Properly implemented psychiatric efforts are scarce in developing countries, as patients are often misdiagnosed and mistreated, while understaffed facilities coupled with a lack of funding exasperate this situation.
The World Health Organization (WHO) defines mental health as 'a state of well-being in which every individual is able to realize his or her own potential, can cope with the normal stresses of life, work productively and make a contribution to his or her family and community'. Conversely, mental disorder is often classified as 'clinically significant behavioral or psychological syndrome with enough personality, mind and/or emotional organization that seriously impairs individual and social function with an increased risk of suffering, death, pain, disability or loss of freedom'. Ikedinachukwu Nwankwor, a psychiatrist hailing from Nigeria but currently residing in Winnipeg, Manitoba, has explained a few factors that contribute to the struggles of his field's operations in third world countries.
While the rationale explaining 'mental health' and 'mental disorder' cannot be denied, physicians are in constant disagreement about the roots of these afflictions. Physicians might misdiagnose a patient, proposing that he or she is suffering from a genetic disease or recovering from a stressful life encounter, directly leading to imprudent treatment methods such as psychotherapy, prescribed pharmaceuticals and brain stimulation techniques. As Ikedinachukwu Nwankwor suggests, mental health practitioners must first come to a common ground in their diagnosing and treatment conclusions; too many clinics, hospitals, religious organizations, and unorthodox traditional practices are administering their own brands of resolutions.
Funding & Facilities
Not nearly enough resources are apportioned for mental health treatment, especially in developing countries. Indonesia, for example, is home to 250 million people, yet is a tremendously under-resourced nation for mental health care needs. On average, WHO asserts that high income nations pledge five percent of total health spending on mental health, whereas lower middle-income countries commit fewer than two percent of their national budget. A country of Indonesia's state is, unfortunately, thought to have access to less than one percent of the country’s total budget is dedicated to mental health.
Clearly, these statistics require a shot in the arm; however, the possibility of that hinges on a greater number of reputable, well trained psychiatrists making their presence felt. Indonesia currently only has approximately 700 psychiatrists, one for every 350,000 citizens. Despite a population of roughly ten million people, Haiti only has ten licensed psychiatrists and Rwanda a mere five. Mexico and Indonesia, among other countries, see most of their psychiatrists crammed into central, heavily populated areas, leaving the other zones or communities empty handed.
Due to the lingering presence of overwhelming illnesses like tuberculosis or malaria, developing countries don't prioritize mental health care. Consequentially, funding is insufficient for low-middle income and low-income countries, as mental health care is simply at the back end of the financing queue. Respiratory illnesses from smoking, cardiovascular diseases and diabetes will take precedence in the health ministry's preparations. While developed nations have dealt with these issues years ago, developing nations are only starting to be able to catch up.
A Shortsighted Approach
Too many psychiatrists have been guilty of supplying anti-psychotics, anti-depressants and sedatives, many of which were discovered over 50 years ago, for genuine disorders. Certain cases may very well warrant them; however, they are frequently utilized as a band-aid solution, papering over the cracks of the illnesses. As evidenced, Ikedinachukwu Nwankwor opined that psychotherapy or counselling sometimes could work as well as medication and hence need to be explored early in the management of patient presenting to mental health facilities.
Research has proven that anti-depressants have fared only slightly better than placebos in clinical trials, while anti-psychotic drugs have exposed patients to social withdrawal, befuddled thinking, lethargy and other debilitating side effects, even after curbing hallucinations and delusions. Several pharmaceutical companies have noticed these chains of events, resulting in budget cuts and fewer clinical trials or research. Hopefully, more will follow suit and understand that many of these patients' diagnoses cannot be amateurishly analyzed as “chemical imbalances”. Definitely supportive psychotherapy or some other psychotherapeutic modalities may all that is needed especially to those who would rather prefer not to take medication for some reasons. Depending on the psychosocial events behind the mental break down, family therapy of family support may be all that is needed. Sometimes, the cultural background to mental illness should be taken into consideration before deciding an acceptable mood of treatment.
Finally, the Diagnostic Statistical Manual (DSM) is perceived to be imprecise, as the number of diagnostic criteria has expanded to the point that previously normally held behaviors are now categorized as potential symptoms. Ill-suited labelling and treatments are the inevitable aftermath, introducing powerful medications and side effects that can become more lethal than the disorders they are meant to treat. Papers that report on the effects of pharmaceuticals prescribed for mental disorders are vague, describing the potency as being 'modestly superior', only facilitating the doubts around what definitively helps and what doesn't. Ikedinachukwu Nwankwor concludes that until swift changes are brainstormed, applied and tenaciously upheld, third world countries will continue to rightfully cry out for more deserved, exceptional psychiatric options that will be affordable.
With that being said, the combination of antidepressant and psychotherapy is found to be more effective than either of the two treatment modalities individually.