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A major change is needed in the way mental health is perceived at the policy level. The number of medical students entering psychiatry in the United States has been on the decline for six years, according to the American Psychiatric Association. But, as an editorial in The Lancet emphasized, the situation has global dimensions, with the worst outcomes in resource-limited settings where there are 0.05 psychiatrists per 100,000 people, a rate which is 170 times lower than in high-income countries.
Declining continuously and dramatically, the global mental health workforce is among the cadres most affected by brain drain1. According to a World Health Organization (WHO) report published last year, if the supply of mental health workers remains unchanged, the shortage will increase in 2015 by 45%.
There are more causes behind the crisis. As quoted by The Lancet, Tom Brown, from the Royal College of Psychiatrists, UK, says psychiatry is seen as not “scientific enough,” not medical enough, and too difficult due to its challenging relationships between patients and doctors and low rate of success in recovery. Tom Brown believes concerted campaigns to promote the specialty are needed in order to make psychiatry more attractive. But, as The Lancet editorialist points out, “more fundamental issues need to change,” such as putting evidence-based interventions at the core of psychiatric and mental health teams. The Lancet cites scientific evidence showing that “psychiatric patients have poorer overall health than the general population.” This evidence “should ensure that psychiatry is strongly connected to other medical specialties.”
I agree with the editorialist’s view that fundamental changes are needed to revive the mental health workforce. But I would argue that even putting evidence-based interventions at the core of the profession won’t be enough to increase the demand for it. The root cause of this increasingly worrisome situation is, in my view, the low priority given to mental health by governments and donors. Mental health remains the neglected stepchild of public health and of international development projects despite the fact that mental, neurological, and substance use disorders account for an estimated 14% of the global burden of disease. Yes, evidence-based interventions should be at the core of the profession. But, even more than that, scientific evidence should be at the core of political and public agendas. The WHO estimates that depressive illness will become the main cause of disability for women and children by 2020. How is the global health community preparing for this?
Without major changes in the way mental health is perceived at the policy level, any attempted campaigns to make psychiatry attractive would have the same effect as a campaign for freedom of expression led by a government that imprisons bold journalists.
1. Kakuma, Ritsuko et al. Human resources for mental health care: current situation and strategies for action. The Lancet 378(9803).
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