In any given year one person in six is afflicted by a mental illness. Most cases involve mild-to-moderate depression or anxiety. Some sufferers recover on their own. For many, however, the condition is left untreated and may become chronic or severe.
In the past social stigma meant that people kept their pain to themselves. The stigma is now melting away. Yet in rich Western countries two-thirds of people with a mental-health problem do not receive any treatment for it. In poor countries hardly any do. And almost everywhere, psychiatrists and clinical psychologists are scarce. Often they are the only people whom states or insurers will pay to treat mental illness, so those who seek help must wait months for it. The cost in human misery is huge. Mental-health care needs to change.
The reasons people don’t seek treatment are vast. The stigma and shame around receiving treatment can keep people from getting help. Poverty or embarrassment can also keep someone from asking for help. It may be difficult to find a therapist you like. Many medications for depression, anxiety, and other mental illnesses have undesired side effects. Mental illnesses often isolate people and make it difficult to keep searching for solutions. Unfortunately, some people give up without finding the right combination of therapies.
In the past two decades care for mental distress in such emergencies, whether wrought by conflict or natural calamity, has become an immediate priority—on a par with shelter and food. And what has been learnt from disasters has inspired new, pared-down mental-health care models that can be deployed quickly to help lots of people. In parts of Indonesia, Sri Lanka, the Philippines and elsewhere these models became part of rebuilt health-care systems. They are now being picked up in America and Europe, as people wake up to the scale of mental-health problems and the shortage of specialists to treat them.
In particular, the psychiatric profession’s over-tight grip should be challenged. Talk therapy, which the World Health Organisation recommends as a first line of treatment for mild-to-moderate depression and anxiety, can be delegated to non-specialists—a concept known as “task-shifting”.
Task shifting is the name given to a process of delegation whereby tasks are moved, where appropriate, to less specialized health workers. By reorganizing the workforce in this way, task shifting presents a viable solution for improving health care coverage by making more efficient use of the human resources already available and by quickly increasing capacity while training and retention programmes are expanded.
All you need to do is talk someone