Wednesday, 10 October 2012


“There are wounds that never show on the body that are deeper and more hurtful than anything that bleeds.” - Laurell K. Hamilton

October 10th has been declared by the WHO as World Mental Health Day. This is a day that raises public awareness about mental health issues. It promotes open discussion of mental disorders, and investments in prevention, promotion and treatment services. This year the theme for the day is “Depression: A Global Crisis”.

Depression affects more than 350 million people of all ages, in all communities, and is a significant contributor to the global burden of disease. Although there are known effective treatments for depression, access to treatment is a problem in most countries and in some countries fewer than 10% of those who need it receive such treatment.

On this 20th anniversary of World Mental Health Day it is appropriate to remember the founder of the event, Richard Hunter (1914-2004). He was a man with a vision that mental health concerns would be recognised as an integral part of overall health, and who felt that mental health should be considered with equal importance alongside physical health. He did much to improve the care of people with mental illnesses, and each year without knowing it the organisers of national and local World Mental Health Day activities carry forward his vision. He would have been very proud to see how widespread World Mental Health Day is now and how aware people have become of mental illness through the activities organised on this day.

Richard Hunter trained as a lawyer in Minnesota, USA. His career changed direction when he registered for alternative service as a conscientious objector during World War II, having declined to serve in the armed forces. He was assigned to work as an attendant in a psychiatric hospital and spent three years at institutions in North Carolina and New Jersey. Those years made him aware of the plight of people with mental health problems and the need to improve standards of care.

He was also moved by the writings of Clifford Beers (1876- 1943), who experienced severe mental illness and in recovery led a movement in the United States to reform the conditions he had experienced in mental hospitals. After the war Dick Hunter joined the staff of the National Mental Health Foundation and later became a senior staff member of the National Mental Health Association (now Mental Health America). On his retirement, Dick was recruited as the Deputy Secretary General of the World Federation for Mental Health, serving in that capacity as a volunteer from 1983 until 2002, a central figure in the Federation’s worldwide network.

He continued to work at his office as an advisor to the Federation until a few weeks before his death in 2004. It was he who promoted the idea in 1992 that mental health deserved an annual “Day,” like similar observances for other causes. He saw that an international World Mental Health Day could be, in his own words, “a focal point around which global mental health advocacy could gain maximum public attention.” When the suggestion came up that the World Federation for Mental Health should sponsor an international telecast, he saw a valuable opportunity. A broadcast received in many countries could become a central feature of a wider celebration linking activities not only for advocacy but for much needed public education.

Depression is a common mental disorder that presents with depressed mood, loss of interest or pleasure, decreased energy, feelings of guilt or low self-esteem, disturbed sleep or appetite, and poor concentration. Moreover, depression often comes with symptoms of anxiety. These problems can become chronic or recurrent and lead to substantial impairments in an individual’s ability to take care of their everyday responsibilities. At its worst, depression can lead to suicide. Almost 1 million lives are lost yearly due to suicide, which translates to 3000 suicide deaths every day. For every person who completes a suicide, 20 or more may attempt to end their life.

While depression is the leading cause of disability for both males and females, the burden of depression is 50% higher for females than males.  In fact, depression is the leading cause of disease burden for women in both high-income and low- and middle-income countries. Research in developing countries suggests that maternal depression may be a risk factor for poor growth in young children. This risk factor could mean that maternal mental health in low-income countries may have a substantial influence on growth during childhood, with the effects of depression affecting not only this generation but also the next.

Depression is a disorder that can be reliably diagnosed and treated in primary care. Preferable treatment options consist of basic psychosocial support combined with antidepressant medication or psychotherapy, such as cognitive behavior therapy, interpersonal psychotherapy or problem-solving treatment. Antidepressant medications and brief, structured forms of psychotherapy are effective. Antidepressants can be a very effective form of treatment for moderate-severe depression but are not the first line of treatment for cases of mild or sub-threshold depression. As an adjunct to care by specialists or in primary health care, self-help is an important approach to help people with depression. Innovative approaches involving self-help books or internet-based self-help programs have been shown to help reduce or treat depression in numerous studies in Western countries.

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