Health: Non-communicable Diseases

Baroness Murphy Excerpts

Thursday 6th October 2011 Lords Chamber

[Baroness Murphy]

My Lords, I add my voice of thanks to the noble Lord, Lord Crisp, for securing this debate and for the opportunity that it gives us to talk about the scourge of these five chronic diseases. This is also an opportunity for me to express my personal admiration for his commitment in recent years to the cause of improving global healthcare through the improvement of the education of healthcare workers in developing countries. I wish all strength to his arm in that area.

Before I go on to talk about mental health—which will be no surprise to anybody because everyone knows that that is what I do—on behalf of the well rounded of this world I want to pick up on something that the noble Lord, Lord McColl, said. He is absolutely right that the obese should eat less and that we should all eat less—that is a message that comes over strongly—but I should like to point out that an obese individual losing weight permanently by eating less is as likely as a heroin addict coming off heroin. It is almost impossible. We must go back to the comments of the noble Lord, Lord May: we need population solutions; we need to support people to eat less; and we will need to tackle the food industry to do so. I am sure that the noble Lord, Lord McColl, will forgive me but it is an issue which is so easy to say but so difficult for many people to follow.

As we have heard, the World Economic Forum, which through the Harvard School of Public Health did the research on the anticipated costs of these five chronic diseases, found that mental health will account for one-third of the overall $47 trillion. I am not sure that I can take on board what a trillion is, but a huge amount of money—about one-third of the anticipated costs that NCDs pose—will be lost due to the dependence of people with mental health problems. As a result, countries and economies are losing people in their most productive years. About 70 per cent of lost economic output is due to mental illness and heart disease alone. That means that it is the largest burden of disease globally, measured by disability-adjusted life years; there is a greater economic toll globally from mental disorders than from any of the other major disorders. I suppose that that is not surprising, as the human brain is the seat of all higher intellectual, emotional and cognitive functions, which are essential for individuals to fulfil their fullest potential. Many of these disorders begin in childhood and adolescence—a critical period of life when an individual is being educated, establishing effective social relationships and laying the ground for a successful career.

Even in the least developed regions, where infectious diseases are prominent and still important sources of disorder and disability, mental and neuro-psychiatric disorders remain and are a growing source of disability. Suicide claims the lives of 800,000 people annually. That is clearly a gross underestimate; the way in which we collect suicide statistics is very poor. Over 90 per cent of the 24 million people suffering from schizophrenia reside in low and middle-income countries, and less than half those 24 million receive any treatment, even in developed countries. Some of the treatments available in near neighbours such as eastern European countries are pretty frightening. There are still some profound human rights abuses in some of our neighbouring and many developing countries, akin to the sorts of treatments that were available here in the medieval period. They are still happening in many countries. Countless millions of mentally ill people go untreated, suffer misery and poverty and, quite often, grave human rights abuses.

The World Economic Forum research was published just a fortnight before the UN meeting on non-communicable diseases, which was billed as a once-in-a-generation opportunity to tackle the predicted wave of the diseases. I cannot but express my disappointment that mental health was scarcely given a mention. It was not on the agenda and the final communiqué had three and a half passing mentions of it. Our Government were urged to promote mental health at this meeting but did not do so. How are we to get the countries of the world to take it seriously if our Government do not?

We can guess why these disorders were ignored. The problems of stigma, the rejection of mental health patients and the denial of how economically important they are, are all too frequent. But of course there are unique challenges associated with mental disorders because of the cultural influences in the manifestation of illness, the stigma which attaches to family and healthcare workers as well as patients, and pervasive misunderstandings about causes and appropriate treatments. Most diseases have straightforward diagnostic systems that are relatively impervious to the influence of culture and context, but mental disorders are hampered by shifting and imprecise diagnostic systems, a weak evidence base for their causality and a lack of awareness and resources for appropriate assessment. The treatment facilities for mental disorders are generally segregated from those for other health problems. That is a problem that goes back to the way in which European colonialists often viewed these disorders in the past two centuries and has resulted in very fragmented funding streams, haphazard training and care pathways. In many countries, the system of care is based around a single large, rare specialist facility, often in an old mental hospital—maybe one per country in an urban centre—which provides for a tiny fragment of the country’s mentally ill and separates people from the care of the community where patients and families live. There is a need for decentralisation of services to scale up access to treatment and care. We now have evidence-based knowledge of very effective treatments and delivery systems that can be adapted to meet the needs of different cultures.

This morning I was talking to Professor Martin Prince, who is Professor of Epidemiological Psychiatry at the Centre for Global Mental Health at the Institute of Psychiatry. I asked whether he could give me some up-to-date good examples of where some new cost-effective delivery systems were in place. He particularly wanted me to mention two excellent services. One is in Goa and is being delivered by community mental health workers, picking up antenatal depression across large numbers of people in the community. I understand that the cost of treatment there is less than the cost of a loaf of bread a day, so it is extremely cost-effective. There is another one around Rawalpindi in Pakistan, where a system of community mental health workers provides basic community mental healthcare across a very wide area on an algorithm that reaches a primary care physician for those where the provision of community mental health workers is uncertain. Again, that is extremely cost-effective, and it is very well researched to show how effective it is in bringing sustained benefit over a number of years. There are many examples such as those.

To echo the point made by the noble Baroness, Lady Hayman, we have a lot to learn from some of the systems that have been put in place. There are some very cost-effective, economical and simple ways in which to pick people up and treat them early, using people trained with specific tools over short periods of time. Nevertheless, these are isolated good examples that I can quote—there is an enormous gap—and the time for global action has come.

Sadly, while we know that mental health is integral to achieving social, economical and health goals of development, it continues to get short shrift. It needs to be included explicitly and independently as a key component of discussions and recommendations. The World Federation for Mental Health has set up a convention of working groups to aid the United Nations in developing guidelines, goals, tasks and outcome measures—all those United Nations phrases which I suspect sometimes do not lead to much action. However, we have to start somewhere. There is much good work going on and it deserves government support.

Finally, can the Minister explain why the Government, whom I will praise for having done so much to foster mental health as a priority at home, have not given a vigorous lead at the United Nations? I understand that this particular meeting wanted to get some action on smoking, diet and exercise—particularly smoking—and that there was some hard stuff to be done. I understand the importance of that, but it does rather play into the hands of the ignorant, stigmatising mental health yet again by denying its crucial importance to suffering and national economies. What plans do the Government have for putting right that neglect of mental health on an international stage? It is really one of those disorders that we cannot stand by and ignore.