Four in 10 mentally ill people going untreated, says professor

2009-10-13 00:00

ABOUT four in every 10 people who have a mental illness worldwide are not being treated for a number of reasons, including the difficulty of detecting mental health problems, said Professor Anthony Pillay, principal clinical psychologist at Nelson R. Mandela School of Medicine and Fort Napier Hospital.

Pillay was speaking at the eleventh annual World Mental Health Symposium held at Town Hill Hospital last week to mark World Mental Health Day. The theme of the day this year was “Mental health in primary health care: enhancing treatment and promoting mental health”.

“Although it’s a good idea, economically and otherwise, to integrate mental health into primary health care, it poses many challenges, something that countries around the world struggle with,” said Pillay.

“One of the greatest difficulties is with detecting mental illness at the primary health care level. Research indicates that this is a problem in both developed countries like the U.S. and developing countries like ours.

“For example, the biggest mental health problem all over the world is depression. However, research in the U.S. shows that many people with anxiety or depression are actually being treated for high blood pressure (hypertension) or related conditions, while the underlying mental health problem remains undiagnosed.

“This means that large numbers of people with conditions like depression, which are very treatable, are not receiving the care they should,” he said.

Pillay said failure to detect mental illness has many other ramifications, as research shows that depressive illness increases the risk posed by many other physical illnesses.

With the high rate of HIV and Aids in KZN, mental health problems such as depression are particularly relevant, considering that research shows depression in up to 36% of HIV positive people. This is significant because “depression reduces motivation and energy levels, and therefore treatment adherence is also reduced”.

In other words, being depressed affects patients’ ability and willingness to take medication like ARVs or TB medicine.

Therefore, it is crucial that the associated depression is treated.

“This shows the importance and wider benefits of diagnosing, treating and caring for people with mental illness,” Pillay said.

Describing what can be done to address the problem of detection, he said: “Obviously community awareness and education are important. Educating health care workers is also critical.

“A study on the island of Gotland in Sweden showed that in-service training for the primary health care sector not only increased the rate of detection of depression, but also reduced the suicide rate.”

A follow-up to that research emphasises the importance of continuing, rather than once-off, education programmes, he added.

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