Global Health Blogs with Professor Swahn

Student Reflections on Topics Covered in our Class

Global Health Blogs with Professor Swahn

Technology in the Developing World: Innovative New Applications

November 19, 2020 · 1 Comment · Technology, Uncategorized

We are currently in a period of rapid technology growth, which some have termed the “fourth industrial revolution,” and new innovative technologies are expected to benefit health and healthcare greatly. As more people across globe, including developing nations, gain access to technology, the possible applications of such tech in the health field widens. Many advanced technologies are too expensive, having little effect on health crises in areas where high-tech healthcare isn’t available, so developing ways technology can provide lower cost solutions to billions of people in less developed countries is necessary.

Many health care systems are looking into telemedicine, but there are also other ways new technologies are being employed and evaluated as possible modes of help for health officials in such countries. The following examples highlight how technologies such as, robotics/drones, mobile phones, 3D printers, and artificial intelligence can also make strides in increasing the access and effectiveness of health care where there are limited resources.

Technological Innovations being used in Developing nations:

Drone Delivery System in Rwanda:

Rwanda, like many less developed countries, is plagued by bad road infrastructure, and during the rainy season it only worsens, with many roads becoming impassable by cars and motorbikes. This transportation issue coupled with Rwanda’s high prevalence of mothers dying during childbirth due to blood loss, were the main reasons for the launch of Zipline, a California based company focused on delivering medical supplies to such areas.

Many hospitals and health centers are not able to stockpile large amounts of blood because of the short shelf life and storage requirements. When emergency blood is needed at a hospital it can take up to 5 hours, in many instances resulting in the death of the patient in need. By using drones to deliver blood, a 50 km distance, which takes over an hour by car, can arrive in less than 15 minutes.

How does it work?

When a hospital needs emergency blood, a request is sent via SMS, phone call, or website. The blood is then loaded with a parachute into the drone by the storage facility, and a smartphone application provides a preflight checklist to follow, including requesting flight clearance from the Rwandan aviation authority. A few minutes before the drone arrives at the hospital, staff are alerted by an automated text to go outside and prepare for the drop.

Though the process has shown many successes and is an impressive technology, there are many limitations and concerns. The technology is expensive and without the current subsidizes by the Rwandan government, drone use may not be cost effective; but arguments against this focus on the effect it would have on minimizing wasted blood due to expiration, paying for itself in the long run. In 2018, hospitals that used Zipline reported no waste.

Another issue is the necessity to share airspace, needing new legislation and trust by a country’s government, which many are skeptical or uncomfortable with drones. Until the drones can hold larger quantities of blood, they are only useful in emergency deliveries. The project plans to expand to deliver medicines and vaccines and move drone assembly from the U.S. to Rwanda.

mTrac in Uganda:

In 2015 Uganda’s mobile phone usage grew to about 65%, creating new opportunities for healthcare workers and patients to improve access to “real-time” information, identify disease outbreaks, and strengthen engagement and accountability. MTrac was launched in 2009 by the Foundation for Innovative New Diagnostics and was made country wide in 2011 with the help of UNICEF. The mTrac services include the timely communication and response of healthcare workers and local governments through weekly reporting and conduction of polls and surveys able to reach all health facilities across Uganda at a low cost.

Health workers use their own basic cellphones to submit surveillance data weekly, medicine stockpile information, maternal and neonatal deaths, typhoid cases, etc., and when a “threshold” is met an alert is sent to the district health management teams for a quick response. It also includes an anonymous toll-free text hotline for Ugandans to place complaints, such as health service problems.  

How has it helped?

By 2016 62,000 health workers and 4,431 health facilities were registered in the database and weekly reporting increased with 80% of facilities completing reports. Client satisfaction increased from 46% to 68% over 5 years and increasing accountability of worker absenteeism and medical supply theft. Some challenges that have arose are workers feeling “overwhelmed” because they cannot respond to everything, budget gaps, and network interferences. [case study article].

3D printing in Haiti:

The 2010 earthquake in Haiti resulted in over 100,000 deaths and the destruction of over 60% of their healthcare facilities [3dprint]. Due to the issues of transportation networks becoming congested by many different crisis relief organizations and such organizations occasional deployment of unnecessary equipment, a 3D printer pilot program, 3DforHealth, was implemented in Haiti to try and reduce such strains on resources and allow for a quicker, in country response to medical material needs.

The program helped aide in “rapid and cost effective on demand production of much needed medical instruments” [3dprint], as well as manufacture broken and missing parts of existing equipment. After interviewing medical personnel after the earthquake ended, the implementation team and local community members developed an umbilical cord clamp. The program proved to reduce the dependency on time sensitive services, and its success led to its absorption by Field Ready, a larger program for disaster response. More uses of 3D printing for health are outlined here.

AI and Malaria:

IBM Research Africa and the University of Oxford have begun using artificial intelligence to help in the decision making of officials and “explore more effective malaria policy interventions.” Interventions such as bed nets, insecticides, and repellents are known to be effective in malaria control, but with decreasing budgets is can be difficult for public health officials and policy makers to choose where to focus the money. Through the use of these AI algorithms and publicly available research and models, like OpenMalaria, officials can determine the most effective strategies for specific locations, as well as explore “what if” scenarios to assess future needs.

Through computational experiments of a 5-year intervention simulation of a region in Western Kenya, they demonstrated how AI can determine the best performing interventions in the future. While a 2017 study reported insecticide-treated bed nets were consistently the most effective across locations, these simulated scenarios showed that in Western Kenyan regions it may be more cost effective to do indoor spraying for a small portion of households rather than large scale deployment of insecticide-treated nets. Read more about AI and Malaria here

These programs serve as examples of how new technological initiatives could improve health in developing countries and could be implemented in similar communities. There are many ways technology can help that are not mentioned including improving health education and training, clean water and sanitation, and sustainability and access to health services. Technological innovations not only can help the health field directly in low resource rural areas, but also in other fields that tend to affect health, such as agriculture, economic improvement, and transportation. There are a lot of current initiatives focusing on the needs of wealthy countries, so more inexpensive technology designed for the world’s poorest needs to be developed to improve health globally.

 

 

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Technology and Global Health: Is it a Blessing or a Curse?

November 19, 2020 · 1 Comment · Technology, Uncategorized

We were blaming it often. Apparently technology was a blessing and a curse. It is human nature to always evolve, and with its evolution and the new hazards faced, it is our nature to blame something for it. 

