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Depression is the second largest contributor to disability worldwide, reveals an analysis for a major health study.  The findings are the latest to emerge from the Global Burden of Disease Study 2013, a survey that mapped trends of diseases and injuries in 188 countries between 1990 and 2013. As well as reporting depression’s great impact, the analysis shows it particularly affects people in poorer countries.
Critics from the FundaMentalSDG initiative, which aims to strengthen mental health inclusion in the Sustainable Development Goals (SDGs), argue that this evidence raises questions about why mental health is neglected in the goals, and how new ways to measure it could help galvanise the recognition and support it urgently needs.
Jagannath Lamichhane is principal coordinator of the Movement for Global Mental Health, a network that promotes mental health services underpinned by scientific evidence, and is on FundaMentalSDG’s steering group. He tells me mental health is being sidelined due to a “collective failure to rectify a historic neglect”.
In principle mental health is part of global health, but when it comes to investment and advocacy, it hardly gets a look in, Lamichhane says. He calls mental health the “most underserved area of science, health and development”.
This table shows the top 20 causes of 'years lived with disability'. Major depression is the second leading cause, while other mental health conditions are also prevalent.
Source: Global Burden of Disease 2013
Globally, 600 million people are disabled as a result of mental illness, the vast majority in low- and middle-income countries, according to FundaMentalSDG. Most receive no treatment. Lamichhane says that, locally and nationally, this neglect stems from deeply rooted discrimination and stigma, which limit the quality and accessibility of mental health services.
At a global level, health specialists have cited the complexity of measuring mental health in different cultures as a hurdle for interventions because communities can express their mental health in different ways and use different ‘labels’ to describe it.
But are patients with depression and psychosis in Nepal really suffering so differently from patients with these conditions in Zimbabwe? Lamichhane suggests this isn’t necessarily true. While understanding local and cultural norms is important, this does not prevent ways of measuring mental health in one cultural setting from being effective in another.
And, if ways to measure mental health are transferrable, then this means it is possible to find global indicators for mental health, Lamichhane says. This is crucial to getting the global health community to give the same consideration to mental health as other physical health conditions, and to increase resources for support and treatment.Currently the gap between need and SDG coverage is stark, with the draft goals mentioning mental health just once, when they merely call for the ‘promotion of mental health and wellbeing’.  Unless this is changed, Lamichhane says, the SDGs will “fail millions of people and families struggling with mental health problems”, particularly those in poor countries who tend to be invisible in global debates.
He is now working with FundaMentalSDG to call for edits to the SDGs, to put in place targets and indicators that align them with the WHO’s action plan on mental health, published in 2013.  The action plan’s main goal is to broaden evidence-based information on mental disorders and collect essential data on each country’s mental health system, Lamichhane explains. Matching the SDGs to this plan would help countries get a better picture of their mental health needs — and potentially pave the way to better services and support for millions of people.
 Open Working Group proposal for Sustainable Development Goals (UN, September 2014)
 Mental health action plan 2013-2020 (WHO, 2013)