It has become increasingly difficult to ignore the fact that mental health issues contribute to a significant proportion of the global burden of the disease. The largest part of this burden occurs in the developing countries, where the lack of skilled human resources and scarcity of financial resources cause people suffering from mental diseases and have low-quality care. Even in the context, where adequate care is affordable to a population, widespread stigmatization experienced by people with mental disabilities results in their unwillingness to access this mental health care. Thus, the current paper discusses and analyzes the global perspectives on mental health.

Historical Perspective on Mental Health Disorders

In order to gain a proper understanding of origins of global mental health concerns, it is appropriate to discuss a historical perspective. The current analysis helps to identify the focus of Global Health learning in nursing as well as reveal the reasons for previous failures in addressing mental health needs. In many societies, mental health diseases were regarded from a religious standpoint. In the 17th century, a secular view of mental disorders as a physical state was broadly popularized in Europe and North America. Many low-income people with mental diseases were confined in prisons and poorhouses. The early interpretation of mental diseases did not encourage any research in the field of nursing, powerfully promoting intolerance towards mentally disturbed people among the population. With the rise of humanitarian movements, people with mental diseases were provided moral treatment programs for the first time. In the 1950s, community mental health services were initiated to support the shift from hospital-based treatment approach, which ultimately resulted in the increased interest in mental disorders within the field of nursing. In developing countries, mental health services remain scarce, addressing relatively small proportion of the population, and confront a severe shortage of highly skilled providers as well as adequate health care facilities. In such countries, learning efforts in nursing are limited due to associated high economic costs. In the 21st century, the learning focus has been wider, providing an opportunity for improvement in care of people with impaired mental health. The research in social sciences has offered valuable insights into the social origins of the diseases. The Global Health Learning in nursing acquires a broader research base and contributes to optimal health outcomes.

The Importance of Health Care Disparities

Health care disparities are causing a great amount of human pain and suffering around the world. Inequalities in mental health care across different cultures, races, ethnicities, and socio-economic domains persist today. Many developing countries lack effective mental health programs, policies, facilities, and financial resources within their health care systems. Many people diagnosed with mental disorders do not receive appropriate care due to prevalent stigma, poor socio-economic status, inadequate level of education, and discrimination on the basis of race, ethnicity, etc., which consequently may prevent them from seeking medical assistance at all. Such mental injuries, as suicide and violence, accounted for nearly 30% of the disease burden in Europe and Middle East areas. Compared with the majority of the world’s population, people with mental disorders occupy lower socio-economic status and, thus, are less likely to access to adequate care and more likely to receive incompetent medical assistance.

Moreover, people with mental illnesses are often affected by stigma, which prevents them from social inclusion and using community services. People with mental disorders may be subjected to intentional discrimination, similar to those from ethnic minority groups. Stigmatization is demonstrated as avoidance, stereotyping, biased perception, fear, and intolerance. For people living with mental illness, there have been numerous cases of violation of the right to freedom or civil and political rights. Mentally ill people experience both psychological and physical abuse on a day-to-day basis.

Formalized Regulatory Guidelines

The Affordable Care Act aims to make health insurance affordable for people with low socio-economic status. Patients, living with mental disorders, often encounter serious difficulties while acquiring private health insurance. According to the regulations, mental health services represent ten essential benefits that must be included in most health insurance plans. The services primarily involve counseling, behavioral health treatments, and psychotherapy. Another regulatory guideline is Mental Health Parity and Addiction Equity Act. The regulation requires health insurance plans, providing coverage for mental diseases, which helps to make these benefits similar to surgical and medical health coverage.Treatment limitations, copayments, deductibles, and out-of-pocket limit for mental diseases must be as restrictive as the conditions provided by other types of medical care.

Moral, Legal or Ethical Issues

In mental health care, moral, legal, and ethical issues play an increasingly important role in maintaining adequate quality of care. Ethically oriented care facilitates affordable services and wider access to health benefits. Continued demonstration of fundamental ethical principles, such as respect, justice, beneficence, and nonmaleficence are essential in health care delivery. However, difficulties arise when attempts are made to treat a person who is incapable of independent decision-making. Therefore, there has been little agreement on whether it is morally right to violate the principle of respecting autonomy, if a patient’s ability to understand reason and act is being impaired. In Sweden, patients with severe mental impairments undergo treatment courses in special psychiatric settings, regardless of their willingness to participate. Such decisions should be necessarily clinically justified in order not to put health care providers in legal jeopardy. The main legal requirement suggests that the autonomy can be violated when a person threatens the physical or mental safety of others. Even though decision-making regarding mental illness treatment should be based on the ethical principles, it is not always possible to provide interventions pertaining to appropriate quality of care based on laws and regulations. Clinicians by nature of their therapeutic engagement are held legally and morally accountable for actions chosen on behalf of people with mental disorders.

“Burden of Chronic Care”

Neurological and mental diseases are the reason for more than 10% of the global disability-adjusted life years. While mental disorders account for nearly 56% of disability-adjusted life years, neurological disorders comprise nearly 28%. It is estimated that these statistics will gradually increase in the next decades. It is worth admitting that chronic disorders are prevalent in young adults, who comprise the most productive level of the population. Developing countries with the poor quality of chronic care are likely to encounter the most considerable growth in the burden associated with mental illness. The major reasons causing the burden of chronic care include continued macroeconomic changes, urbanization, wars, and natural disasters. The inadequate health care system of developing countries affects their ability to deliver high-quality chronic care and, therefore, creates unintended problems in health and economic sectors. A lack of sophisticated strategies to implement chronic care results in suffering of millions of people worldwide, going unaddressed. The considerable underestimation of burden of chronic care partnered with poorly developed health care contributes to further increase in years lost due to disability.

Health Care Productivity and Economic Costs

The treatment of chronic diseases, such as mental disorders, causes increased requirements and health care costs. Economic costs associated with the burden of chronic diseases are responsible for nearly 75% of national health expenses in the United States. More specifically, the government annually allocates more than $147 billion to the treatment of mental disorders. Adding to these expenditures disability insurance payments and lost earnings attributable to mental disorders, it is estimated that in 2012, the economic cost of mental health care was nearly $467 billion. Nevertheless, the U.S. population manifests a greater prevalence of chronic conditions compared to other developed countries. As a result, the life expectancy becomes substantially decreased affecting well-being of citizens. From a global perspective, the financial cost of mental disorders will reach $16 trillion in the coming two decades, which is equal to 25% of global gross domestic product in 2010. Even though the economic costs continue to increase, the treatment rates for people living with mental diseases remain relatively low, with treatment gaps comprising nearly 90% in low-income countries. In industrialized countries, the medical treatment can be also delayed and provided many years after the disease starts to develop.

Mental health problems account for a substantial burden of disease worldwide. Today, effective intervention strategies are available but are often inaccessible to the population with low socio-economic status or education level. People suffering from mental illness may experience intentional discrimination and stigma, which create barriers to receiving appropriate care. Therefore, both the Affordable Care Act and Mental Health Parity and Addiction Equity Act aim to make mental health services affordable to the majority of the U.S. population. Moral and legal issues arise, when there is no clinical attempt to deliver adequate services without violating basic ethical principles, such as respect for autonomy. Chronic care presupposes prolonged episodes of treatment, which require increased demands and effort from health care systems in all societies. Lastly, mental disorders are increasingly associated with substantial global economic costs.

Chloe Mendez, writer at affiliate writing service and a book lover.