 

When the COVID-19 pandemic started to evolve, one thing was clear: Technology would help us handle this pandemic. Everyone started working remotely because technology could allow us. We ordered online and we had delivered our order in our house. Doctor’s appointments were shifted online, just a call or a video call away. Apps were made to show you if you were in close contact with a COVID-19 case. Public Health officials were able to do contact tracing and to deliver public health messages through technology.

 

So how is technology helping health:

 

  1. Is Helping to Fight the Opioid Crisis

 

Delaware created a free new app which shows people what actions they need to take in the event of an opioid overdose. It also helps on how to recognize an overdose and where to buy naloxone locally to reverse such an event. Lifes can be saved if you know how to recognize an overdose and if you have access to naloxone usage.

 

  1. Is Helping to Fight Skin Cancer

 

Do you have a mole which has suddenly changed form or color and you are unsure about it. Or do you just want to keep an eye on them. Nothing can compare to a doctor’s appointment, but there is an application which can help you. They can track moles and lesions which can potentially become skin cancer.  Early detection of skin cancer can make it curable and completely reversible. Here are some of the apps you can use.

 

  1. Is Helping to Train and Educate Physicians 

 

A lot of telehealth centers have helped communities in training providers about the best practices to tackle different health issues.  Examples of training are multiple and diverse. Minnesota for example is training its primary care doctors through a Prevention Pilot Project. The program involves training on pill consumption cut, care for opioid use disorder, and the use of MAT (medication assisted treatment) which uses medications to help withdrawal symptoms.    

 

  1. Is Helping During COVID-19 Pandemic

 

We already mentioned some of the examples, but one that stands out is how technology is helping doctors in treating patients. When a new disease emerges, protocols are not immediately available. Doctors learn from their experience and from others’ experiences. The New England Journal of Medicine created a treatment stimulation to help doctors in deciding what was the right approach and treatment for different cases 

 

Why is technology important to health information?

 

Health information through technology can improve health outcomes and achieve health equity. According to Healthy People 2020 health information technology is important because they bring about an age of patient- and public-centered health information and services.

When we combine IT tools and effective health communication processes, there is the potential to:

 

  • Improve health care quality and safety
  • Increase the efficiency of health care and public health service delivery
  • Improve the public health information infrastructure
  • Support care in the community and at home
  • Facilitate clinical and consumer decision-making
  • Build health skills and knowledge

What about technology and Global Health 

Even though the great benefits of technology in health, communities in low and middle income countries are missing out on the benefits of digital health and technology usage. One of the reasons is because they continue to face a fragmented digital health landscape in which multiple public and private actors and agencies with varied technologies and interests are working separately and with overlap. According to the National Academies of Science, Engineering and Medicine: “there is a lack of coordinated funding aligned with government priorities; limited regional leadership and peer support; and a lack of low-cost, easily reused, and adapted technologies such as those built with open source softwares.”

 

The Global Initiative on Health Technologies  is a WHO initiative which aims to make health technologies available to communities in resource-limited settings. They want to challenge the business and scientific community to identify and adapt “innovative” technologies that can have a significant impact on public health and they want to challenge the international community to come up with frameworks.

In 2018 a self-insertable and removable one-year contraceptive vaginal ring received regulatory approval from the FDA; this form of contraception can help women overcome barriers to consistent use in countries like Uganda.  Male contraceptive gel, a technology that could bring more equality to the burden of family planning, is now on its phase 2 clinical trial. 

Different partners are working to find innovative and applicable solutions. A lot of student projects are on Innovation and Global Health Systems. From health care app to help women refugees to hurricane-resistant vegetable gardens. Imperial College London has an annual student competition on global health innovation  They welcome ideas from improving hygiene conditions to developing diagnostic tools for usage in remote areas. Yale and Stanford do have the same award type of programs.

The bottom line remains that even though we have advanced in technology, technology access and its usage remains low in middle and low income countries. We have the potential to find solutions and innovations which do not need to be the “discovery of the year”. They can be small things which will help the local community. We need to monitor, evaluate, adapt, and advocate and the most important way is to go where the people are. Only by being in the local community we can learn the local context and can learn what works, and what does not. 

 

    

 

 

 

    

 

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Technology and Global Health: What Has it Done?

November 17, 2020 · No Comments · Technology, Uncategorized

 

Technology and Global Health : What has it done?

GLOBAL health is ever changing, the times , people , the movements and ideas  are all submerging under one roof, “HOW TO DO IT QUICK?”

The time it takes for one person to heal requires equal opportunity. Some people like to enjoy the benefits of their home without reaching there neck out into a greater pool. Technology CERTAINLY has it benefits but it also has wasted up the sciences of the Natural World. We have to be careful not cross the Old world with the New.

“Core medical equipment refers to technologies that are commonly considered as important or necessary for specific preventive, diagnostic, treatment or rehabilitation procedures carried out in most health care facilities. WHO has been working, along with experts, collaborating centers and Member States, to develop several tools for better resource allocation, selection, incorporation and safe use.” 

https://www.who.int/medical_devices/priority/en/

 

This can be helpful in countries that have already de-voided themselves of nature; such as countries which have already adapted guidelines for preventive health, and ushered in Western Medicine and technology.  However we should be VERY careful before entering places where tribes, aboriginals, or even natives to a region exist and live under Natural Law. These technologies can CAUSE MORE Damage and Distress.

 

The story goes that the Spanish conquered there minds then decided to conquer anothers, (Christopher Columbus and the  Seven Seas)

The gift they gave was different , but they still offered something positively and the Natives banished there careful.

 

 

 

 

 

Technology and Stolen Land

 

The Native American Legend of Water TEACHES US HOW PRECIOUS LIFE IS

Water can calm the flame, but we can’t fully accept it like the fire does it. We put it on our shelves, store it, and spread it to each other. But let  us question how we drink  to sustain, and  how to better collect technologies for better living to sustain better balance and harmony with the world, the animals, the trees and nature as a whole. I believe if this happens then the natural balance of the Earth and the individuals health will return.

     Native Americans have been pouring there spiritual value into the  importance of giving up the greater technology to better understand the deeper meaning of there health . The push to advance global technologies into first nations, and indigenous cultures will destroy this value; the intrinsic simple way, and put pressure on matters of their heart, health, and safety. You can live long with a broken tooth, but you cant live very long from a broken heart.

