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Box 2 The previous section showed how people with mental health conditions meet criteria for being considered as a vulnerable group. This section looks at the situation from a different perspective, by describing how vulnerable groups targeted by development stakeholders – for example, people living with HIV (see Box 2) – also have high rates of mental health conditions. 1 Studies indicate an increased prevalence of mental health conditions among vulnerable groups. HIV/AIDS and mental health conditions Between11%and63%ofHIV-positivepeopleinlow-andmiddle-income countrieshavedepression. 164,165 DuetotheunpredictablenatureofAIDS progression,peoplewiththeconditionalsoarepronetoanxiety,stress,and panicdisorder. 166 Stresshasbeenshowninseveralstudiestoimpairimmune function 167 anddepressionislinkedtopooradherencetoantiretroviral therapy. 168 IntheUnitedRepublicofTanzania,onestudyshowedthat57% ofHIV-positivewomenexperienceddepressionatleastonceduringthe studyperiodof6to8years,andthatdepressionwasassociatedwitha greaterlikelihoodofdiseaseprogressionanddeath. 153 28 MentalHealthandDevelopment:Targetingpeoplewithmentalhealthconditionsasavulnerablegroup Clockwise from top left: IRIN/Manoocher Deghati; UN Photo/John Isaac; WHO; IRIN/Allan Gichigi
Box 3 How does vulnerability lead to poor mental health? Stigma and marginalization generate poor self-esteem, low self-confidence, reduced motivation, and less hope for the future. In addition, stigmatization and marginalization result in isolation, which is an important risk factor for future mental health conditions. Exposure to violence and abuse can cause serious mental health problems, including depression, anxiety, and psychosomatic complaints. This relationship has been observed for all forms of violence and abuse, including physical, sexual, and psychological abuse, and across a range of situations, from wars and conflicts through to adverse living conditions. It is not the physical abuse which is the worse but the terror which follows – the emotional abuse. I am still angry and terrified. —A woman subjected to domestic violence, Australia 163 Poor mental health can be both a cause and a consequence of the experience of social, civil, political, economic, and environmental inequalities (see Box 3). Mental health conditions are more common in areas of deprivation and poor mental health is consistently associated with unemployment, less education, low income or material standard of living, in addition to poor physical health and adverse life events. 169 The cycle that can develop between vulnerable groups, mental health conditions, and adverse development outcomes is illustrated in Figure 1. Poverty and mental health conditions – a vicious cycle Povertyandmentalhealthconditionsinteractinanegativecycle: • Peoplelivinginpovertynotonlylackfinancialresourcestomaintain basiclivingstandards,butalsohavefewereducationalandemployment opportunities.Theyalsoareexposedtoadverselivingenvironments suchasslumareasordwellingswithoutsanitationorwater,andareless abletoaccessgood-qualityhealthcare.Thesestressfulconditionsplace peopleathigherriskofdevelopingamentalhealthcondition. • Peoplewithmentalhealthconditionssometimesareunabletowork becauseoftheirsymptoms.Duetodiscrimination,othersaredenied workopportunitiesorloseemployment,drivingthemdeeperintopoverty. Manyhavenomeanstopayforneededtreatment;inotherinstances, moneyisspentoncostlymentalhealthcare.Ifthiscareisineffective orinappropriate,theresultisevenworseinthatpeoplehavenotonly expendedtheirfinancialresources,butalsofailedtogetbetter. 3.Othervulnerablegroupshavehighratesofmentalhealthconditions 29
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MENTAL HEALTH AND DEVELOPMENT: Targ
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WHOLibraryCataloguing-in-Publ
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Executive summary . . . . . . .
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This report on mental health and de
Page 10 and 11: Association for Mental Health and A
Page 12 and 13: Supporting statements H.R.H. Prince
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Page 23 and 24: Supportingstatements Gerard Quin
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Page 33 and 34: 1. Pan American Health Executive
Page 35 and 36: 1.Introduction People with menta
Page 37 and 38: 1.Introduction community, to ens
Page 39 and 40: 2. People with mental health condit
Page 41 and 42: assumed to be lazy, weak, unintelli
Page 43 and 44: Box 1 Prisons - unsuitable holding
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Page 67 and 68: 4.2 Specific actions Specific progr
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Page 71 and 72: 4.2.2 Integrate mental health issue
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Page 75 and 76: Box 10 AYouthLinkclient,21
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Page 81 and 82: 4.2.7 Strengthen human rights prote
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Page 99 and 100: References 46 South Central Somalia
Page 101 and 102: References 93 Alonso J et al. Popul
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Page 105 and 106: References 192 What works! Employme
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