Mental illness: A ghost in a shell

This article was exclusively written for The European Sting by Ms. Sadia Khalid, early-stage researcher (ESRs) at Tallinn University of Technology (TalTech), Estonia. The writer is affiliated with the International Federation of Medical Students Associations (IFMSA), cordial partner of The Sting. The opinions expressed in this piece belong strictly to the writers and do not necessarily reflect IFMSA’s view on the topic, nor The European Sting’s one.

Inn an aspect of today’s slowing economy, the public health and socioeconomic challenges brought forward by Covid-19 make mental health promotion and prevention topics more critical than ever.

1 in 10 of us (and 1 in 5 young people) experience mental health challenges at any given time. More than 100 million in the WHO European Region experience mental illness struggles in silence. Even in higher resource countries, the coverage for common mental health conditions is less than 30% and sadly the coverage is less than 5% in less-resourced nations. Every year 800,000 deaths happen due to suicide globally (140,000 in EURO); suicide is the second leading cause of death in adolescents and young adults.

In 2022 if we still think of mental illnesses as an invisible threat then we might be inconsiderate, ignorant, and fooling ourselves. The signs and symptoms of mental illness often set in even before we know it. Even when identified early the concerns get labelled as a phase and are discouraged to take it seriously.

We all need healthy psychological strength and good mental health to flourish in current global challenges. And if you talk about mental health promotion to foster individual competencies and strengthen community assets to prevent it, we understand most countries are ill-equipped to prevent and manage it well.

Here we will propose a few strategies and principles to enhance the well-being and quality of life of people and communities. We will discuss a few existing policies, and what we can learn and take from the actions of others.

As sad as it may sound, half of all mental health conditions start at 14 years of age. Mental health difficulties account for 16% of the global burden of disease and injury in youth 10–19 years (World Health Organization, 2020). WHO establishes a clear and concise overarching aim to improve the well-being of the population and reduce the burden of mental disorders, with a particular focus on vulnerable groups, exposure to determinants, and risk behaviours.

Youth mental health support and services highly vary across sociocultural contexts. We see in Europe an increasing number availability of tools and resources for national suicide prevention and mental health protection strategies been developed and modest resources available for effective strategic planning and implementation.

But in less-resourced countries with limited specialists and representative literature, it is important to capture the perspectives of youth with lived experiences of mental illness such as anxiety and depression for planning needs-led interventions and services. Youth with lived experience of mental illness should be involved in service planning, implementation, and monitoring through surveys and interviews that focus on their experience while accessing mental health care services.

This approach will reduce power imbalances and enable spaces for youth to be heard. As youth is often marginalized or excluded from service planning and implementation in several countries. (1) Secondary and high schools should introduce special programs where students with mental health difficulties can learn their potential role as future advocates of mental health promotion.

Youth can greatly benefit from shared experiences, discussions and awareness that may offer relatable therapeutic engagement and processes, in contrast with professionals who focus on outcomes and service delivery. It is important to capture their shared lived experiences of support across different sociocultural contexts and systems.

This will offer a pseudo-multi-modal intervention that potentially addresses the needs of youth across their socioecology and is positioned within a stepped care model.

Mental health awareness and integration of interventions with social support are essential, especially in disadvantaged communities where there is limited access to structural support. Understanding that mental health support can be extended beyond specialist services to family and community networks, schools, religious groups, and social activities is crucial in health promotion as these valuable resources have been found to provide greater accessibility and acceptability, trust, and family engagement.

It’s never too late to introduce an opportunity for Health promotion and suicide prevention fellowship to health care and public health workers. This fellowship should incorporate a mix of experiential learning, reflective practice and group activities, mandatory neuropsychology, and public policy research work with the aim of progressing the next generation of mental health sector leadership.

It will be ideal to encourage neuropathologists, neuroscientists, geneticists, behaviour scientists, psychiatrists, public health workers/scientists, policymakers in this respective field, and psychologists to consider a one-year fellowship in mental health promotion and suicide prevention as it will benefit everyone involved. Communication sciences training, which is an important aspect of any fellowship or a research degree in this case, should include a young audience from high school and medical school to attract youth into this profession.