We should think very seriously before giving another technology  or spreading it to a developing nation ; they may not be ready, The very weapons used to  protect life have been used to destroy it

https://www.arcgis.com/apps/MapJournal/index.html?appid=f64e8a94e16249a38bf24f15ac5f1c6f

 

IT IS BETTER TO GROW the tools we can use to strive to serve our environment  naturally. Then the viruses may see we are working positively, are immune systems may change , nature, the earth and its movements will may even grow!  Thinking positively in nature can do wonders !

Agriculture , Farming, Plowing, Herding, Gardening,

 

 

 

How has Television impacted our food?

How has food affected the balance of our daily energy?

How many people are eating what they watch instead of watching what they eat?

 

Sedentary Behavior of TV Viewing, and Exposure to Extensive Marketing Causes Diabetes, and Energy Imbalance.

The mind, specifically the childhood mind is sensitive. The child has a brain, keep it good, not drowned in mental stimulation. Childhood obesity is a reaction to fix the excess firing of inter-neurons to calm and relax the nerves through food.

Exposure to high-energy food advertisements, unhealthy eating habits, and less sleep duration.”

“This has been a serious public health problem in both developing and developed countries . In China, 19.4% of children were obese or overweight by the year 2014, and the rate is predicted to increase to 28% by the year 2030. Obese children are more likely to develop into obese adults , who are more likely to have chronic diseases which could increase the mortality in adulthood .The fundamental cause of overweight and obesity is an energy imbalance between calories expended and calories consumed. Furthermore,  the effects of TV viewing on childhood overweight/ obese status was considered possibly mediated by unhealthy behaviors related to TV viewing, Exposure to high-energy food advertisements, unhealthy eating habits, and less sleep duration.”

https://bmcpediatr.biomedcentral.com/articles/10.1186/s12887-019-1557-9

People’s cognitive capabilities are  challenged in multiple ways, including their capacity for analytical thinking, memory, focus, creativity, reflection and 

“A number of Survey respondents said people’s cognitive capabilities seem to be undergoing changes detrimental to human performance.

These deficits are found most commonly among those who live a highly digital life, and are being attributed to constant connectivity online.

According to Meg Mott, a professor of politics at Marlboro College,

 

In Conclusion

Technology can help those suffering and looking for ways to understand the modern world. However those who are comfortable with Nature, and there beliefs may fear the push of technology into there societies. Developing  countries which are pushing the envelope for better tools , while looking to MIMIC developed resourced nations will need technology to continue , global health has amassed a large part of its umbrella under technological advancement especially for Medical devices, which provide preventive care, such as EKGS, Pacemakers, and etc.. now during Covid.

However technology through the use of providing TV, and Monitors, Can do more harm then good for the general global health of the world ( Obesity, diabetes and over consumption, mental dilution).

 “The devices make it very easy to find answers elsewhere that students forget to ask deep questions for themselves. This lack of uninterrupted introspection creates a very human problem: the anxiety of not knowing oneself. The more the culture equates knowledge with data and social life with social media, the less time is spent on the path of wisdom, a path that always requires a good quotient of self-awareness”  We currently live in a culture that fosters attention-deficit disorder because of hyper connectivity.
NIKKI GRAVES

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TECHNOLOGY: The Future of Global Health

November 16, 2020 · No Comments · Technology, Uncategorized

The present day seize no boundaries when it comes to connectivity, collaborations, socializing and network building. This was and is still evident while we all are managing to cope with the so called “unprecedented” time (COVID-19 Pandemic) experienced globally. The technological advancements helped to manage and detect (efficiently or not is the topic of discussion for another time) the spread of the deadly virus (SARs Cov 2). The public health departments were able to remotely contact trace individuals that might have been exposed or carriers of the coronavirus. Along with contact tracing, the health departments and federal governments were able to promote safe procedures and protocols to the cases (individuals that tested positive for covid-19) regarding self-isolation and quarantine guidelines. Similarly, technological advancements have proved to be a great tool in promoting safety, health, and well-being globally for over a decade now. Use of technology and innovation to improve global health is an advancing topic which has infinite potential for capacity building especially in developing countries.

What is Global Health?

The recent spread of infectious diseases such as Ebola, SARS, HIV/AIDS and the most recent SARS-Cov 2 across continents, Global Health has gained considerable attention. But what exactly is Global Health? The most acceptable definition of global health is based on the foundation of justice and human rights and defines it as “an area for study, research, and practice that places a priority on improving health and achieving equity in health for all people worldwide.” With increased globalization, the spread of infectious diseases has also increased. People travel from one country to other more frequently than before and this results in transfer of viruses from one place to other. The governments of some countries are not well-equipped and prepared to handle the spread of diseases all by themselves and therefore, governments of different countries come together to aid in tackling the spread of such diseases. However, global health is not limited to the spread of infectious diseases but also includes food patterns and cultures that contribute towards the increased burden of Non-communicable diseases such as obesity, diabetes, heart diseases and types of cancers. Global Health also pertains to girl’s education, women empowerment, reducing poverty etc. which leads to lower child mortality rates, enables individuals to provide for basic needs such as provide food, housing, education, and health services for themselves and their families. In addition, it also includes exchange and flow of goods, money, technology, knowledge, and services that promote better health and well-being. Global health takes into consideration the social, cultural, economic, political, environmental, behavioral, and biological factors that affect the health of an individual and tries to collaborate with stakeholders from across countries and of different sectors to develop solutions for increasing health equity.

Technology in Global Health

When it comes to global health and considering the entire globe as one single community, it sometimes become difficult to reach to different places at the same time. However, the technological advancements have worked as an important tool to reduce these limitations. Even though the world is progressing, the United Nations Sustainable Development Goals and its emphasis to reduce child mortality and maternal mortality, end poverty and spread of non-communicable diseases along with reducing spread of infectious diseases such as HIV/AIDS etc. especially in developing nations show the disproportionate burden of challenges and economic prosperity these low- and middle- income countries experience. Digital solutions can increase progress towards better health outcomes in low- and middle-income countries through speed and reach, while increasing access to goods and services in a more people-centric, affordable, and sustainable way. The technological advancement can help to train and coach health care workers (remotely or via phone) and thereby improve quality of care in rural settings or hard to reach areas. This will also help to reduce unnecessary referrals to the hospitals and improve efficiency. Patients that require immediate care can be served by the local health care providers/workers after digital trainings so that long, bumpy travels of hours to the hospital can be avoided by ailing patients (especially pregnant women during labor or older patients who are bedridden). Moreover, technology can not only help in expanding access but also be help in empowering patients, through education and knowledge, in taking responsibility and management of their own health. Therefore, technological advancement and the digitized sector can be used to reduce inefficiencies, improve access, reduce costs, increase quality, and personalize care under the global health umbrella.

