Mental Health: Cittadinanza & WHO
A conversation with Benedetto Saraceno, Director of the Department of Mental Health and Substance Abuse of the World Health Organization
How is the situation of mental health in poor countries?
It is quite difficult to give a comprehensive answer, taken into consideration the extreme heterogeneity of social, political, cultural and religious factors.
Poverty is indeed playing a crucial role in the origin and the development of and the recovery from several mental disorders. Nevertheless, it would be more correct to speak about poor people then poor countries, since mental illness is getting more and more cross-income, bringing together high and low income nations.
Male depression, for instance, lists unemployment among its decisive factors, while female depression hits frequently low income working mothers. Both factors are quite common in both high and low income countries. Actually, mental retardation is more common in those countries where more frequently delivery takes place in unhealty environments and poor hygienic conditions, with high neonatal infection risks, but psychosis, like schizophrenia, have a similar incidence in all countries and are not linked to the population’s wealth (except for the recovery path, still affected by the socio-economic conditions of each country). Youth suicide is occurring especially in eastern european countries (the first ten countries with the highest suicide rate in the global rank are eastern european) and this is very likely due to the dramatic social, more than economic, break up after the collapse of former socialist regimes.
If historical and socioeconomic factors do affect the onset of several mental disorders, indeed they are even more closely linked to how national health systems provide people suffering from mental illness and their families with adequate assistance and care. But, once again, an easy simplification (poverty = poor services, wealth = good services) has to be avoided. Things are much more complex, since mental health services often depend on the overall healthcare policy/ideology adopted by a government, and evidence often proves that rich countries do not always offer adequate services, while some low income countries are able to set up much better and more adequate mental health policies and structures than we could reasonably expect.
What are WHO objectives in this respect?
WHO objectives can be streamlined into six main strategies, to be obviously adapted on a country-by-country basis:
(1) – raising national sensitivity towards mental health issues, which are too often ignored or underestimated;
(2) – setting high on national development and public health agendas the issue of human rights and ‘citizenship’ rights;
(3) – improving legislative frameworks;
(4) – promoting community-based mental health and development policies;
(5) – disseminating adequate scientific and technical knowledge not only among mental health specialists (often non-existent in poor countries) but among all health workers;
(6) – listening and feeding back the patients’ and their families’ needs, demands and requests.
Which role can an association like Cittadinanza play in collaborating with the WHO?
The organizations and associations of the civil society can play a significant role in collaborating with the World Health Organization. They can help the WHO not to lose touch with the society’s demands and needs, they can contribute to identify new problems and new answers and they can keep monitored the respect of human rights at ground/local level better than intergovernmental organizations like the WHO itself.
Cittadinanza, for instance, is providing the WHO with ad hoc financial support that is more independent and needs-and-results oriented than the official institutional and governmental funds. Moreover, the small cooperation projects funded by Cittadinanza are jointly defined together with the WHO and can be more easily monitored and assessed by such a small organization. The ‘small’ dimension allows Cittadinanza to focus on very practical and concrete objectives and establishes a direct link between donors and beneficiaries, something that is so difficult to be created by big intergovernmental institutions.
In other words, I would say that a very special ‘niche’ exists in the complex framework of international cooperation that only collaborations like the one between Cittadinanza and the WHO can successfully fill. Furthermore, associations like Cittadinanza can play an important role as provider of scientific and technical expertise to the WHO.
Benedetto Saraceno
Director
Department of Mental Health and Substance Abuse
WHO, Geneve