Strategically vital approaches to mental health promotion and protection would be a life course approach, an equitable, rights-based, and person-centred person, an evidence-based approach, and a multi- based approach.

It is important to develop policies where respecting the rights of people with mental health problems is pivotal and offering these people equitable opportunities to attain the highest quality of life and addressing stigma and discrimination must be a priority. Every citizen accessing the mental health system deserves to receive safe care and has the right to be treated with dignity and respect.

This calls for the abolishment of the use of restrictive practices such as seclusion and restraint that affect consumers’ right to dignity, therefore it is essential to monitor the frequency of restrictive practices over time as they can provide an indication of the performance of mental health services. Surveys that allow anyone to access mental health services can help mental health services and consumers work together to build better services, by identifying areas where consumers believe improvements can be made.

Currently, carers lack a way to contribute to the ongoing improvement of mental health services easily and routinely. In-depth discussions should also be carried out with health care providers about how they think the system could be improved. These inquiries are valuable for identifying and understanding deficiencies in the mental health system.

They also provide a unique opportunity for action, and it is critical that governments use the recommendations of these inquiries as the basis for system improvements. Mental health care facilities should make sure to establish accessible, safe, and effective services that meet people’s mental, physical, and social needs and the expectations of people with mental health problems and their families.

The National Mental Health Commission of respective countries should regularly meet with representatives across the full breadth of the mental health sector. They must listen to the experiences of consumers and carers, and understand the significant challenges faced by service providers in mental health. So, when there is an action to bring forward reforms in Mental Health and Suicide Prevention Plan, they feel confident in their policies and activities in suicide prevention, and the National Disability Insurance Scheme that it will certainly lead to significant improvements in the mental health system.

Although system reform takes time, working together as a team as all these governing bodies and service providers strive towards ensuring that mental health and wellbeing should be a primary focus of all governments, allowing all citizens to lead contributing lives.

A well-coordinated, multisectoral strategy based on good evidence, anchored in human rights, and integrated with other priority programs provides the foundation for enhanced mental health promotion and protection. Innovation and the use of new technologies is a key to accelerating the process of accessing / effective coverage of evidence-based care.

Open and easily accessible information is central to raising mental health literacy, as well as monitoring performance and tracking progress towards agreed mental health system goals
The current focus on mental health and suicide prevention in the world marks a significant turning point in our history.

There is an increased awareness of the impacts of mental health and suicide – not only from a health and well-being perspective but also from a social and economic one. There is also a sense of urgency to improve mental health and reduce suicide. I believe we are heading in the right direction.

References

1. P. Vostanis, F.Ruby, J. Jacob, Ş. Eruyar, E. Mironga Getanda, S. Haffejee, M. Krishna, J. Edbrooke-Childs,
   Youth and professional perspectives of mental health resources across eight countries,Children and Youth Services Review,Volume 136,
   2022,106439,ISSN 0190-7409, https://doi.org/10.1016/j.childyouth.2022.106439

Further reading

https://www.who.int/health-topics/mental-health#tab=tab_1https://apps.who.int/iris/handle/10665/310981

About the author

Sadia Khalid, early-stage researcher (ESRs) at Tallinn University of Technology (TalTech), Estonia. She has been working on her PhD research project “The role of Helicobacter pylori intestinal microbiota in the development of liver diseases. under supervision of Dr. Pirjo Spuul at Faculty of Science, Institute of Chemistry and Biotechnology.,TalTech. Previously, she has worked as a research specialist in the institute of biomedicine and translational medicine, University of Tartu (UT), Estonia. She obtained her MD in emergency medicine in 2017 from the Dalian Medical university, China and MBChB in 2013 from the Weifang Medical university, China. Her current research interests include infectious diseases, bacteriology, hepatology, and gastroenterology.