Technology as the Future of Global Health

Owing to the current transformation and development in health care systems and care models through advanced technology and digital health incorporation, the day is not far when technology and health care will be inseparable like two sides of a coin. Digital health has changed the balance of power between provider and patient by enabling new models of care and shifting the focus of health systems toward client-centered health care, especially within low- and middle-income countries. Currently, the health care models run top-down where doctors and nurses at the top of the pyramid and patients at the bottom. However, this model fails to meet the growing needs of the population who want more convenience, better information, and better access to care where and when they want it. Just as taxi and hotel businesses have experienced disruptions by Uber and Airbnb and other commercial businesses by sales on Amazon and Alibaba, Health care is experiencing a similar trend due to access to digital technology. The use and easy accessibility to smartphones has immensely shifted the power balance from traditional vendors to the new digital models where services are made more accessible and more flexible depending on the needs of the consumers. For example, in healthcare, medical information is available online or through telemedicine and medicines can be delivered to homes through online pharmacies. Patients have access to their own medical records and may communicate with their providers using email or online portals rather than needing to visit a facility. Access no longer means physical access; for many purposes, it can mean virtual access through telecommunications. In high-income countries, these changes are being driven by the need to lower (or at least limit growth of) costs, whereas in low-income countries the driver is the poor access and quality of the care that is delivered and the explosion in access to digital technology. We all experienced this during the Covid-19 lockdowns. However, just with any innovation, growth of digital health also brings along many challenges including who owns, controls, and manages the data being collected and how to maintain privacy and confidentiality in this data-rich world (but that is a topic for another discussion).

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Science, Technology, and Global Health

November 13, 2020 · No Comments · Technology, Uncategorized

Lately, it seems that technology has been contributing to our health and communication given the current circumstances. In-person classes and doctor’s appointments have shifted to virtual platforms. We’re meeting with friends and colleagues through Zoom and getting most of our work done through laptops and computers.

Technology plays such an important role in public and global health topics and initiatives. For example, the health technology initiative aims to help make health technologies benefits available to communities with resource-limited settings in order to control and prevent important health issues. This initiative is also designed to diagnose and treat diseases and illnesses. The two objectives of this initiative are to:

  1. Challenge the international community to establish a framework for the development of National Health Technology Programs that will impact the burden of disease and ensure effective use of resources
  2. Challenge the business and scientific community to identify and adapt “innovative” technologies that can have a significant impact on public health

Another important impact on public and global health is the enhancement of medical devices. Devices such as x-rays, MRIs, vaccines, life support equipment, and surgical machines are just a few examples of the huge impact technology have had on the health of everyone worldwide.

People are able to carry EpiPens in case of an allergic reaction; people can have pacemakers implanted after a heart attack to control their heartbeat. It truly is amazing how far technology has come and how it has helped shape the lives of everyone around us.

The most important target groups for such products are people living in low-income countries because their financial resources are limited and their countries typically have health systems that are poorly organized. In addition, there are an existing number of low-cost but highly effective interventions that are not used widely enough. For example:

  • Reducing infant morbidity and mortality by promoting exclusive breastfeeding for 6 months
  • Reducing neonatal deaths by training birth attendants in resuscitation, keeping the baby warm, and the provision of antibiotics for infection
  • Reducing child deaths by expanding vaccination coverage with the 6 basic antigens and rotavirus and pneumococcal vaccines
  • Reducing maternal disability and deaths by higher identification of complications, speedy transport to the hospital, and appropriate emergency obstetric care

These simple interventions can help save the lives of infants and children in low-income countries.

Further, improvements in information technology, genetic and molecular epidemiology, robotics, and chemistry will facilitate the development of new and better antibiotics and other drugs and medications. They will allow scientists and doctors to better understand the nature of disease, as well as to enable them to quickly try different chemical compounds to address these pathogens. That being said, there is an increasing understanding of the promise of science and technology for improving global health, in particular:

  • Affordable and appropriate technologies in low- and middle-income countries
  • Addressing the most pressing health needs
  • New technologies being developed in the next 5 to 10 years to improve health
  • Advance knowledge on the technological benefits

Not only is technology beneficial for the invention of new drugs, but also for ‘safe spaces’ for people feeling stigmatized by certain health problems, including mental health issues. SafeSpace is an app designed for just that – an on-demand counseling app that connects people to professional counselors and therapists in a space where they feel safe. This helps people feel safe and they can connect with professionals from any location.

Especially during these difficult times of racism, police brutality, and anxiety and depression from the COVID-19 pandemic, it is crucial to get the help and support we need without any judgement or fear.

Counselors and therapists have also moved their sessions to online platforms to continue meeting with their patients without the fear of spreading the coronavirus. Further, technology is a way people can stay connected with others all over the world; several online platforms can be used as a ‘safe space’ and can be used to seek support for almost any problem.

Apps are also used for patients to make doctor appointments, to shop online for groceries, etc. They have shown even more helpful during these times.

Finally, emergency communication, disease monitoring and surveillance, and access to health information are all important aspects of science and technology. We need technology to continue to improve our research and our health, both physical and mental. It is also important to make these technologies accessible to people living in poorer countries to provide them with better medical resources. Thus, science and technology have the potential to make major contributions to the development of diagnostics, vaccines, drugs, and medical devices that can help address the highest burdens of disease in low- and middle-income countries. Technology has already made great contributions to science and medicine, but there are always areas of improvements and benefits to new developments.

