Stakeholder Feedback for the Elements Paper and the Declaration: Support for Mental Health and Wellbeing (submitted February 2015)
It is important to build on the success achieved by the inclusion of health as Goal 3 of the proposed Sustainable Development Goals (SDGs) and of “promote mental health and wellbeing” in Target 3.4.
The rationale for specifically including “mental health and wellbeing” is vast, given the numerous UN conventions, resolutions and conference outcome documents that mention mental health and wellbeing (see below); the reciprocal relationship between physical and mental health; the costs to people, with 450 million people worldwide suffering; and, the cost to governments estimated to escalate from over $2T to $6T by 2030. More importantly, we need to prevent and manage well the cost of suffering for all, in all countries.
Examples of UN Conventions, Conference Outcome Documents and Reports of High-Level Meetings that support the Importance of Mental Health and Wellbeing in Development
In the International Covenant on Economic, Social and Cultural Rights (1966), the States agree to “recognize the right of everyone to the enjoyment of the highest attainable standard of physical and mental health” (Article 12).
The Convention on the Rights of the Child (1989) calls attention to “the right of every child to a standard of living adequate for the child's physical, mental, spiritual, moral and social development” (Article 27).
In the Declaration and Programme of Action of the 1995 World Conference for Social Development, governments committed “to promoting and attaining the goals of universal and equitable access to … the highest attainable standard of physical and mental health, and the access of all to primary health care, making particular efforts to rectify inequalities relating to social conditions and without distinction as to race, national origin, gender, age or disability” (Commitment 6).
The Declaration and Programme For Action of the 1995 UN World Conference on Women in Beijing, China, notes as one of 12 critical areas that “women have the right to the enjoyment of the highest attainable standard of physical and mental health. The enjoyment of this right is vital to their life and well-being and their ability to participate in all areas of public and private life. Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity…” (Paragraph 89, Beijing).
The World Conference Against Racism, Racial Discrimination, Xenophobia and Related Intolerance Declaration and Programme of Action (2001) “urges States, individually and through international cooperation, to enhance measures to fulfill the right of everyone to the enjoyment of the highest attainable standard of physical and mental health, with a view to eliminating disparities in health status, as indicated in standard health indexes, which might result from racism, racial discrimination, xenophobia and related intolerance (Paragraph 109 of the Programme of Action).”
The UN World Report on Violence Against Children (2006) addresses abuses against children’s mental health and psychosocial wellbeing in social contexts ranging from the family to the community.
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 and work productively, and make a contribution to their community.
The Secretary General’s Report to the Commission for Social Development on Poverty Eradication (E/CN.5/2012/3) mentions “wellbeing”: (1) in paragraph 24: “Not only do the idle young suffer deterioration in their skills set and motivation, and physical and mental well-being, but the loss of human and productive potential undermines social cohesion and stability”; (2) in paragraph 50: “Social protection measures shield individuals and families from economic shocks as well as social and economic changes, and enhance their capacity to manage and overcome situations that affect their well-being”; (3) in paragraph 54: “The right to social security calls for a progressive move towards universal social protection to ensure the basic well-being of all individuals.”
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 wellbeing in planning how to achieve and measure social and economic development. At the United Nations Conference on Well-being and Happiness: A New Economic Development Paradigm, 24 April 2012, experts and representatives from all sectors of the international community addressed the significance of a new development paradigm that adds wellbeing to a system based solely on GDP (Gross Domestic Product). These events were followed by the release of two editions of the World Happiness Report (2013, 2014) edited by three noted international economists, which provide extensive research as well as practical examples of measurements in support of this approach.
The Report of the 2012 High-Level Panel on Global Sustainability: Resilient People, Resilient Planet: A Future Worth Choosing (A/66/700) recommends a sustainable path to enhance human well-being, further global justice, strengthen gender equity and preserve the Earth’s life-support systems for future generations, with specific mention: (1) on page 3, in paragraph 8: “More than anything, we need to mobilize public support and excite citizens around the world with the vision of finally building a sustainable world which guarantees the well-being of humanity, while preserving the planet for future generations;” (2) on page 4: “Over time, we believe that following a more sustainable path will enhance human well-being, further global justice, strengthen gender equity and preserve the Earth’s life-support systems for future generations”; (3) on page 32, in paragraph 58: “Eradicating poverty is critical for the well-being of both people and the planet, and to do so, Governments need to deliver on the existing commitments of the Millennium Development Goals”; (4) on page 37: “More than 250 chief executive officers, including those of major multinational corporations, have affirmed support for these principles… to promote gender equality; fair treatment and mutual respect in the workplace; health, safety and well-being of all workers”; (5) on page 46, “The Great Barrier Reef is also critical to the economic and social well-being of more than 1 million Australians”; (6) on page 67, in paragraph 198: “Efforts in a number of countries to include happiness and well-being in national progress indicators are also important steps;” and (7) in paragraph 199: “While material prosperity is important, it is a long way from being the only determinant of well-being. As the Commission on the Measurement of Economic Performance and Social Progress noted in its 2009 report, purely economic indicators say nothing about whether material well-being is bought at the expense of environmental and social impacts or at the risk of putting undue stress on natural resources.”
The Hyogo Framework for Action 2005-2015: Building the Resilience of Nations and Communities to Disasters (A/CONF.206/6)recommends social and economic development practices, inparagraph 4,ii,g, to: “Enhance recovery schemes including psycho-social training programmes in order to mitigate the psychological damage of vulnerable populations, particularly children, in the aftermath of disasters.”
The Global Youth Call from the Global Partnership for Youth in the Post-2015 Agenda notes that suicide is among the top three causes of death among adolescents, and identifies, among key target areas, improving “the health and well-being” and “the treatment of mental health issues amongst adolescents and youth.”
