Depression: World’s leading disability

Highest loss of productivity from mental health disorders.

A recent report  released by the World Health Organisation (WHO) on ‘Depression and Other Common Mental Disorders estimates that in 2015 there were over 1.1 million cases of depressive disorders in Malaysia[1].  The report further states that depression is a major contributor to suicide deaths accounting for 800,000 or 1.5% of all deaths globally.  If we extrapolate this estimate locally, in 2015 out of the over 155,000 deaths recorded in Malaysia[2]  about 2300 could have been due to suicide. Unfortunately there are no published statistics on suicides in Malaysia.

Depression is ranked by WHO as the single largest contributor to disability. Globally the total number of people with depression was estimated at 322 million in 2015, equivalent to 4.4% of the global population.  The total estimated number of people living with depression increased by 18.4% between 2005 and 2015.

According to another report by the World Economic Forum and Harvard School of Public Health[3], mental health disorders account for the highest loss of productivity.  A large proportion of this can be attributed to depression as depressive disorders are the most common form of mental illness.

The total global cost of mental illness (treatment and loss of productivity) was an estimated US$ 2.5 trillion in 2010 and is projected to rise to US$ 6.0 trillion by 2030.  This is higher than other non-communicable diseases such as cardiovascular disease, diabetes and cancer.

Depressive disorders are characterised by sadness, loss of interest or pleasure, feelings of guilt or low self-worth, disturbed sleep or appetite, feelings of tiredness and poor concentration. Depression can be long-lasting or recurrent, substantially impairing an individual’s ability to function at work or school or cope with daily life. It can happen to anyone at any time although women tend to have higher episodes of depression than men.

The question that arises here is – how prepared are we as a nation to deal with this crisis. Since the release of the National Health and Morbidity Survey 2015 data on mental health, the Ministry of Health has not announced any concrete plans to address this pressing issue. Treatment of depression requires a team of professionals comprising of psychiatrists and psychologists as both counselling and medication must go hand-in-hand.

WHO recommends a ratio at least 1 psychiatrist to 100,000 patients in developing countries[4].  Malaysia’s ratio stands at 1 psychiatrist to 125,000 patients[5] and 1 psychologist to 110,000 patients.  These figures are an average and the situation would be even higher in rural areas where the ratio could be as high as 1 professional to 200,000 patients. Health systems around the world are struggling to meet the needs of people with mental illness.  Global data[6] indicates that only 2% of national health budgets are dedicated to mental health.

Mental health services and facilities have definitely improved in Malaysia over the years. All General and District Hospitals in the country provide mental health services.  However this is still a long way from meeting the needs of the total burden of the mental illness in Malaysia.  Several studies allude to the fact that mental illness has not been given the attention it deserves due to the lack of resources.

Non-governmental organisations provide much needed counselling services and community support but most of them are located in urban areas and are hampered by lack of resources – both financial and manpower.  As such most counselling services are provided within specific hours only, usually office hours or by appointment.

Britain recently acknowledged the importance of taking mental health seriously and the need for better funding for mental health. Some measures suggested are better training in schools to identify pupils who are struggling and to tighten employment law so as those who take time off for mental health issues are not penalised.

Depression can happen to anyone. No one, however rich or powerful is immune. Unfortunately it often goes undiagnosed and untreated. CAP calls on the Ministry of Health to take the mental illness challenge seriously and launch immediately action plans to combat the scourge. Some recommendations include:

· Mental health should be included in all medical checks and treatment of mental illness should be easily available at primary care level.

· Increase the budget for treatment of mental illness as there are no quick fixes for mental illness and treatment is long term.

· There should be no discrimination against people with mental health issues at the work place.  If people with diabetes or high blood pressure can work well with treatment and support there is no reason why people with mental illness should be treated any differently.

· It should be made mandatory for health insurance to cover mental illness as well.

· There should be easy access to counselling services all over the country and not just in urban centres.

· Leverage the mass media and social media for mental health education for the masses. Empower and support non-governmental organisations to conduct such education programs.

[1] World Health Organisation, ‘Depression and Other Common Mental Disorders, Global Health Estimates,’2017

[2] Vital Statistics Malaysia, 2015

[3] The Global Economic Burden of non-communicable diseases. Geneva. World Economic Forum and Harvard School of Public Health, 2011

[4] Amber Haque, “Mental health concepts and program development in Malaysia”, Journal of Mental Health, April 2005

[5] Mental Health Atlas, Country Profile, 2014, WHO

[6] World Health Organisation, The WHO MIND Project: Mental Improvement for Nations Development.

Press Statement, 30 March 2017