 

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Let’s Talk About Global Mental Health

October 30, 2020 · 1 Comment · Mental Health, Uncategorized

When the word “illness” is mentioned, the majority of the population will most likely picture an outwardly noticeable and physical condition that is interrupting the normal functions of a body. Diseases like cancer, congestive heart failure, or diabetes may immediately come to mind when picturing what an “illness” looks like. As humans, we look for outward signals portraying an abnormality when someone expresses their struggles. However, what people do not realize is that some of the most debilitating illnesses are ones that may not be visible to the naked eye. Mental health illnesses are known to affect about 10.7% of the global population (Ritche & Rosner, 2018). That equates to about one in ten people in our world that are currently suffering from a mental illness. Even more astonishingly, these diseases do not garner the attention they should with such a high number of the population being affected. Now, more than ever, it is crucial to speak about mental health illnesses and figure out how we can help decrease the burden of this issue worldwide.

definition of mental illness

According to a 2001 news release from the World Health Organization, approximately 450 million people worldwide reported that they had suffered from a mental health illness at some point in their lives. In this news release, action was called upon, asking for governments to implement new programs geared towards the suffering population, increase the percentage of their health budgets spent on this specific issue in order to create accessible treatment options for low income populations, and to integrate mental health care into primary health care. It was reported that either one percent or less of healthcare budgets were spent on mental health in more than half of the world’s countries, amplifying the lack of attention these illnesses receive. In 2001, it was abundantly clear that mental health illnesses were increasing in number and it was becoming imperative for people to acknowledge the severity of this issue. Unfortunately, the warnings and suggestions highlighted in the 2001 reports were not heeded and the abundance of these issues only grew. In 2017, a report from ourworldindata.org estimated that there were 792 million people living with a mental health illness. Just 16 years after the news release from WHO, there was a massive increase in the abundance of these diseases. Now, healthcare systems are taking notice, but these issues are not as easily fixed as they may seem to be. 

           

As the rates of mental health illnesses continue to increase, so do the opinions of others who may not identify with suffering from a mental health illness. The stigma wordlesurrounding this particular issue is extensive and is providing barriers that interfere with the quality of care that patients who suffer from these illnesses receive. Many people often stereotype those who have mental illnesses as incompetent, weak, and dangerous. These stereotypes all contribute to how the community treats those who are struggling. Although some are more explicit with their views on mental health illnesses, there are many medical providers who may not realize they are treating these patients with stereotyping attitudes. According to a research study that evaluated the impact of explicit and implicit biases of mental health illness held by medical providers, it was found that there is a mixture of both positive and negative views that essentially contribute towards the care provided. In some cases, providers feel more empathetic towards these populations which often results in very intentional methods of care for these patients. In other cases, implicit biases may creep behind the surface in which a provider may write off the patient’s symptoms. Not only do provider biases create a barrier in treatment options for these patients, but the explicit biases of the general population contribute greatly to those who need to seek care. Patients of mental health illnesses are often afraid of the judgement they may face when seeking treatment, as they are afraid to be thought of as “crazy.” It is important to realize that there is an aura surrounding this sector of health that exudes negativity and it can often influence not only the care these patients receive, but also the process of healing for those living with these diseases.

 

Another important factor to consider as mental health issues continue to rise involves the access and quality of mental health care. In a study focusing on the inequity in access to mental health care in seventeen different countries varying in socioeconomic status, it was found that in each country at least two thirds of individuals with common mental disorders went untreated (Alegria et al., 2018). This lack of treatment for patients can be attributed to a myriad of things including their eligibility to enter programs, the lack of linguistic capacity of the programs, policies that discriminate based on legal status, a lack of information regarding where and how to obtain care, or logistical, psychological, and economic barriers (Alegria et al., 2018). These issues are very much ones that can be addressed in a better capacity if more of the funding for healthcare is allotted towards mental health disorders. It is imperative that mental health be interwoven within primary care practices in order to decrease the burden of these diseases. Many issues that are associated with patients who are not able to access treatment for their symptoms pertains to their socioeconomic statuses. Policies need to be reviewed, funds need to be allotted, unconscious bias training with providers need to be required, increasing the access of treatment without linguistic barriers are crucial, and the overall stigma of mental health must be discussed as these issues have persisted for far too long.

There are many different types of mental illnesses that people can suffer from. Whether it be depression, anxiety, bipolar disorder, or schizophrenia, treatment should not be considered a luxury. People need to understand the severity of these issues and the support of not only the medical community, but also the general population is required for patients to heal. If someone is suffering or is suspected to be suffering from a mental health disorder, it is imperative that they utilize the resources available to the general population. It is important to check in on family members, co-workers, and friends who may be struggling, Brain puzzle. Could fecal transplants help treat mental health disorders?especially amidst the COVID-19 pandemic. The prevalence of mental health illnesses is rising each and every year, and with the recent quarantine orders, the rates of these diseases are only increasing without a sufficient means of assistance for these populations. Mental illnesses should not be stigmatized, stereotyped, or discriminated against. Once we begin to change the language of how we approach this sector of health, the rest of the issues pertaining to mental health illnesses will begin to unravel and improve.

 

 

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The Stigma of Suicide in the U.S.

October 30, 2020 · 1 Comment · Mental Health, Uncategorized

Suicide- a topic that is still considered almost taboo to talk about, but is actively taking people’s lives day by day. As a certified Youth Mental Health First Aid Instructor who has taught over 500 adults how to recognize the signs and symptoms of mental illness in youth, I can tell that out of the entire 8 hour course, the hardest thing to teach people is how to do their part to reduce the stigma associated with mental illness (especially suicide). I’ve done trainings where participants are making stigma-related jokes within an hour of our “reduce the stigma” conversation. People who are responsible for being vectors of suicidal behaviors typically engage in behaviors including stereotyping, avoidance, shunning, and distrust towards people who are affected by suicide (Cvinar, 2005). The negativity associated with is not just frustrating, especially as an advocate for mental health awareness, but it is dangerous. Many victims of suicide suffer from psychological trauma brought on by the shame and hurt from attempting suicide of knowing someone who has died by suicide.
Woman sitting with her head down

Photograph: Carlos Ciudad Photos/Getty Images

So, why is this even a thing? And further- why is it such a difficult tradition to stop perpetuating? Let’s look at the roots. The history of suicide would be longer than the post of the blog would permit, but there are some important truths to keep in mind. One is that the very act of killing yourself used to be a crime in some countries (and attempted murder of anyone, including yourself, is still a crime in many). The criminal language and context has followed the idea of suicide through time, criminalizing the idea to its core. This is why the phrase is “committed suicide”, and not the less stigmatized phrase that I teach in my courses of “completed suicide”. The many myths associated with suicide have also played a part in the current stigmatization of the act. It’s been found that people believe that those who kill themselves are “weak” or “selfish”, or even worse” attention seekers, who don’t need to be taken seriously”.