Introduction:
“Mental health” commonly applies to serious conditions like clinical depression, schizophrenia or organic brain syndromes. However, the population of every country suffers from more widespread emotional distress as a concomitant to, and result of, poverty, inadequate living standards, violations of human rights, lack of decent work, migration, natural disasters and other conditions. Vast numbers of the population with “less clinically serious” or diagnosed conditions are suffering emotionally, but are not recognized or treated. This results in both extensive human and economic costs to nations. Further, in many countries, stigma against mental health or lack of recognition of the importance of what can be considered milder stress-related debilitating conditions may result in people seeking help that is inadequate and to being abused by or ostracized from families and communities.
Global Statistics
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 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. Therefore, WHO (2010) recommends that “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.”
Mental health conditions affect millions of people in the world. Poor mental health conditions and stress debilitates and also kills. The World Health Organization (WHO) estimates that 151 million people suffer from depression, 26 million people from schizophrenia, and 125 million people are affected by alcohol use disorders. About 844 thousand people die by suicide every year. According to the World Drug report in 2013 (UNODC, United Nations, New York), 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. As many as 40 million people suffer from epilepsy and 24 million from Alzheimer and other dementias. Violence is pervasive worldwide, affecting all ages, including increasing numbers of youth subject to bullying in schools. Studies in Asia, Europe, and North America have increasingly identified individuals with Autism Spectrum Disorders and other disabilities. The psychosocial and mental health impacts of emergencies and disasters also undermine affected populations both in the short-term and long-term. The World Health Report has estimated the high burden of post-traumatic stress disorder. Further, there is extensive empirical evidence that other stress- related disorders are directly related to the Open Working Group focus areas of poverty, employment and decent work (Carr, MacLachlan & Furnjam, 2012).
Economic and Social Costs/Benefits
WHO (2010) has reported that mental illnesses are the leading causes of disability adjusted life years (DALYs) worldwide, accounting for a loss from Non-Communicable Diseases (NDSs) of 37% of healthy years. Depression alone accounts for one third of this disability. The economic cost to countries of emotional conditions is high. 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 (NCD), 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 (Schwab, 2011).
According to the Organization for Economic Co-operation and Development (OECD), “emotional health can lead to success in work, relationships and health.” The OECD is supportive of the concept of wellbeing. Their mission is “to promote policies that will improve the economic and social well-being of people around the world” including “to ensure that people of all ages can develop the skills to work productively and satisfyingly in the jobs of tomorrow” (OECD, 2011).
An increasing number of programs in various countries have shown the promise of empowerment and training in psychosocial wellbeing, health education and income generating activities. Initiatives of psychosocial empowerment of rural women and girls as a means of effecting positive socioeconomic change has been demonstrated in the Women’s Earth Alliance in India and in Africa, at the Ann Sullivan Institute in Peru and the Tata Institute of Social Sciences in India (Kirkman & Kuriansky, 2012).
The Reciprocal Relationship Between Physical 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 many physical disorders, including cardiovascular disease, respiratory disease and diabetes. Therefore, the true costs of mental illness must be even higher than those provided above. Extensive research on this subject is available from issues of the Journal of Health and Wellbeing, by the International Association of Applied Psychology (http://onlinelibrary.wiley.com/journal/10.1111/(ISSN)1758-0854). Harmful drinking is a major determinant for neuropsychiatric disorders, such as alcohol use disorders, epilepsy and other noncommunicable diseases 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). Furthermore, the trend in health today is a holistic approach, integrating the various health-related disciplines.
Cross-Cutting Issues
Physical and Mental health, Psychosocial Well-Being and Stress-related Disorders are cross-cutting issues to many of the focus areas under consideration by the GA OWG and therefore can be mainstreamed into the document. These include poverty eradication; education and lifelong learning; gender equality and women’s empowerment; economic growth, employment and infrastructure; sustainable cities and human settlements; sustainable consumption and production; climate change; ecosystems and biodiversity; global partnerships for sustainable development; and peaceful and inclusive societies.
Consideration of these factors must take into account cultural differences (even in similar economic strata) both within and among developing and developed countries. A significant body of psychological research exists about such differences as well as similarities, including those among families (Georgas, Berry, van de Vijver, Kagitçibasi et al., 2006).
References (selected list)
*Carr, S., MacLachlan, M. & Furnjam, A. (Eds.). (2012). Humanitarian Work Psychology. Palgrave Macmillan Publishers.
*Georgas, J., Berry, J.W., van de Vijver,F., Katholieke, Kagitçibasi, C. & Poortinga, Y.H. (2006). Families Across CulturesA 30-Nation Psychological Study, Cambridge University Press.
*Kirkman, C. & Kuriansky, J. (2012). Transforming Communities through Psychosocial Empowerment of Poor Rural Women and Girls: Parallel Event of the Psychology NGOs Accredited at the United Nations at the 56th Session of the Commission on the Status of Women”. Bulletin of the International Association of Applied Psychology, 24: 2-3 July/October. http://www.iaapsy.org/uploads/file/newsletters/July2012.pdf Part 13.
*Schwab, K. (2011). Global Competiveness Report, 2009-2010. Geneva: World Economic Forum.
*World Health Organization. (2010). Mental Health and Development: Targeting People with Mental Health Conditions as a Vulnerable Group. Geneva: WHO.
Contacts:
Judy Kuriansky, Ph.D., Chair of the Psychology Coalition of NGOs accredited at the UN, Main UN/NGO Representative of the International Association of Applied Psychology (IAAP). Email: DrJudyK@aol.com
Corann Okorodudu, Ph.D., Past Chair of PCUN, UN/NGO Representative of the Society for the Psychological Study of Social Issues. Email: okorodudu@rowan.edu.
