Pacific mental health: still more work to do
Dunya Tomic, Chief of Editorials and Publications PMSA
The 2010 Global Burden of Disease (GBD) report has been one of the most informative publications regarding the progress of healthcare in the Pacific region, and provides insight into the current challenges that will need to be addressed in years to come. Although the report showed a vast improvement in the rates of communicable diseases, non-communicable diseases (NCDs) appear to be on the rise. Whilst NCDs were responsible for only 34% of total disability-adjusted life years (DALYs) in 1990, this figure increased to a substantial 48% in 2010 according to the GBD report (1). Of particular significance were the statistics regarding mental health in the region; when grouped with disorders relating to substance use, mental health disorders were the number one cause of disability across the Pacific, constituting nearly one-quarter of total years lost to disability in 2010. Looking at individual causes of mental illness, major depressive disorder (MDD), which was the second-leading cause of disability in 1990, rose to become the leading cause in 2010 (2).
Although the disability burden imposed by mental illness in the Pacific is a momentous issue in itself, this is perpetuated even further by the associated mortality rates; evidence shows that individuals experiencing mental health and substance use disorders have, on average, a significantly lower life expectancy (3). Local studies from Australia suggest that compared to healthy members of the population, men with mental health conditions have their life expectancy reduced by up to 15 years, and women by up to 12 (4). The reasons postulated for this phenomenon include the higher predisposition for suicide, and higher rate of co-existing physical health conditions; people with chronic conditions are far more likely to be affected by issues such as depression and anxiety. Beyond the adverse effects of mental illness on the individual, in many Pacific cultures, whole families can be victimised by discrimination (5). On an even broader level, mental health disorders result in poorer work productivity, which can have economic effects on entire nations when these issues are highly prevalent, as is the case in the Pacific (6).
There have been several measures implemented to address mental healthcare across the Pacific, which have improved the picture of mental health in many Pacific nations. Key drivers of this change include the World Health Organisation (WHO) through their evaluation of Pacific mental health needs released in 2005 (7), and the formation of the Pacific Islands Mental Health Network in 2007 (8). Although progress has undoubtedly been made, there is still a long way to go in reducing the burden of mental illness amongst the Pacific. Data from across several Pacific nations showed that over 90% of mental health patients had not received any form of healthcare in the past year (9). This statistic speaks volumes to the inequities in healthcare for those with mental health disorders; hopefully, as more research highlights where the issues lie, there will be a further drive for change to Pacific mental health.
IHME. GBD compare [Internet]. 2013 (cited 11 May 2018). Available from: http://viz.healthmetricsandevaluation.org/gbd‐compare/
Ferrari AJ, Charlson FJ, Normal RE et al. Burden of depressive disorders by country, sex, age and year: findings from the Global Burden of Disease study 2010. PLoS Medicine. 2013;10(11):e1001547.
Crump C, Winkleby MA, Sundquist K, Sundquist J. Comorbidities and mortality in persons with schizophrenia: a Swedish national cohort study. Am J Psychiatry. 2013;170(3):324-33.
Lawrence D, Hancock KJ, Kisely S. The gap in life expectancy from preventable physical illness in psychiatric patients in Western Australia: retrospective analysis of population based registers. British Medical Journal. 2013;346:f2539.
Thornicroft G, Rose D, Kassam A, Sartorius N. Stigma: ignorance, prejudice or discrimination? The British Journal of Psychiatry. 2007;190(3):192-3.
Bloom DE, Cafiero E, Jane-Llopis E et al. The global economic burden of non-communicable diseases, program on the global demography of aging.
Hughes F, Finlayson M, Firkin P et al. Situational analysis of mental health needs and resources in Pacific Island countries. World Health Organisation, Geneva.
Hughes F. Mental health in the Pacific: the role of the Pacific Island mental health network. Pac Health Dialog. 2009;15(1).
World Health Organisation. Regional agenda for implementation of the mental health action plan (2013-20) in the Western Pacific.