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Displacement, trauma, and why global mental health matters

Colloquially, the term “bag lady” refers to a female who carries all of her belongings from place to place in overfilled, broken sacks. It’s how my grandmother would describe her aunt, that is, my great-aunt, when discussing her memories of living in Jamaica. My aunt suffered from an undiagnosed psychosis for most of her life, and it moved her through ramshackle, porous constructions, known as shanties, within the slums of Kingston, instead of her living in a home with family. Her story is akin to many who live separately from Jamaica’s wealthier enclaves. Poor Jamaicans subsist in squalor, with poor housing, an unsustainable food supply, and inadequate access to clean water, education, or quality health care. What’s more, their lives, including my great-aunt’s life, are further shrouded in cultural stigmas and homelessness.

It is estimated that 1% of the world’s population, or roughly 70 million people, are refugees: persons displaced either from their homes or their home country. Since the end of winter, the BBC reported 135,711 migrants and asylum seekers have made Europe their new home. They add to an already congested one million and more who found refuge in previous years. Their resettlements are necessitated by conflict stemming from the Middle East to levels of unabated poverty increasing in countries such as Kosovo. Like my aunt, they arrive with “baggage” filled with physical wounds clear to the naked eye, and mental afflictions not so easily seen. On average, more than 50 per cent of refugees develop mental health problems ranging from chronic mental disorders to trauma, distress, and lots of suffering, according to the World Health Organisation (WHO).

What’s occurring in Syria’s civil war is exactly this: the five-year conflict continues to vacillate in severity, producing an almost never-ending campaign of airstrikes and rocket attacks, killing up to 400,000 people, and driving millions more out of the country. It’s a repeating reel of displacement; the loss of children, parents, family, homes, and neighbourhoods; the terror of being hunted by extremists; the raining of bombs; the witnessing of violence against family members; the multiple acts of destruction wreaked upon homes, neighbours’ homes, and the dislocations these cause internally, or, ultimately, across geographic borders to a disconcerting future. Amidst the multiple humanitarian needs of refugees in these instances, due attention to their mental health and psychological wellbeing is vital.

Refugees in Idomeni, Greece © CAFOD

In a lifetime, mental health and psychological disorders can have debilitating and long-term effects. A mental health assessment of displaced Syrians in Jordan revealed that feelings of distress, such as fear and anger, and feelings of hopelessness became barriers to carrying out the essential activities of daily living; over half have manifested post-traumatic stress disorder (PTSD), clinical depression, and suicidal thoughts, among other mental illnesses. These findings further link violence, loss, unrest, and radical changes in social and living status to some negative psychological reactions. Moreover, a series of longitudinal studies were conducted that examined Cambodian children aged 8 to 12 who escaped the Pol Pot regime. The research revealed that many survivors who experienced such inhumanities as forcibly living in labour camps or witnessing the murder of others revealed symptoms of PTSD (48%) or were clinically depressed (41%). In addition, the 12-year follow-up to the original study saw a decline in PTSD (35%), whereas rates of depression were much lower (14%) with upticks over time. These findings reveal how children and adolescents can adjust to severe life situations. However, they also demonstrate the importance of having mental health interventions and professionals on the front lines of a refugee crisis for these adjustments to occur.

Worldwide, many people who suffer from mental disorders receive no treatment or care and are further hindered by unequipped families. According to the WHO, governments spend on average 3 per cent of their health care budgets on mental health, varying from less than 1 per cent in low-income countries to 5 per cent in high-income countries. The imbalance is so great that recently, the New York Times reported that the ratio of mental health professionals to global citizens was about one to a million. The majority of those with treatable diseases such as depression and anxiety are often left on their own, or seek the augmented, unconventional methods of traditional healers.

This spring, hundreds of doctors, aid groups, and government officials converged on Washington, D.C., with ambitions to fill this gap between treatment and access, shifting mental health to the forefront of the international development agenda. Their efforts parallel an unprecedented publication by the Lancet, which announced the first global estimates of returns on investing in treatment programs for depression and anxiety, the most common mental illnesses. The movement is a response to the economic challenges these disorders pose to society as a result of lost economic production and consumption opportunities, and health and social care expenditures. With no fixed response to the mental health crisis, it is estimated that US $2.5–8.5 trillion will be lost, and economic outputs attributed to mental, neurological, and substance use disorder will double by 2030. In this investment analysis of data from 36 countries, from poor African and Asian nations to wealthy European ones, the findings were calculated from every dollar of investment in potential scale up treatment coverage for depression and anxiety disorders. It revealed between now and 2030, scaling up treatment coverage, estimated at $148 billion, would lead to 43 million extra years of healthy life for people suffering from depression and anxiety. To put those years of healthy life in an economic context, that’s a return of $3 to $5 in recovered economic contributions to a county’s economy—a net present value of $310 billion. With these investment returns in mind, more can be done to help abate the largest refugee crisis of our time.

As 2016 continues, each month a few more thousand refugees stumble into a refugee camp or attempt to traverse seas to reach Europe. When they arrive, what should await them is a path to create a new normal through the efforts of not only the host country, but also the international community. As evidence shows, immediate mental health services are key to restoring basic psychological functioning and supporting wellbeing in life. What’s more, the investments in these services contribute to increases in economic participation and productivity. Good public mental health is a sound and equitable investment of a community’s resources that can lead to clear health, economic, and social benefits, and more humanely, curb the trauma of displaced people.

Featured image © Steve Evans

AvatarJCJustin Campbell
is a native of Atlanta, Georgia, now residing in Washington D.C. He is an advocate of global and public health issues with research endeavours from environmental sustainability to mental health and the built environment. He received his Master’s in Global Health and Development from UCL, and hopes to combine his education and management consulting experience to address urban health and development initiatives and policies.

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