Jigsaw of suicide statistics in the shape of a head

Photo: https://adaa.org/learn-from-us/from-the-experts/blog-posts/consumer/quick-tips-combat-stigma-around-mental-health
Judgmental attitudes tend to be very common in most communities, which makes sufferers less likely to open up about their pain. It has been found that people typically face three types of stigma after people learn that they have attempted to take their own lives: societal stigma, personal shame, and structural stigma (discrimination). Structural stigma can be described as victims worrying. “What will happen to me if I disclose this painful history of mine?”. Australia’s suicide prevention adviser Christine Morgan says “When you are looking at somebody wanting to talk about their suicidation, they need to feel safe. They need to talk to somebody and not be judged for it so they can open up and reach out for support – but the barriers are very real.” People tend to be confused about how to access support services, and when they do access them, there tend to be gaps in services. These gaps are harmful, because people who are suicidal need a continuous layer of support and care around them. Writer Katharine Murphy of The Guardian says that “…up to 25% of people who attempt to take their own lives try again, and the risk of relapse is significantly higher during the first three months following discharge from hospital after an attempt.”

Hospital patient looking out of window

The stigma associated with suicide is killing our young people. People’s sons, daughters, nieces, nephews, mentees, and students. Youth tend to be impulsive, which tend to be part of the reason attempts affect younger adults. Attempts tend to be associated with feelings of self-doubt, stress, financial uncertainty, loss, disappointment, and pressure to succeed. They may see suicide as a way out of their problems. Among younger children, suicide attempts are typically associated with feelings of anger, confusion, sadness, problems with attention, and hyperactivity. According to ourworldindata.org/suicide, suicide is one of the leading causes of death in young people. However, it has been found that this statistic is largely due to older people dying to other causes (most people 70 years old and up die from cardiovascular diseases, dementia, cancers, and respiratory diseases). Suicide is the second leading cause of deaths in the U.S., for youth ages 15-24 (with leading cause being accidents). Millions of people are affected or are mourning the loss of someone who died by suicide every year. I would say “Can you imagine?”, but that is not grief I would wish upon anyone.
So what can we do? How can we address this dangerous but incredibly common mindset related to suicide? Well, one big thing we can all do is use appropriate, non-criminalizing language when referring to suicide. Another would be to inform and educate people on suicide, and the importance of mental health. Explain that many of the myths still believed about suicide aren’t true, when you are able. It will be a long process, but I’m proud to say that as a society we are making progress, especially with movements like the suicide prevention movement, and #BeThe1To. Check out the charts and graphs below illustrating just how much Americans are becoming more open about mental health.

Pie chart of americans who agree that a mental disorder is something to not be ashamed of bar graphs of attitudes toward mental health

References
Cvinar, J. G. (2005). Do Suicide Survivors Suffer Social Stigma: A Review of the Literature. Perspectives In Psychiatric Care, 41(1), 14-21. doi:10.1111/j.0031-5990.2005.00004.x
Lozano, M. (n.d.). Quick Tips to Combat Stigma Around Mental Health. Retrieved October 26, 2020, from https://adaa.org/learn-from-us/from-the-experts/blog-posts/consumer/quick-tips-combat-stigma-around-mental-health
Murphy, K. (2019, November 12). ‘Horrific’ level of stigma: Biggest barrier to suicide prevention is discrimination. Retrieved October 26, 2020, from https://www.theguardian.com/society/2019/nov/13/horrific-level-of-stigma-biggest-barrier-to-suicide-prevention-is-discrimination
Olson, R. (2017, March 01). Suicide and Stigma. Retrieved October 26, 2020, from https://www.suicideinfo.ca/resource/suicideandstigma/
Ritchie, H., Roser, M., & Ortiz-Ospina, E. (2015, June 15). Suicide. Retrieved October 26, 2020, from https://ourworldindata.org/suicideSegal, C. (2016, September 18). Why do suicidal patients wait hours for a hospital bed? Retrieved October 26, 2020, from https://www.pbs.org/newshour/health/suicidal-psychiatric-beds

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The Need to Destigmatize Mental Disorders!

October 30, 2020 · No Comments · Mental Health, Uncategorized

Mental illness is such a vast subject. There are more than 200 diagnosed mental illnesses such as depression, anxiety disorder, bipolar disorder, schizophrenia, dementia, attention-deficit/hyperactivity disorder (ADHD), autism, and post-traumatic stress disorder, to name a few. Depression, anxiety, bipolar disorder, and schizophrenia are some of the most common disorders. Almost all people globally suffer from some form of mental disorder at least once in their lifetime.

According to the National Institute of Mental Health, in the US, nearly one in five adults live with a mental disorder accounting for approximately 47 million people in 2017 (19% of the population). The prevalence of any mental illness is higher in women (22.3%) than men (15%).  Young adults between the ages of 18-25 years have the highest prevalence of any mental illness (25.8%) followed by adults aged 26-49 years (22%) and those aged 50 years and older (13.8%). Unfortunately, only about 42.8% or 20 million people receive the appropriate care they need to combat mental disorders. Even more disturbing is the fact that of all young adults aged 18-25 years, only about 38.5% received care, the lowest for any age group.

The statistics bring us to two very crucial questions. Why is the prevalence of mental disorders high, particularly in women and young adults? The second important question is why are more than half of those with mental health problems silent about the same?

The different gender-specific rates of mental health might be related to gender-based roles, stressors, and negative life experiences. According to the World Health Organization, factors like violence on women, low socioeconomic stratum, income disparity, inequality, sexual income, and increased workload might be the causes for this difference. The rise of social media, the need to validate oneself, peer pressure, and increased stressors are to be blamed for high rates of mental disorders among young adults.

This brings us to the next vital question. Why is the percentage of people seeking help for mental illness is low? It might be due to the stigma associated with the discussion about mental health. Stigma is defined as a mark of disgrace or infamy; a stain or reproach, as on one’s reputation. As Psychology Today explains there are two types of mental health stigma: social stigma and perceived stigma. Social stigma is the biased attitude and discriminatory behavior towards individuals with mental health because of the label they have been given. For instance, the belief that people with mental disorders, especially schizophrenia, bipolar disorder, etc. are dangerous, or the belief that mental disorders are not real. On the other hand, perceived stigma or self-stigma is the internalizing by the mental health sufferer of their perceptions of the discrimination. Additionally, such stigmatizing beliefs are not only held by strangers, but also, most commonly, by family members, friends, and peers. Mental disorders not only affect physical health but might also lead to loss of employment, loss of family or relationships, alienation, and unfortunately, suicide, in some extreme cases.

