Submitted by Dr. Judy Kuriansky (Chair) on behalf the Psychology Coalition at the United Nations (PCUN) on the occasion of the 10th Session of the Open Working Group (OWG) on Sustainable Development Goals (SDGs), 31 March - 4 April 2014, UN Headquarters, New York.
Co-sponsored by PCUN members including the International Association of Applied Psychology (IAAP), the World Council for Psychotherapy (WCP), and the Order of Portuguese Psychologists (OPP)*.
This proposal offers support for the inclusion of “Mental Health, Stress-related Disorders and Psychosocial Well-Being” in the OWG focus area of “Health.” Health and mental health is supported as a stand-alone focus area and also as an inter-linkage to all the focus areas being considered by the Open Working Group.
“Mental health” commonly applies to serious conditions like clinical depression, schizophrenia or organic brain syndromes; however, the populations of every country suffer from more widespread emotional distress as a concomitant to, and result of, poverty, inadequate living standards, violations of human rights, interruption of decent work, and natural disasters. Vast numbers of the population with “less clinically serious” or diagnosed conditions are suffering emotionally, but are not recognized or treated. In many countries, stigma against mental health or lack of recognition of the importance of what can be considered milder stress-related debilitating conditions leads to people seeking help that is inadequate or to their being ostracized from their families and communities.
Justification in UN documents and actions.
Human rights standards and UN documents increasingly recognize mental health and psychosocial well-being as basic human rights. The preamble of the 1946 Constitution of the World Health Organization (WHO) defines health as “a state of complete physical, mental and social well-being, and not merely the absence of disease or infirmity.” In 1948, the Universal Declaration of Human Rights included the right to a standard of living adequate for health and well-being (Article 25). A number of international human rights standards provide for physical and mental health (for example, the 1966 International Convention on Economic, Social and Cultural Rights, the 1989 Convention on the Rights of the Child, and the 2006 Convention on the Rights of Persons with Disabilities).
Some outcome documents of major UN world conferences have focused on mental health goals, e.g., the 2001 World Conference Against Racism and the 1995 UN World Conference on Women at Beijing. Physical and mental health was one of the 12 critical areas in the Beijing Platform for Action. The UN World Report on Violence Against Children (2006) includes abuses against children’s mental health and psychosocial well-being in social contexts ranging from the family to the community and the WHO report, Mental Health and Development: Targeting People with Mental Health Conditions as a Vulnerable Group (2010), presents compelling evidence that poor mental health impedes an individual’s capacity to realize their potential, work productively, and make a contribution to their community. The United Nations General Assembly Resolution on Happiness (A/RES/65/309) calls for Member States to take a holistic approach to development, giving attention to happiness and well-being in planning how to measure and achieve social and economic development.
At the United Nations Conference on Well-being and Happiness, 2-4 April 2012: A New Economic Development Paradigm, experts and representatives from all sectors of the international community gathered at the UN to address a new development paradigm that replaces the present narrow system based on GDP (Gross Domestic Product) with a “Gross National Happiness” (GNH) model. The extent of global support for Gross National Happiness was evident in the participation of high level representatives from countries around the world, as well as that of UN Secretary-General, Ban Ki-moon; President of the General Assembly, Mr. Nassir Abdulaziz Al-Nasser; and President of the Economic and Social Council, Mr. Miloš Koterec.
Justification in the World Health Organization’s 2010 report, Mental Health and Development: Targeting People with Mental Health Conditions as a Vulnerable Group.
An estimated 450 million people globally are suffering from mental disabilities and many are affected by widespread stigma and discrimination making them vulnerable to violence, exploitation, physical and sexual abuse, malnutrition, illnesses and even death. In recent years, there is a growing conviction globally that unless the rights of persons with mental disabilities are mainstreamed in development sectors, people will remain caught up in a vicious cycle of poverty and mental ill health. Targeted policies, strategies, and interventions for reaching people with mental health conditions should be developed, and mental health interventions should be mainstreamed into broader poverty reduction and development work.
Global Statistics on Mental Health conditions.
