By Amanda Mauri, MPH Candidate at the University of Pennsylvania
On September 18, 2015, the United Nations made history by increasing its global commitment to mental health and substance use disorders (MH/SUDs) when they adopted the post-2015 Sustainable Development Goals (SDGs). The SDGs act as a blueprint that will direct the global agenda for years to come, and, for the first time, MH/SUDs are included in the final list.
This new commitment has the potential to transform the lives of the approximately 450 million people worldwide who suffer from a mental, substance use or neurological disorder. It will also begin to curb the $2.5 trillion global cost of mental illness that, if it continues on its current trajectory, is projected to reach $6 trillion by 2030 (Insel).
The Millennium Development Goals (MDGs), the predecessor of the SDGs, galvanized national governments, international donors and others to meet the goals of ending extreme poverty, reducing child mortality, increasing female education and promoting gender equality. The MDGs are seen as the most successful global campaign ever. In his 2008 address to the UN General Assembly, Bill Gates called the goals “the best idea for focusing the world on fighting global poverty that I have ever seen.” A UN report released in June 2015 claims that the MDGs confirm “that goal setting can lift millions of people out of poverty, empower women and girls, improve health and wellbeing, and provide vast new opportunities for better lives.” Many expect the SDGs will be a similarly transformational campaign.
While the MDGs are seen as “the most successful anti-poverty movement in history,” they almost completely ignore MH/SUDs. The SDGs mark the first time MH/SUD sufferers may benefit from inclusion in a global list of priorities (UN).
Following a year long process, the UN proposed a set of seventeen SDGs that target both developed and developing countries. MH/SUDs are included in the preamble and in three goals that focus on promoting mental health (target 3.4), strengthening treatment and prevention of substance abuse (target 3.5), and achieving universal health coverage (target 3.8). This is a watershed moment that will begin to address the stigma and discrimination faced by people with MH/SUDs all over the world.
By the end of this year, the UN will release the list of indicators they will use to monitor progress towards meeting the SDGs. While the UN strongly encourages countries to contextualize the indicators with supplemental national and local goals, a global list helps countries develop strategies and holds governments accountable. The UN list includes multiple indicators per goal and, when possible, relies on objective quantitative metrics.
On October 26-28, 2015, the UN held their second meeting of the Inter-agency and Expert Group on Sustainable Development Goal Indicators in which members discussed and released a list of the proposed global indicators. Three potential indicators address MH/SUDs -
- 3.4.2 – Suicide mortality rate
- 3.5.1 – Coverage of treatment interventions (pharmacological, psychosocial and rehabilitation and aftercare services) for substance use disorders
- 3.5.2 – Harmful use of alcohol defined according to the national context as alcohol per capita (15+ years old) consumption within a calendar year in liters of pure alcohol.
These indicators focus on suicide, alcohol use and substance use disorder treatment. While these indicators are critical for assessing the progress of the SDGs, they leave out the majority of mental health conditions The UN must expand beyond this proposal and include all MH/SUDs in the indicators they will use to measure the SDGs.
360 million people suffer from a mental health disorder. Depression and schizophrenia alone account for 150 million and 25 million of this number respectively (WHO). Depression is the third leading contributor to the global burden of disease and was estimated in 2010 to cost at least $800 billion.
While few global statistics exists on other mental illnesses, it is widely accepted that other mental disorders exact large disease and financial burdens. Panic disorders have been shown to be the primary cause of morbidity and increased utilization of medical services in the primary care setting. In a literature review of OECD countries, eating disorders were associated with a considerable cost burden. In the US, PTSD impacts nearly 500,000 veterans and costs $11,342 annually for health care per veteran, more than double the VA cost for a veteran without PTSD. A review of studies from around the world found that generalized anxiety disorder is associated with substantial disease burden and economic cost.
Furthermore, significant comorbidity exists between MH and SUDs. To reduce the financial and disease burdens associated with one of these disorders, the UN must develop indicators on all MH/SUDs.
By not including mental health in the indicators, the UN also risks fostering prejudice against individuals with mental illness. By segregating between disorders, the UN continues the long-standing discrimination against individuals with mental illness by implying that these diseases are somehow not “biological” or “medical.”
The UN must expand the proposed indicators to include mental illness. #FundaMentalSDG, the only international consortium advocating for MH/SUD’s inclusion in the post-2015 goals, proposes an additional indicator - proportion of persons with a severe mental disorder (psychosis, bipolar affective disorder, or moderate severe depression) using services. This indicator was included in the March 2015 list of potential indicators but has since been removed. This indicator would not require any additional efforts because it is already included in the World Health Organization’s Mental Health Action Plan 2013-2020.
No indicator has been proposed for other mental disorders. However, the disease burden, financial cost and significant comorbidity between mental illnesses and substance use disorders requires the development of an indicator on other mental disorders as well.
For the first time, the UN has the potential to improve the lives of the millions of people who suffer from MH/SUDs. But, without the inclusion of all MH/SUDS in the list of indicators, the SDGs may become a missed opportunity.
Amanda Mauri, is a second year Master of Public Health student at the University of Pennsylvania. Amanda has worked on several initiatives focusing on mental health and substance use disorders as a public heath concern, including work with Community Behavioral Health and The Kennedy Forum. She now resides in Philadelphia, Pennsylvania.