In such unprecedented times, the effects of mental disorders are particularly aggravated. COVID-19 pandemic has taken the world storm. Isolation, social distancing, online campus, almost negligible interaction with peers, unemployment, and being locked indoors have increased the mental health symptoms in those already suffering from some form of mental disorders and have introduced signs and symptoms in the others. These effects can be seen in college students, women, and middle-aged men. A recent Active Minds survey found that 89% of college students say that they are experiencing major stress and anxiety due to COVID-19. Not being able to move outdoors and being stuck alone has drastically increased stressors and negativity. The loss of employment, lack of sufficient salary, and closing of businesses have taken a toll on the mental health of middle-aged men. Additionally, a lot of women who were abused or had suffered from physical violence are now locked in homes with their abusers. This has led to increasing rates of depression and anxiety among women, especially those in the lower socio-economic stratum. The effect is particularly severe in low- and middle-income countries which has a large labor population. Loss of jobs, lack of existing resources, and unaffordable care have been extremely damaging.

This explains the importance of recognizing and fighting mental disorders. There is a lot of resource and help available to those suffering from mental disorders. However, the help is all worthless unless the world is rid of the stigma associated with mental health. The National Alliance on Mental Health talks about ways to help with the stigma surrounding mental health. The most vital first step is talking openly about the struggle with mental health and educating yourself and the people around you about its importance. Being compassionate to those with mental health, empowering people to fight against it, and most importantly, discouraging any negative comments or adjectives associated with mental health, on social media, television, in conversations, or otherwise. These are some of the most critical ways to equalize physical health and mental health, which is the first step in the fight against mental disorders. There are several organizations like the National Institute of Mental Health, American Psychological Association, and helplines like suicide prevention helpline,  mental health mobile crisis team, which are constantly motivating and encouraging people to fight and overcome mental disorders, and not succumb to those.

Despite a vast number of resources, the growing numbers are a wake-up call. The prevalence of mental disorders, especially depression and anxiety, calls for coordinated efforts across the globe.

 

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Different Sides of Global Mental Health

October 30, 2020 · 1 Comment · Mental Health, Uncategorized

Global Phenomenon     

There has been a significant increase in mental health disorders among young adults over the past decade but this increase has not been seen in older adults. This shows an issue environmentally that only applies to the younger generation. The problem is confirming the environmental risks that contribute to mental health issues. This is needed to create successful intervention plans. Over 4% of the world’s population suffers from depression which is 300 million individuals. We often think of the mental health of our nation but it is a global issue. Low income countries often do not have organizations dedicated to the promotion of mental health though vulnerability is higher in these areas. For example, countries with political instability have high risk of mental health illnesses and do not prioritize mental health among the famine and violence.

Environment and Mental Health

The environment we grow and live in is as much part of our health as our DNA. There are both physical and social environmental factors. This can be access to foods and clean air but also the presence of a support system among the family and community. There is systemic racism that has placed minority groups in poorer neighborhoods where they generally have worse nutrition that can contribute to poor mental health outcomes. There is sleep deprivation due to students and young adults going both to school and work to care for families. The structural racism in our society can itself be a source of stress especially when it comes to police brutality. Constantly seeing those like yourself killed and refused justice over something beyond your control (skin color) is frustrating and stressful.

 

 

Suicide 

Nationally we need to rethink the environment we create for younger generations that set them up for thinking suicide is an option. I think one of the things that makes this a huge public health issue is its ability to be prevented. Though logically it can be prevented through a more positive attitude towards life and less stress inducing pressures, this is a much more complicated process than it sounds. These attitudes and societal pressures (like school tests and deadlines for everything) are ingrained in everyday life and are not easy to break down to build up again. The highest jump in suicide rates among an ethnic group was among the Native American women. It rose 139% between 1999 and 2017. Research has shown this may be due to poverty, substance abuse, unemployment and an unusually high rate of abuse among the population. There is also unresolved generational trauma stemming from the history of this country.

 

Stigma

Stigma around mental health issues deter people from seeking the help they so badly need. This is a problem with social and cultural taboos. 24% of adults have self-reported that there was an unmet need for treatment. We as a society have created an environment that looks down on people that have mental disabilities that inhibit self-control over emotions, thoughts and actions. This is very interesting to me because we as humans have this innate ability to sympathize with others yet there is a constant disregard for others situations, mental health being just one of many. There is an increased stigma among minority populations who are more vulnerable to certain mental health issues. This disparity is seen in the seeking and receiving mental health services. There is both a physical and financial barrier to access these services as well as the community stigma in these minority populations. The percentage of White men and women that use mental health services is nearly double that of corresponding African American men and women while rates of mental illnesses are similar.

Quarantine effects on mental health

The current pandemic has had mental health impacts as well. There are issues developed due to things like financial stress as many lost their jobs and their sources of income. Other stressors can come from the lack of clarity and direction from public health and political leaders. There is also a general fear of contracting COVID or giving to family members. We are a social species and the isolation of quarantine can be a stressful reality. The buildup of stressors like these can be damaging to a mind and cause withdrawal and depression like symptoms. This is important to consider as therapists and mental health professionals have to operate virtually. They need to be able to reach out to their patients and possibly welcome new patients with limited contact. These effects can also lead to an individual’s poor physical health through substance and alcohol abuse as well as affecting others through physical and emotional abuse.

Shift

I have noticed a shift in the newer generation of a non-stigmatized attitude towards mental health. A study looking at the change in attitudes towards mental health was done on healthcare professionals and students and has seen a negative trend and increase in positivity. The study attributes this change to healthcare professionals as a result of anti-stigma programs. The world psychiatric association created an “open the doors” program as an initiative to break this stigma globally and many countries have done various campaigns as well to combat stigma. Regarding the students there was an associated stigma leading to fewer psychiatric professionals but has decreased through anti stigma education methods. This reveals the importance of programs that actively work to change attitudes. This applies to not only mental health but things like voting and our impact and role in the political system.

 

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Global Stigmatization of Mental Health

October 30, 2020 · 2 Comments · Mental Health, Uncategorized

 

One in four people around the world will suffer from mental illness at some point during their life. Mental health problems have been stigmatized by society since the beginning of civilization; and though there have been improvements against such stigmas due to increased mental health and scientific knowledge, it is still highly prevalent amongst all global populations. Stigma has been defined as “stereotypes or negative views attributed to a person or groups of people when their characteristics or behaviors are viewed as different from or inferior to societal norms.”