Mental health conditions affect millions of people in the world. Mental conditions and stress debilitates and also kills. The World Health Organization (WHO) estimates that 151 million people suffer from depression and 26 million people from schizophrenia; 125 million people are affected by alcohol use disorders. About 844 thousand people die by suicide every year. According to the UN Office on Drugs and Crime, World Drug Report 2013, while the use of traditional drugs, such as heroin and cocaine, seems to be declining in some parts of the world, prescription drug abuse and new psychoactive substance abuse is growing. About 844 thousand people die by suicide every year. As many as 40 million people suffer from epilepsy and 24 million from Alzheimer and other dementias. Studies in Asia, Europe, and North America have increasingly identified individuals with Autism Spectrum Disorders and other disabilities. X The psychosocial and mental health impacts of emergencies and disasters also undermine the affected populations both in the short-term and long-term. The World Health Report has estimated the high burden of disease for post-traumatic stress disorder. Stress related disorders have been proven to be directly related to the OWG focus areas of Poverty and Employment and Decent work for All (Carr, S. MacLachlan, M. and Furnjam, A., Eds., 2012, “Humanitarian Work Psychology,” Palgrave Macmillan Publishers).
WHO has reported that mental illnesses are the leading causes of disability adjusted life years (DALYs) worldwide, accounting for a loss from Non-Communicable Diseases (NCDs) of 37% of healthy years. Depression alone accounts for one third of this disability.
The Global Economic Burden of Mental Health problems.
WHO estimated that the global cost of mental illness in 2010 was nearly $2.5T (two-thirds in indirect costs), with a projected increase to over $6T by 2030. The entire global health spending in 2009 was $5.1T, in the context of an annual GDP for low-income countries being less than $1T and the entire overseas development aid over the past 20 years being less than $2T. These costs of poor mental health include interference with children’s ability to learn, and with the functioning of adults in families, at work and in the wider society. According to the 2011 World Economic Forum report, among Non-Communicable Diseases, mental health costs are the largest single source; larger than cardiovascular disease, chronic respiratory disease, cancer, or diabetes. Mental illness alone will account for more than half of the projected total economic burden from NCDs over the next two decades and 35% of the global lost output.
Reciprocity of health and mental health.
The relationship between mental health and physical health is reciprocal, as proven by extensive research. For example, individuals suffering from mental distress are at high risk for developing cardiovascular disease, respiratory disease, and diabetes. Therefore, the true costs of mental illness must be even higher. Extensive research is available from all issues of the Journal of Health and Wellbeing, by the International Association of Applied Psychology. Harmful drinking is a major determinant for neuropsychiatric disorders, such as alcohol use disorders and epilepsy and other non-communicable diseases (NCDs) such as cardiovascular diseases, cirrhosis of the liver and various cancers. The harmful use of alcohol is also associated with several infectious diseases like HIV/AIDS, tuberculosis and sexually transmitted infections (STIs).
As a Cross-cutting issue: Mental health conditions, as well as health, is a cross-cutting issue to many of the focus areas under consideration by the OWG. These include education, poverty eradication, gender equality and the empowerment of women, decent work, peace and others.
Targets: PCUN offers targets of:
(1) By 2020, providing programmes raising awareness in the public of mental health issues, stress-related disorders and psychosocial well-being, following a public health model. Such a program has been recently launched by FIAP (the Federation of Iberoamerican Psychologists) to reduce stigma about mental problems, and to encourage people to seek professional help.
(2) By 2020, government policies should implement mental health and psychosocial wellbeing policies and programmes to serve the population, especially the underserved.
3) By 2020, government policies and programmes should offer free services to reduce by 80 percent widespread depression and anxiety which exists throughout all cultures even when the culture may not call their stress or unhappiness by that name.
(4) By 2020, treatments should be made available to reduce by at least 80 percent the number of suicides, since suicide is so widespread in not only developed but also developing countries.
(5) By 2020, “mindset” training should be integrated into employment training for youth and all ages
(6) Under the focus area of sustainable consumption, elaborate target (g) of “awareness raising and education for creating sustainable lifestyle” to include providing, by 2020, free public awareness campaigns through media, and programmes in schools, to highlight the importance of personal well-being and concern for the harmony of all. Regarding target (c ), on recycling, people should be educated to care about the environment so they willingly do what is necessary for the good of the society to resist over-consumption and materialism, and instead to think of the common good.
(7) Under focus area 15, climate, we support (b) building resilience and adaptive capacity in all vulnerable countries, but suggest adding that this apply to universally to a;; countries because many did not know they were vulnerable before a natural disaster like an earthquake hit. Also, that “resilience” be defined as not only physical but also mental, specifically highlighting positive behaviors and increasing personal strengths.
