Treating mental illness around the world

“Things are changing. It’s a great opportunity for young people to join the bandwagon.”

Those were the words of Dr. Ricardo Araya, MD, PhD, speaking to approximately 50 people on Northwestern University’s Chicago campus recently about how mental illness is increasingly being treated—and perceived—around the world.

Dr. Araya, a professor of psychiatry at the University of Bristol’s School of Social and Community Medicine, has spent nearly 30 years studying mental health, with projects and large randomized controlled trials everywhere from South America to Africa and India to the United Kingdom.

Citing a 2010 study on the global burden of disease, Dr. Araya explained how nearly a quarter of the world’s “disability burden” is due to illnesses like schizophrenia, Alzheimer’s disease, bipolar disorder, depression, and anxiety, with the two latter increasing by almost 40 percent in the last two decades. The rate of Alzheimer’s disease, he said, has skyrocketed by 80 percent.
Around the world, he said, people may be living longer lives, but those lives are plagued by chronic ailments.

Dr. Araya has been doing his part to help alleviate some of those ailments in multiple countries. He said the key to earning acknowledgement of and treating mental health problems in places where such illnesses may be stigmatized, misunderstood, or viewed as insignificant compared to other issues is about knowing the patients.

“People have a tendency to oppose change,” he said. “We’re trying to improve what is already there, rather than trying to reinvent the wheel.”

Dr. Araya said that that approach, which he said he has used in all of the countries he has worked, means taking advantage of local resources, combining mental health treatment with existing health programs (such as those for HIV, hypertension, and pregnancy), and bringing the right technology (such as cell phones) into the fold.

For instance, in Nigeria and Ghana Dr. Araya said that patients were treated for depression by technologically inclined community health workers. In Pakistan, postnatal women worked through their depression with “lady health workers.” In Uganda, depressed patients participated in group therapy led by villagers-turned-health workers, an experiment that Dr. Araya said was “one of the most successful trials in low-income countries, as well as in the whole field overall.”

One particularly moving example of the importance of cultural insight in treating mental illness came out of Zimbabwe, where locals who were trained as health workers would simply sit on a bench—dubbed the “Friendship Bench.” That casual, non-threatening atmosphere encouraged people to just come, sit down, and share their concerns.

Dr. Araya said that such approaches to mental health treatment—similar ones of which he has helped conduct in Chile and Brazil—have taught him the importance of “equity, efficiency, effectiveness, and empowerment.”

“Culture is a huge thing,” he said. “We tend sometimes to dismiss it. Thinking about how people function is essential.”

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