Sometimes the challenges in global mental health can seem insurmountable, with more than 90% of people who need treatment not receiving care in some areas of the world. But mental health isn’t the only global health condition that has had to face gargantuan hurdles. Sang-Hee Min, one of my former students and an MPH alumna from Columbia’s Mailman School of Public Health, is working for a global health consulting firm. She recently stopped by – having just returned from a major polio eradication campaign in some faraway lands.
What do polio and mental health have in common? A lot more than I ever imagined.
In the early 20th century, polio killed or left permanently disfigured millions of children around the world. Then a disease with no cure, it wrought fear and havoc. Today most kids have never heard of it. It didn’t disappear by magic. It took sustained effort, over decades. Rising above the shifting sands and staying the course, for the long haul. The story of polio has some lessons for all of us in global mental health.
1. The tipping point. Polio has likely been around for thousands of years – images dating as far back as ancient Egypt depict deformed legs, one of polio’s telltale signs. But it was not until the polio outbreaks in the early part of the 20th century that the magnitude of the problem mobilized a concerted public health response. In NYC alone, 9,000 people were diagnosed with polio in 1916, with no immediate cure in sight. It was enough to tip the scale and mobilize scientists, health care providers, and policymakers to find a cure. For mental health, the tipping point is now. With improved population health assessment, we know that mental health problems are the leading cause of disability globally. Scientists, healthcare providers, and policymakers are finally saying enough is enough.
2. Fear and stigma. The early 20th century polio outbreaks prompted a widespread quarantining of adults and children. Nobody knew how polio was spread or how to contain it. Sound familiar? Mental disorders, even though they are not viral or infectious diseases, are associated with fear and stigma precisely because we don’t understand who is at risk or why some people, but not others, develop them. Even a disorder as common as depression is stigmatized around the world, commonly seen as a character flaw, laziness, or weakness.
3. It takes sustained commitment. In the 20th century, organizations around the globe mobilized to find a cure for polio. Rotary International led the worldwide polio eradication campaign in 1979, and the World Health Organization signed on in 1988. But polio still exists in parts of the world, and on World Polio Day this year, billionaires Mayor Michael Bloomberg, Ray Dalio, and an anonymous donor announced a joint contribution of $70 million to eradicate polio once and for all. In the case of mental health, there are many disorders – some with the prognosis of full recovery and others where cures are incubating somewhere between bench science and public health. With sustained commitment and funding, we can hope that mental health will follow the course of polio. Since 2011, the three largest funders of mental health research in low- and middle-income countries – Grand Challenges Canada, the UK Department for International Development, and the US National Institute of Mental Health – have invested an estimated US$79.3 million in global mental health research and training. We need to stay the course.
4. Consistent, accurate media coverage. We all love to blame the media for overhyping, miscommunicating, and creating stigma around sensitive and nuanced issues in the world. But journalists are quintessential storytellers, and they can play a critical role in global health and development: raising awareness, sparking conversations, and catalyzing long-term change. The media played an essential role in raising awareness and reducing stigma regarding polio. They can do the same for mental illness. But how we tell the story matters, and news that disproportionately describes violence and mental illness and rarely describes successful treatment, for example, perpetuates myths and misconceptions. We need to get the mental health story out there – we just need to get it right, and guidelines from the World Health Organization can help ensure responsible reporting.
5. Our children will be our guarantors. Meeting with Sang-Hee, and hearing about the work she is doing to eradicate polio in the far corners of the world fills me with humility and hope. It is not the wise elders nor the professionals in their prime but rather the children, our students, who will be the stewards for humanity – from the eradication of polio to the pursuit of mental health for all. Millennials are bucking the system when it comes to neckties, briefcases, and water bottles; they are also bucking the system with their insistence on work with meaning and mission.
To Sang-Hee, and the upcoming generation she represents, I thank you. Stay the course, and then stay the course some more. It is a long haul, but wow, look what is possible!