The three levels normally associated with mental health stigma are public or societal stigma, self-stigma, and health professional stigma.

Public stigma refers to stigmas that are shared by the general public and are often structural, embedded in a society’s framework creating barriers for mental health treatment.

Self-stigma refers to the internalization of societal stigmas, negatively affecting one’s perception of themselves and their value. Self-stigma also includes the fear of being labeled.

Health professional stigma, though it seems inherently wrong that a health professional would hold stigmas toward mental health, has been shown to exist and may lead to Individuals with mental illness not receiving the same care once the professional becomes aware of their mental illness. Heath professional stigma is normally based off the professional’s already believed stigmas but can also be due to the high rates of “burnout,” and mental illness amongst themselves, having less willingness and energy to deal with mentally ill patients.

The fear of being stigmatized can have serious consequences if it keeps someone from seeking treatment.        

How Culture Influences Mental Health Care:  

Though there are similarities of basic stigmas associated with mental illness across global populations, culture can have an influence on many aspects of how mental illness is viewed and treated. Four ways culture can impact mental health care:

  1. Cultural stigmas: how a culture regards people with mental illness. If a culture considers people with mental illness inferior, those people may hide their health issues and struggle to ask for help.
  2. Understanding symptoms: culture can influence how someone expresses their symptoms, possibly only discussing physical symptoms rather than emotional ones, or vice versa.
  3. Community support: depending on the culture and mental health stigmas, this can affect how or if a person gets support from their community.
  4. Resources: it can be difficult to find resources and treatments that consider one’s specific cultural factors and needs.

Stigmas Around the Globe:

There are common stigmas shared by most, if not all, global populations in terms of mental health, but certain countries, regions, and/or cultures also shows differences in their stigma beliefs and degree. In general, people in Eastern countries report more stigma with mental illness across all levels of society than in Western countries. The stigma towards depression is significantly more pronounced in Eastern countries. While Western countries stigmatize mental illness in minorities more, Eastern countries show more stigma towards majority group members. Studies have revealed that “global attitudes towards seeking mental health treatment vary by sociodemographic characteristics and past exposure to mental health treatments.”

Here are some specific findings of mental health stigmas in the U.S. and other global regions:

The United States:

In the past decade stigmas have seemed to stabilize, not increasing, or decreasing in the United States, and in general, Americans hold positive attitudes towards seeking help for mental health issues. That being said, this review highlights specific stigmatizations still occurring. American adults were not only found to view children with depression and ADHD as more dangerous to themselves and others, but also viewed children with depression as lazy. Also, in the U.S., age and political views were associated with blaming and punishing someone with mental illness, with young conservatives being more likely to hold such beliefs. “Social distance,” the exclusion of those with mental illness from social gatherings, working relationships, marriages, etc. was found to be widespread across U.S. populations. According to research published by The Commonwealth Fund, minorities in the U.S. are less likely to get mental health treatment or will wait until symptoms are severe before seeking help.

Europe:

One review found that amongst 5 European countries studied, 56.4% of the respondents said they were not okay with a person with depression or schizophrenia to marry into their family, but reported less rejection within the work force, with only 23.5% saying someone should not be hired if they have a mental health problem. Like many regions globally, schizophrenia results in significantly more rejection than depression in European countries. In general, within Europe, post-communist, and less developed countries, showed more stigmatization than more economically advanced ones.

Africa:

                African countries hold similar stigmas as mentioned above, but also hold very specific beliefs behind the stigmatization of mental health religious and cultural factors. Similar to other regions, mentally ill people are assumed to be violent and destructive, even within the health care system. In many cases people with outwardly obvious mental illness in rural African communities are thought to be possessed by spirits or involved in witchcraft, with an estimated 90% of people with such mental illnesses being taken to spiritual leaders first. The accusation of witchcraft can lead to exclusion from the community. In Zimbabwe many believe mental illness to be a punishment from the gods, leading to family and community members not associating with a person as to not bring the punishment on themselves. experience the wrath of god themselves. Many African countries are not willing to provide mental health services, but rather direct those with mental illness to “prayer camps.”

Asia:

                While Asian countries also have stigmas of danger associated with mental illness, as well as supernatural and religious stigmas, they show significant differences in family stigmas. According to this study, in China 56% of those with a mental illness kept it secret from their family for fear of discrimination, with 75% believing such discrimination would cause significant stress on their family. Though Japan as shown great improvement in their stigmatization of illnesses like schizophrenia, stigmatization of illnesses like bipolar disorder have increased. In Korea, people with alcohol dependence are 4 times less likely to seek treatment than those in the U.S. because of increased stigmas associated with substance abuse. There was also a significant negative portrayal of people with mental illness in the media. In general, Asian countries have a high belief that depression is due to a weak personality. Read more about these stigmas in specific Asian countries and their current mental health programs here.

Global Health, How Can We Combat Mental Health Stigmas:

The most pronounced stigma across the globe is the portrayal and belief that people with mental illness are dangerous and should feel ashamed. Stigmatization decreased across populations with increased education, younger generations, lower socio-economic people, and more developed nations. Stigma itself can worsen mental health due to the discrimination, reduced self-esteem, increased psychological burden, ultimately interfering with the seeking of services and treatment. The fear of rejection by society can lead to avoidance in acknowledging mental health problems and missed life opportunities.

The assistant director of The Carter Center Mental Health Program suggests 3 key ways we can combat stigma: the media portraying stories about recovery and how prevalent mental illness actually is,  policy changes to increase mental health support and services, and by people who have experienced mental health speaking out and telling their stories. One initiative in Australia, Stop Mental Illness Stigma Charter, defines 7 commitments aimed at reducing the impacts of stigmas which could be used in a global context.

“The Global Burden of Disease Study showed that by 2020 depression is going to be the second leading cause of morbidity across the globe. And yet it receives nowhere near the societal attention, funding, research money that either cancer or cardiac disease do.”

With 41% of developing nations having no mental health policy and no treatment facilities for severe mental disorders, global health officials need to address the barriers in specific countries when it comes to mental health treatment and cultural stigmatizations to adequately develop appropriate mental health interventions and preventative measures. Researchers need to conduct more studies to better understand the impacts of “different cultural traditions, attitudes, values, and beliefs on stigma.”

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