Millennium Development Goals

Baroness Hollins Excerpts

Thursday 22nd November 2012 Lords Chamber

[Baroness Hollins]

My Lords, I will restrict my contribution to considering one possible barrier to achieving the current goals: the lack of attention to mental health. This is not just another “must”. The current MDGs do not explicitly address non-communicable diseases such as cancer, cardiovascular disease or mental illness. This may be because when they were agreed in 2000 it was believed that infectious disease, malnutrition and a safe childbirth were the most important health problems facing poorer countries. Mental health was not mentioned; perhaps it was not seen as relevant or because of the stigma of mental disorders. In 2005, the World Health Organisation presented a rather different view. It published a report called Preventing Chronic Diseases: a vital investment. It made the point that non-communicable diseases kill people at economically and socially productive ages and kill them mostly in the developing world: 80% of chronic disease deaths were said to occur in low and middle-income countries.

Neuropsychiatric disorders are non-communicable diseases and make up 13% of the global burden of disease. It is estimated that by 2020, 20% of the world’s population will experience depression—a treatable condition. In 2011 the WHO mental health atlas report showed that in most countries worldwide, there has been little progress in implementing mental health programmes. At the United Nations high-level meeting on non-communicable diseases in 2011, the political declaration concluded that,

“there is a need to provide equitable access to effective programmes”,

on mental health. At last attitudes to mental health across the world are changing. This year 500 organisations representing the mental health community and civil society worldwide signed up to the World Federation for Mental Health’s great push for mental health programme. A survey of these organisations demonstrated a high level of agreement on what they wanted the WHO to do to progress mental health globally. Ministers of health from many member states have prepared a comprehensive mental health action plan to be presented to the WHO executive in January next year. This draft action plan suggests targets for countries for mental health service development.

Mental health is now being recognised formally as important on the world stage—not just in the United Kingdom, where we now have a commitment to work towards parity of esteem between physical and mental health. Like other non-communicable diseases, mental disorders affect all aspects of life and frequently co-occur with physical illnesses. I suggest that mental disorders are relevant to all of the current eight millennium goals. I will give some brief examples to explain what I mean. For example, goal 1 aims to eradicate extreme poverty and hunger. We know that acute and chronic mental disorders are associated with unemployment and a descent into poverty and thus treating mental illness as a root cause of poverty is key. Goal 3 aims to promote gender equality and empower women. We know that in most cultures women experience higher rates of mental illness than men, including prenatal and postnatal depression, and the emotional problems associated with domestic abuse, for example as a victim of violence, perhaps due to the mental health of their partners.

I take goal 4, reducing child mortality, and goal 5, about maternal health, together. Maternal depression affects birth weight and a failure to thrive in children. Mothers are more likely to cease breastfeeding early and their babies are more likely to develop serious diarrhoea and not complete their immunisations. Even with goal 7, ensuring environmental sustainability, we need to think about the mental health of migrants forced to leave their homes because of environmental disasters or war. Ignoring mental disorders is no longer acceptable. Mental health must not only be included in programmes serving the millennium goals, but must be seen to be included. Will the Minister indicate how the UK will contribute to making mental health a global priority in the development of successor millennium development goals, perhaps through advocacy but also through supporting alliances between economic, social, mental health and other stakeholders?