Mental illness is the worlds leading health issue affecting more than 450 million people, with the greatest burden of depression and anxiety experienced by women. Undiagnosed and untreated, mental illness has a staggering impact on labour productivity, resulting in a global economic loss of a trillion US dollars each year. The World Health Organization (WHO) defines mental health “as a state of well-being in which every individual realizes his/her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to her/his community.” The World Bank and the WHO have been working to bring more collective action to addressing mental illness through research and campaigning, and are hoping that national governments and development partners operating in low-income countries will respond. However, linking health and socioeconomic interventions is still largely understudied; particularly the impact on women. For this reason that a coordinated effort must be made to implement policy and resources in the field to bring mental health into the fold instead of treating it as a “black sheep issue.”
A rich body of research supports the idea that investing in women has a multitude of positive outcomes for families, communities and economies. Evidence shows that increasing education for women and girls contributes to higher economic growth, that household income controlled by women benefits children, and that when women work, communities benefit through increased levels of equality. In other words, women who are provided access to interventions and resources, not only thrive but the economy benefits as well. Donors love success stories where women cross educational thresholds, succeed in business or shatter archaic traditions like child marriage. So why not breakthroughs in mental well-being? Why not see victory when a woman overcomes depression after the loss of a loved one? Or recovers from the trauma of a violent assault? If the strong measurable results linking women’s mental health and economic growth on a global scale were highlighted, the narrative of these benefits could have a significant impact on donors.
What would this narrative look like? Behavioural economist Professor Nava Ashraf, from The London School of Economics, conducted field research in collaboration with the WHO to identify barriers for women in low-income economies who suffer from mental illness. The study looked at women living in a community in Zambia where limited access to birth control contributed to feeling a lack of agency over their own bodies, thus leading to high levels of anxiety and depression. Ashraf designed an intervention providing access to birth control, and found that “once these women could take charge of their bodies, there was a marked increase in their mental well-being and productivity.” Ashraf argues that health policies and programs often overlook the corresponding effect between mental illness and economics, thus leaving a significant gap in developing strategies that could improve the conditions for millions of people.
Despite this growing evidence, several barriers continue to impede investment in women's mental health which is on average only 5% in high-income countries and a meagre 1% in low-income countries. One of these barriers is the stigma associated with mental illness. Often family members, friends or employers perceive mental illness as a weakness or worse, as a poor choice. Sufferers are labelled, made fun of, denied wages and in some severe instances physically abused. Stigmas are also perpetrated by members of government and health care professionals who lack the necessary education to understand the clinical understanding of mental illness and its corresponding effects. Thus sufferers can be denied care and ridiculed for seeking support. While these examples are tied to studies in low-income countries, it’s important to note that many of these stigmas are experienced in high-income countries as well. Depending on the cultural context, women may consider it too risky to seek help, thus perpetuating a sense of helplessness and powerlessness that comes with depression. These are stories that rarely make it into the media because they are not sensational and in fact, they exist insidiously below the radar. Stigma keeps the issue of mental illness hidden and unpopular making it extremely difficult for people to engage in constructive dialogue.
In 2016 the WHO published a return on investment analysis indicating a strong economic case for investment in diagnosis and treatment of mental illness in low-income countries. This report called for the implementation of cost-effective interventions and an increase in education. The World Bank supported these findings and published their own report that showed for every $1 spent on diagnosing and treating mental health, an economy would see a $4 return on its investment. The WHO followed-up in 2017 with a year-long campaign Depression: Let’s Talk to generate more awareness. The outcome of the campaign published on the WHO website showed that the issue had started to gain some traction, but that the response in policy or investment in the field has been slow, and continues to be inadequately funded.
So where should governments and development partners be investing their resources and how should they be measuring the effects? In addressing the link between mental health and economic productivity it’s crucial to acknowledge there is no universal solution. It is also not fair to assume that interventions designed within and for populations of high-income countries are appropriate in middle or low-income countries, and vice versa. When strategizing how to support people living in low-income countries, particularly women, some fundamentals need to be addressed. Firstly, it is important to prioritize and target women because we already know that when they are supported there are far-reaching positive effects on children, families and communities at large. There need to be resources for providing safe, holistic and relevant tools for their needs, such as programs like gradual reentry when returning to work after childbirth. Taking their childcare responsibilities into account, looking at strategies that support their children and teachers.
Next, an investment in community leadership is needed to help de-stigmatize the issue. Each culture has a distinct set of traditions. When community leaders are included in the healing process they can help to eliminate negative stereotypes and advocate against abuse. Leaders can become part of the framework around support and care to signal to the rest of the community grounds for compassion, help others self-identify their own challenges and develop a sense of mental wellness agency available to all. Third, an acceptance of and commitment by national governments to judiciously spend more on public services. This entails training for staff, and frankly an acknowledgement that staff themselves may need mental health support. Lastly, an on-going campaign to communicate consistently, far and wide, what mental illness is, that it can affect anyone and that it is part of what makes us human.
For more than 450 million people, especially women, suffering in the shadows of mental illness, the corresponding effects of mental health and economic interventions might help reframe the conversation just enough to make much-needed support accessible. Investing in women who suffer from mental illness will have far-reaching benefits for them, their children and their immediate community, but also the global community at large. With a coordinated effort fewer people may suffer and as a result, the global economy would reap significant benefits.
Sarah Tesla is a documentarian and researcher who works with non-profits, NGO's and media organizations to report on misrepresented issues, places and people. She focuses on post-conflict in the Middle East, Indigenous reconciliation in Canada, mental health and dispelling cultural myths. Her work has taken her to over 63 countries and she continues to seek out more complex assignments.
References:
Araya, Ricardo. “Opinion Piece: Are We Ready to Implement Global Mental Health Solutions?” Understanding the Impact of Mental Disorders | Centre for Global Mental Health, 8 Mar. 2018,
The World Health Organization, 2017, Depression and Other Common Mental Disorders, Global Health Estimates.
The World Bank, 2016, Making Mental Health a Global Development Priority
O Egbe, Catherine, et al. “PRIME Policy Brief 9: Psychiatric Stigma and Discrimination in South Africa: Perspectives from Key Stakeholders.” Mental Health Innovation Network, 23 Mar. 2015
Organization for Economic Cooperation and Development (OECD), Gender Equality in Education, Employment and Entrepreneurship: Final Report to the MCM 2012. p. 17.
Klasen, S. and Lamanna, F. (2009), “The impact of gender inequality in education and employment on economic growth: New evidence for a panel of countries,” Feminist
Economics, 15: 3, pp. 91-132 (as retrieved from UN Women, Progress of the World’s Women 2015-2016: Transforming economies, realizing rights Chapter 4, p. 199)
The World Bank, 2012, World Development Report: Gender Equality and Development, p. 5.
E. Gakidou, et al., 2010, “Increased Educational Attainment and its Effect on Child Mortality in 175 Countries between 1970 and 2009: A Systematic Analysis,” The Lancet, 376(9745), p. 969.
Nobel, Carmen. “The $1 Trillion Link Between Mental Health and Economic Productivity.” HBS Working Knowledge, 29 June 2016
Chupein, Thomas, and Ariella Park. “Recognizing World Health Day: Discovering What Works to Improve Mental Health around the World.” The Abdul Latif Jameel Poverty Action Lab, 2017,