Poor countries lack capacity to handle mental disorders

By Bernard Muthaka

In Kenya, the fate of many persons with mental disabilities depends on the depth of their relatives’ pockets.  Those whose parents have means will usually be sent to mental institutions where they are arbitrarily detained for as long as payment to the institution is sustained.

For those whose relatives cannot afford the cost of mental institutions, many are isolated, chained, and caged at home where they are exposed to extreme inhumane and degrading treatment.

With the prevalence of non-communicable diseases, experts are worried that families are likely to face a problem the health sector is ill-equipped to handle; the mental disorders in children.

According to the World Health Organisation ( WHO), mental disordersarising from neurological and substance use contribute to one in every three cases of non-communicable diseases, and are major contributors to illness and premature deaths. Three out of every four people with mental disorders come from poor countries.

The report says restoring mental health is not only essential for individual well-being, but it is also key to economic growth and reduction of poverty.

A study of how countries are handling the problem of mental disorders says that mentally handicapped children in the poor countries are worst hit by the inadequacies of health systems. 

Data from WHO indicates that children and adolescents make up about 12 per cent of the patients in mental health outpatient facilities. “In these countries, resources are scarce but it is also where the probability of extreme hardships, which can enhance vulnerability to develop mental disorders, is greater,” says a study by the Centre for Global Mental Health, London School of Hygiene and Tropical Medicine in UK. The study says that developmental disabilities, emotional disorders and disruptive behaviour disorders are the leading mental health-related causes of the global burden of disease in children aged below 10 years.

Extreme poverty

In poor countries, extreme poverty, low birth-weight and under-nutrition, high burden of communicable diseases, humanitarian crises and lack of access to education only make the bad situation worse. According to the study, the three major barriers to effective interventions for the disorders include inadequate research information, poor identification systems and shortage of trained workers who can handle the disorders. To illustrate the large data gap for child mental disorders, the study says that nine in ten published studies on child and adolescent mental health come from high-income countries, with only about 0.3 per cent coming from poor countries.

Out of about 670 published clinical trials looking at treatment of mental disorders, so far only one has originated from a low-income country.

“This contrasts starkly with the global population of children, with 90 per cent of adolescents living in the poor countries,” says the study. As a result of few studies, little is known about the factors that influence mental disorders, the different types and treatment in these countries.The most challenging barrier of all is the great shortage of skilled human resources to address child mental disorders in most regions of the world. Over 95 per cent of medical staff trained to handle child mental health is found in high-income countries. The Kenya Psychiatric Association currently has only 73 registered members.

“As one stark reminder of this inequity, there are fewer child psychiatrists in the whole of Africa than in the state of California,” says the study.

The common different types of mental disorders

There are few formal training programmes for developmental and behavioural paediatrics, child psychiatry, speech and language therapy or other major disciplines concerned with child mental health in poor countries.

The massive shortage of specialised human resources is unlikely to be bridged in the foreseeable future.

Types of disorders

There are several different types of mental disorders that can affect children and adolescents, including: Anxiety disorders: Children with anxiety disorders respond to certain things or situations with fear and dread, as well as with physical signs of anxiety (nervousness), such as a rapid heartbeat and sweating.

Lack of Concentration

Attention-deficit/ hyperactivity disorder (ADHD): Children with ADHD generally have problems paying attention or concentrating, can’t seem to follow directions, and are easily bored and/or frustrated with tasks. 

Disruptive behaviour disorders: Children with these disorders tend to defy rules and often are disruptive in structured environments, such as school.

Affective (mood) disorders: These disorders involve persistent feelings of sadness and/or rapidly changing moods, and include depression and bipolar disorder.