health problems and psychosocial suffering of affected people were closely intertwined with the material hardships and social inequities they experienced.
It was apparent that inequitable and adverse social, political and economic conditions meant that some individuals and families were more liable to suffer from violence, loss, displacement, risky livelihoods and discrimination. Difficult life circumstances also degraded and depleted the resources and supports that adults and children could draw on protect them from events that would otherwise overwhelm their capacity to cope. There often was simply not enough in their lives that promoted mental health and resilience. As a result, individuals and families in such disadvantaged situations faced increased likelihood of experiencing serious psycho-social and mental health problems. For people with existing mental health conditions, the disabling impacts of these on their lives were invariably compounded by the social and material conditions in which they and their families lived. Of course, the establishment of accessible, good quality, humane mental health services made a huge difference to individuals and families that had no prior recourse to biomedical treatment and professional support. People who used the services reported improvements in their ability to carry out functions in daily life – returning to education, work and valued family or community roles. However, to address the social and economic factors that impacted most significantly on producing and maintaining psychosocial disability and marginalization was often outside the remit and capacity of the mental health services alone. Other interventions to bring about social and economic transformation were required for this.
Framing the ‘ask’ for mental health within the Sustainable Development Goals
As deliberations and negotiations progress towards a post-2015 global development framework, it is important to ensure that mental health is effectively represented within the final goals. It is especially important that the language and indicators related to mental health allow for a balance between the provision of broad mental health services for treatment and support, as well as interventions to address the social and material factors that produce and maintain psycho-social disability. It is advantageous that many of the current draft Sustainable Development Goals may contribute to addressing both social and economic determinants of mental health, and also deal with many problems that impact on the lives of persons with psycho-social disability. It would be useful to make considerations related to mental health more explicit in the descriptive language of the relevant SDGs.
Considering that the goals and indicators established by the UN will stand for the next 15 years, it seems advisable that the campaign for inclusion of mental health within the SDGs should aim at securing a commitment to ensure better outcomes in terms of the lives of people with psychosocial disabilities, rather than seeking only an undertaking to improve financing and coverage of services (for which there is already a commitment made by 194 states under WHO’s Mental Health Action Plan 2013-2020). I would hope therefore that an outcome indicator around reduced burden of psychosocial disability be considered for inclusion in the SDGs, possibly framed in terms of established instruments such as the Convention of Rights of Persons with Disability and International Classification of Functioning.
As important as the current campaign around the SDGs is, we must also keep in mind the limitations of the Millennium Development Goals that preceded them (Fehling et al, 2013) and develop strategies to ensure that we can pursue a broad global agenda around mental health that is sensitive to the specifics of local context and places persons with psychosocial disability at its centre.
This blog is part of a series advocating for the inclusion of mental health in the Post-2015 Sustainable Development Goals. More information is available on the Mental Health Innovation Network, at FundaMentalsdg.org or by emailing Nicole Votruba. We encourage you to post your questions and comments about this blog post on our Facebook page Grand Challenges Canada and on Twitter @gchallenges