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Minister
Ongeri,
Secretary
Meme,
Dr Samba,
Director
Muga,
Commissioner
Maina,
Mayor
Ndirangu,
Dear
friends,
I am very happy to see so many of you on this
celebration of World Health Day, even though we are three days early.
Here in Kenya, this day is special. This is the
first time that so many visitors have come to Mathari. For most of
you, it is the first time you are setting your feet inside a hospital
for those suffering from mental illness. For some of you, it will not
be the last.
For mental illness doesn’t only happen to
"other people". One person in every four will be affected by
a mental disorder at some stage of life. It is a rare family that will
never have an encounter with it. I would ask you all to use this
opportunity to talk to the patients, the doctors and nurses, and the
family members of those who are treated here.
What you will find is that mental illness has
nothing to do with personal failure. It is a set of mostly curable,
but crippling diseases that attack our most vulnerable possession: our
sense of self. Hopefully, when you leave here this afternoon – or in
some weeks, if you are a patient – mental illness will be less
misconceived and less threatening. You will learn that all cases of
disease have a history, and most patients have a positive future
waiting when the disease is brought under control or cured altogether.
Not long ago, it was hard to speak about AIDS –
and before that about cancer. It still is, in some places, but
gradually, these taboos are being broken down. Yet many of us shy away
from talking about mental illness. We don’t want to know and we don’t
want to see. We don’t dare to understand and to care.
We treat mental illnesses differently from physical
ones. We don’t always accept that as any other illness, mental
disease and brain disorders have causes, certain symptoms and
treatment. Where there is no recognition, there is no awareness –
and there is no action.
This might have been understandable if we were
facing an insignificant public health problem. But mental disorders
affect a vast amount of people, causing tremendous suffering and also
economic costs.
Today, more than 400 million people world-wide are
estimated to be suffering at any given time from some kind of mental
and neurological disorder, including alcohol and substance abuse
disorders.
Mental disorders account for more than 10% of the
burden of all disease in 1999. It is one of the dominating causes of
years lost to disease, something too few people realize. The share was
greater in high income countries at 23%, than in middle income
countries at 11%. The overall figure is expected to increase to 15%
over the next 20 years.
Five of the ten leading causes of disability are
mental problems such as depression, schizophrenia, bipolar disorders,
alcohol dependence, and obsessive-compulsive disorders.
Depression is ranked fourth among the 10 leading
causes of the global burden of disease, which includes the developing
world. By 2020, it will have jumped to second place. The world over,
there are on the average twice as many women who are suffering from
depression than men. Between ten and 20 million people attempt suicide
each year. One million die. That death toll is as high as from
malaria!
Mental illness and brain disorders can be a very
heavy economic burden on families. The main bread winner may not be
able to work for long periods of time. Or one or several family
members will be tied up caring for someone who is not able to take
care of himself or herself.
For centuries, there was little to do to treat
mental and brain disorders. But today, we have cost-effective
interventions to treat the majority of mental and neurological
disorders. Yet, there is a great gap between the number of people who
suffer from these diseases and the number who receive treatment and
care.
- 70% of those suffering from Depression can fully recover if
treated with antidepressant medications and cognitive
psychotherapy but fewer than 25% of those affected receive
treatment. This gap also occurs in industrialized countries.
-
The relapse rate of
Schizophrenia can decrease up to 60% if patients receive proper
medication and families receive proper education and support.
Still, only 25% of those suffering receive such treatment.
-
80% of those suffering
from Epilepsy can live a normal life if treated with
anticonvulsivants but 90% of cases in developing countries do not
get treatment !
-
Severe Mental
Retardation can be easily prevented through iodine supplementation
of salt but still many countries don’t use this cheap and
effective method.
A global survey WHO has carried out among 181 of
its 192 Member States show that seventy-eight countries – or 43% –
have no mental health policy at all. Thirty-seven countries – or 23%
– have no legislation on mental health. Sixty-nine countries – or
38% – have no community care facilities, and in 73 countries – or
41% – treatment of severe mental disorders is unavailable in primary
health care.
Many will be surprised by these figures. But we
should not shy away from communicating these facts - we have to do it
as part of the vital process of rolling back the many taboos that
deter prevention, treatment and care.
The taboos lead to discrimination. In many
countries, insurance companies discriminate between physical and
mental disorders. Labour policies are less open to welcoming people
with a history of mental disorders than those with physical ones.
Often, the mentally ill are outcasts in their local society. In many
countries, even basic human rights of mental health patients are
routinely being violated, mostly in psychiatric hospitals.
With this discrimination follows stigma, to the
detriment of those who need help, treatment, care and prevention.
Stigma also creates a hidden burden of mental problems, which need to
be added to the burden we can measure. Only when we address the stigma
and discrimination together will we be able to make real progress.
These are not impossible tasks.
Stigma can be reduced by openly talking about
mental disorders in the community, like we do here today. But we also
need to constantly counter the negative stereotypes and misconceptions
surrounding mental disorders. Governments must review their laws to
ensure that legislation to reduce discrimination in the workplace and
in access to health and social community services is put in place.
Friends,
This is the second time in WHO’s history that
mental health is the theme for the World Health Day. The first time,
42 years ago, in 1959, WHO wrote the following:
"Great numbers of mentally ill still live,
shut away behind hopeless walls by the prejudices and incomprehension
of society. The efforts (…) to have the mentally ill treated as
other sick people who can be cured, are likely to remain fruitless as
long as irrational fear of ‘madness’ is not conquered, as long as
all the influential members of the social hierarchy do not understand
that mental health is not only the business of specialists but must
concern the whole community."
It can seem like we have achieved little during
these forty years. But that is not true. The big difference is that,
unlike then, we now have effective solutions. Today, we have the means
to really make a difference.
We also have a much stronger movement of people who
speak for the rights and interests of those suffering from mental
illness. More than anything, families of those who suffer are
expressing their concerns and are standing up for their loved ones.
The cultural attitudes are changing in many countries. Mental health
is beginning to "concern the whole community" as we said it
must, 42 years ago.
And we have new, effective drugs with fewer and
milder side effects. We have much more knowledge about what really
works.
We know that psychosocial rehabilitation carried
out in communities works. When we place mental health into the general
health care services, we reduce the stigma and enable the health
services to treat people where they live. We also catch diseases in
earlier stages, before they cause total disability and terrible strain
on families. There are great examples of such community work here in
Nairobi.
We know that in some instances, hospitalization is
needed to treat the most serious cases. But we also know that in many
countries, mental hospitals consume almost the entire mental health
budget. With proper community care and the right use of medication,
only a few patients would need hospitalization, and the time they stay
can be cut from months or years down to days or weeks. Here at Mathari,
you have been pioneers in reducing both patient numbers and the
average hospitalization time for your patients. You are an example for
other national institutions to follow.
We know that many mental diseases and brain
disorders can be prevented: either prevented altogether, or prevented
from becoming so serious they destroy lives.
We know that teaching parents and primary health
workers how to detect early signs of mental illness and disorders such
as epilepsy arrests the problems at an early stage where they can be
more easily treated.
We know that although most medicines and the most
effective treatments and prevention are all cheap, a large number of
countries spend so little on mental health it is impossible to achieve
positive results. We know that many governments must make mental
health a higher priority than it is today, and that they will have to
spend the money in different ways.
On Friday and Saturday, the World Health Day will
be celebrated in thousands of different ways in thousands of different
places around the world. In many places, the events will continue
throughout the year.
Let the new awareness become permanent. Let it lead
to real change.
Let us stop exclusion and dare to care!
Thank you. |
