New data from the World Health Organisation (WHO) reveals that one in five people in conflict-affected areas experience mental health problems, far higher than the 2016 estimate of one in 16.
The WHO research, published in the medical journal The Lancet in June 2019, analysed 129 studies of mental health in conflict with data from 39 countries that experienced conflict between 1980 and 2017. This extensive study aimed to tackle the inconsistency of results from previous research. It revealed that 22% of people living in conflict zones experienced depression, anxiety, post-traumatic stress disorder, bipolar disorder or schizophrenia. The rate of mental health conditions in conflict-affected populations is double that of the general population and women were shown to be more likely than men to suffer from mental health conditions in conflict zones. The alarming rate of mental health problems in conflict is of global significance, as 12% of the world’s population was affected by conflict in 2016 (53 conflicts across 37 countries).
This research suggests that the approach to tackling mental health problems in conflict has so far considerably underestimated the extent of the problem. These findings have led the WHO to call for greater and more sustained efforts to provide mental health support in conflict. Globally, spending on mental health still constitutes a tiny percentage of overall government spending on health. According to the WHO Mental Health Atlas 2017, the global median mental health expenditure is $2.50 USD, compared to the global median general health expenditure of $141 USD per capita (as of 2015). As a result, spending on mental health care accounts for just 2% of domestic healthcare spending overall. However, the case for increasing investment in mental health services is clear, as every dollar invested in improving access to treatment leads to a return of $4 USD in better health and productivity.
Dr Mark van Ommeren of the WHO’s Department of Mental Health and Substance Abuse suggests that emergencies such as those caused by conflict and natural disasters can be catalysts for building quality mental health support services, so long as the political will to make this happen exists. For example, before the conflict in Syria, there was little mental health care outside of the psychiatric hospitals of Aleppo and Damascus. However, psychosocial support and mental health care have now been introduced in primary and secondary health services, as well as in community initiatives, women’s organisations and school programmes. Similarly, the government of Lebanon has upgraded its mental health services in response to the movement of refugees from Syria to Lebanon, in order to provide suitable mental health care for those escaping conflict as well as to expand services available to the Lebanese population as a whole.
In addition to meeting the mental health needs of a population during crisis, these gains in support services must be translated into a mental health care system which can be sustainable in the long term. A conference on improving mental healthcare in Syria, held in May 2018, pointed to the need to enrich the skills and knowledge of local mental health workers in order to move from a crisis response to sustainable services for the future.
Another challenge which must be faced in the improvement of global mental health care and in addressing mental health issues in conflict, is to tackle the stigmatisation of open discussions about mental health and the experiences of people with mental health problems. Where stigmatisation persists, those experiencing mental health problems may be marginalised from participating in the civil and political life of their society.
The mental health impacts of conflict can also affect those who assist people in conflict zones, such as humanitarian aid workers and United Nations employees. Fabrizio Hochschild, the Assistant Secretary-General for Strategic Coordination, told the UN Refugee Agency (UNHCR) podcast Awake At Night about his experience of post-traumatic stress disorder resulting from a posting in Bosnia and Herzegovina during the conflict in the former Yugoslavia. He is now committed to ending the stigmatisation of mental illness and increasing mental health support within the United Nations system.
While the WHO’s recent figures suggest that the prevalence of mental health problems in conflict have been significantly underestimated, this news does mark the first step towards addressing the scale of the problem and forms part of the effort – undertaken by governments, the international community and civil society – to promote good physical and mental health worldwide. Creating sufficient and sustainable mental health care, together with a more open and supportive approach to addressing mental health concerns, is vital to the achievement of Sustainable Development Goal 3 for Good Health and Wellbeing.