(8) By 2020, institute free public awareness campaigns through media, and in programs in schools, about disaster prevention and resilience. For example, a university in Argentina has started such a resource for public information on DVD, and Brazil experts have devised board games for children.
(9) By 2020, education be offered in all schools that address stress reduction and strengths enhancement for children across the focus areas. Resources for achieving this target are already available. UN agencies, international humanitarian agencies, and NGOs have developed curricula and tools that teach children about stress reduction and peace. These should include arts, like music and drawing, that have been proven to boost confidence, cooperation and peacefulness, e.g., El Salvador’s school project of Escuela Distrito Italia, where providing music and drawing activities for children have kept them out of gangs. This approach needs to be launched in other countries.
(10) By 2020, institute a “Whole School Approach” that foster strengths-building in the wide school community, i.e., programmes that include teachers, parents and students. A model for this is being developed in Portugal.
(11) By 2020, policies and financial support for programmes that facilitate people in conflict to cooperate. Psychosocial research has shown the positive impact when children from cultures in conflict play soccer together, or teens learn computer skills together, or adults trek across the Sahara together or break bread together. No matter the problems inherent in these programs, if they are mandated and supported, they can reach more critical mass.
12) By 2020, provide consulting services, free of charge, for conflict resolution of many types – whether between neighbors or businesses. A model for this is provided by the New York City government.
13) By 2020, provide services free of charge in clinics, mobile vans and other means for all people for stress reduction, especially to reach those in remote villages.
14) By 2020, launch public awareness campaigns about peace, harmony and conflict resolution. These should be not just on TV, but on radio, accessible in remote villages, and online and on cell phones. Also, social media campaigns should be launched, as we have seen the power of technology, cell phones and texting, especially for youth.
15) By 2020, institute programmes for psychosocial resilience in disaster preparation and recovery that have already been proven useful, but have suffered from lack of funding. (see: the UNDP report, "Towards Human Resilience: Sustaining MDG Progress in an Age of Economic Uncertainty", UNDP, New York, September 2011). These would reduce symptoms of PTSD and also promote coping strengths. In addition, by 2020, launch resources for service providers, first responders, educators and others. Many international humanitarian NGOs applied effective models after natural disasters in places like China and Japan, that were stopped due to lack of funds. A good resource is a DVD for professionals developed by a university in Argentina that needs funding, and the board game for children “Let’s Learn to Prevent Disasters” developed by UN ISDR and UNICEF that should be used widely
(16) Human Rights Standards in support of the well-being of international migrants be ratified and implemented
(17) By 2020, mental health and psychosocial wellbeing coverage be integrated throughout all health systems, including through increased financing, development and training of the health and mental health workforce and access to safe, affordable, effective and quality treatments including those that are physical (e.g., medicines, vaccines) and those that are mental or psychological (therapies, counseling, support systems.
(18) By 2020, provide training for girls (especially those who are vulnerable) in income generating activities (entrepreneurial training) as well as psychological empowerment
(19) By 2020, insure that programmes respect traditional healing in cultures but are also supplemented with availability of other gold standard interventions proven to be “best practices.”
Judy Kuriansky, Ph.D., Chair, Psychology Coalition of NGOs accredited at the United Nations (PCUN), and main UN NGO Representative of the International Association of Applied Psychology. DrJudyK@aol.com (917) 224-5839
Corann Okorodudu, Ph.D., Past Chair, PCUN; UN NGO Representative of the Society for the Psychological Study of Social Issues. Okorodudu@rowan.edu (609) 330-0576
*The Psychology Coalition at the United Nations (PCUN) is composed of representatives of psychology and psychology-related Non-Governmental Organizations (NGOs) accredited at the United Nations (UN) Economic and social Council (ECOSOC) and psychologists affiliated with United Nations departments, agencies and missions. Members of the Coalition collaborate in the application of psychological principles, science, policies and practice to global challenges of the UN agenda. The Coalition seeks to accomplish this overarching aim through advocacy, research, education, policy and program development, guided by psychological and social science knowledge to promote human dignity and human rights through psychosocial well-being, positive mental health, empowerment, and resilience. The Order of Portuguese Psychologists has 20,000 members.