Editorial | Mental illness new public health epidemic

A new report by the World Health Organization (WHO) on the mental health of people who live in war zones is of relevance to Jamaica and, hopefully, will command the attention of the island’s medical authorities, including the health and wellness minister, Christopher Tufton.

According to the WHO’s paper, first published in the medical journal Lancet, and quoted by other outlets, one in five, or 20 per cent, of persons who live in conflict areas suffer from some mental condition. That ratio is substantially higher than the six per cent contained in the agency’s analysis of three years ago. But the WHO said that the latest findings are based on 129 studies, including data from 45 that were not included in the previous survey. This assessment, therefore, is more robust.

Officially, Jamaica is not a conflict zone. It is not among the 37 countries where 53 conflicts, ranging from all-out civil wars to low-intensity insurgencies, affecting 12 per cent of the world’s population, were taking place in 2016. But as Herbert Gayle, the University of the West Indies social anthropologist, pointed out in a series of articles in this newspaper two years ago, Jamaicans exist in civil war-like conditions, at least with regard to the country’s homicide rate.

Each year, more than 1,000 people are murdered in Jamaica. The number reached over 1,600 in 2009, for a murder rate of around 60 per 100,000. That ratio has, in recent years, hovered at around 45 per 100,000. Dr Gayle noted in those 2017 articles, in which he proffered solutions to Jamaica’s criminal violence, that when a country’s murder rate hits 30 per 100,000 or above, academics categorise the numbers of being in civil war territory.

Comparisons with conflict zones aren’t, in the circumstances, unwarranted. Indeed, the congruence isn’t limited to comparative homicide figures. Mental health conditions, too, are noteworthy.

Just shy of a decade ago, a study by psychiatrist Professor Fred Hickling and psychologist Dr Vanessa Paisley determined that 40 per cent of Jamaicans suffered some mental health condition. That was between three and six times higher than the global average. Indeed, a 2008 survey determined that 20 per cent of Jamaicans in the 15 to 74 age group, or around half a million people, suffered from depression.

Further, according to a health ministry report four years ago, 108,000 Jamaicans, which is around four per cent of the population, were treated for mental health issues. That number represented a 20 per cent increase over two years. Eighty per cent of the persons who attended these public facilities were treated for schizophrenia. Such data suggest that Jamaica may be trapped in a mental health crisis, to which the country is paying insufficient attention. Indeed, a 2016 document by the health ministry concluded that the island’s high level of violence had given rise “to many children and adults with post-traumatic stress disorder, personality disorders, depression and anxiety”.

Hickling-Paisley report

Given the stigma attached to mental illness, and the fact that some patients receive private care, the Government’s data is unlikely to paint a full picture. Moreover, as the Hickling-Paisley report suggested, a significant portion of people with mental conditions may not be aware of their illness, so may not seek help. And some, even when aware of their problem, do no seek help because of the stigma attached.

New approaches, taking into account the war zone-like circumstance of Jamaica, are needed to confront this growing public health crisis. For it appears to us that what is being done, or is contemplated by the task force on mental health established in 2016 by Health Minister Christopher Tufton, is inadequate for what obtains. In fact, Dr Tufton may have to revisit his recently released 10-year policy document for health and wellness, to give a greater priority to mental health.