Op-Ed for the World Health Day 2017

Depression: Let’s Talk

By Dr Yungo Liu, WHO Representative in Cambodia

PHNOM PENH, CAMBODIA, 07 April 2017 - World Health Day is celebrated on April 7th every year to promote awareness of different health topics. For World Health Day 2017, WHO chose the theme Depression: Let’s Talk.

Depression is the leading cause of disability worldwide. WHO Global Health Estimates show that the number of people living with depression increased by over 18% between 2005 and 2015. More than 300 million people worldwide now live with depression. Less than half of those with depression are receiving treatment because of fear and discrimination arising from stigma and a lack of available services.

Depression is a serious illness

Dr Shin Young-soo, WHO Regional Director for the Western Pacific, stated “People with mental illness should not suffer in silence. We need to talk openly and honestly about depression, to break down fear and stigma. Lives are at stake. Left untreated, depression can lead to suicide. It is a tragedy that over 500 people take their lives each day in this Region, many of them young people.”

Depression affects people of all ages and in all countries. Depression is different from usual mood fluctuations and short-lived emotional responses to challenges in everyday life. Especially when it is experienced with moderate or severe intensity and is long-lasting, depression may become a serious health problem. It can cause the affected person to suffer greatly and function poorly at work, school and in their family life and other interpersonal relationships. We know that the risk of becoming depressed is increased by poverty, unemployment, events such as the death of a loved one or a relationship break-up, physical illness and substance use disorders. At its very worst, depression can lead to suicide. Globally, suicide is the cause of nearly 800 000 deaths every year and is the second leading cause of death for those aged 15–29 years.

Depression can afflict anyone. It is not a sign of weakness, but an illness, which can be successfully treated. The type and length of treatment depends on severity. The support of family and friends can play a key role in recovery from depression, but patience and perseverance are needed, as recovery takes time. It is important to listen without judgment and offer support. Lack of support for people with mental disorders, coupled with the fear of being stigmatized, prevents many from accessing the treatment they need to live healthy and productive lives.

Cambodia is dealing with a unique and challenging mental health situation as a result of trauma experienced by the entire population during the Khmer Rouge regime and the years of civil war that followed. Today, many Cambodians still suffer from minor to severe psychiatric problems, such as Post Traumatic Stress Disorder, depression, and anxiety. The 2015 WHO Global Health Estimates report 3.4% of Cambodians are affected by depressive disorders.

Need for increased investment

In many low- and middle-income countries there is little or no support available for people with mental health disorders. Even in high-income countries, nearly 50% of people affected by depression do not receive treatment. Of course, awareness is not enough. It is crucial to invest in mental health services and provide training for health staff at all levels, from community to national hospitals. Investment in mental health also makes economic sense. It has been estimated that every dollar invested in scaling up treatment for depression and anxiety leads to a return of four dollars in better health and ability to work. Treatment usually involves counselling or antidepressant medication, or a combination of both. Both approaches can be provided by non-specialist health-workers, following a short course of training.

To meet the need for services at the primary care level, WHO launched the Mental Health Gap Action Programme in 2008. The programme’s intervention guide is available for countries as a training tool for diagnosis and management of mental, neurological and substance use disorders in non-specialized settings. Some parts of this tool have already been adapted and are being implemented to train staff at the primary health-care level in Cambodia. The establishment of the Department of Mental Health and Substance Abuse in 2014, under the Ministry of Health, has been a major step towards increasing services. According to a March 2017 report from the department, 65 out of 110 national and referral hospitals and 112 out of 1202 health centres nationwide, now offer out-patient mental-health services. These are positive signs of progress but also show that much more needs to be done to ensure access to services for those who need help.

Failure to act is costly. A WHO-led study estimated treatment costs and health outcomes in 36 low- middle- and high-income countries over a period of 15 years (from 2016–2030). The study showed low levels of recognition and access to care for depression and anxiety (another common mental disorder), result in a staggering one trillion US dollar global economic loss every year. Households lose out financially when people cannot work. Employers suffer when employees become less productive and are unable to work. Governments have to pay higher health and welfare expenditures.

A better understanding of what depression is, and how it can be prevented and treated, will help reduce the stigma associated with the condition, and lead to more people seeking help. It should also help policy-makers better understand the need to ensure that services are in place to meet a growing demand as awareness increases. People with depression need support to overcome their illness. Such help can come from family, friends and health professionals who serve their communities. We hope that more people who need help with depression will take the first step – and talk about it.

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