A little over a year ago I wrote a blog post entitled Ten Things Not to Say to a Depressed Person. On World Mental Health Day 2012, I find myself coming back to number five: “I don’t believe there’s such a thing as mental illness. People in developing countries like the one where I grew up just don’t have these sorts of problems.” This choice remark came from a South American co-worker, hot on the heels of a discussion in which several of her colleagues had just disclosed personal histories of mental distress. The implication of this remark appeared to be that people in less developed countries simply don’t have time to experience mental distress, because they are too occupied with dealing with poverty and its effects. This line of thinking suggests that mental illness is something of an indulgence, and one only the relatively wealthy can afford.
The Twitter hashtag #firstworldproblems has recently found itself becoming part of a charity campaign. The tag started as a way for people from wealthy nations to, somewhat wryly, share problems they felt could only be an in issue in developed countries. A selection of this morning’s tweets includes:
“Having to clean for the cleaning lady < #firstworldproblems”
“I can’t tweet about twitter being down #FirstWorldProblems“
“I have too many electronic devices and they all use different chargers. #FirstWorldProblems”
The charity Water is Life is a running campaign built on the hashtag, which states “First world problems are not problems.” To get the message across, the marketing firm DDB asked a number of men, women and children from Haiti to read out some #firstworldproblem tweets. “I hate when my leather seats aren’t heated!” says a little boy, perched atop a heap of rubble. A smiling young man, standing in front of the shanty we presume is his home, declaims, “I hate it when my house is so big, I need two wireless routers!”
While the campaign has certainly got people talking, some find it condescending. Teju Cole, a Nigerian American writer and columnist, points out in a recent Guardian article that people in poor countries also suffer so-called first world problems such as tech hassles. As he puts it, “all the silly stuff of life doesn’t disappear just because you’re black and live in a poorer country.” In fact, in countries where mobile phones are individuals’ and businesses’ only means of accessing global communication networks, problems such as a missing charger or the BlackBerry network being down could potentially have a greater impact. Americans or Europeans tend to have access to office, library or internet cafe connections which are simply not available in many places.
Should we view mental health the way many view tech problems, as an indulgence that poor people or nations can’t afford? My colleague had no direct personal experience of mental distress – but the evidence shows that she wasn’t mentally healthy because she happened to come from a poor nation. She was mentally healthy because she was fortunate. The World Mental Health Survey Initiative is an attempt to assess the prevalence of mental disorders, substance misuse and behavioural disorders across the globe. It has found these disorder are common in all regions of the world, with 14% of the overall global “burden of disease” attributed to such conditions. But the majority of people affected – up to 75% in those in low-income countries – are unable to access treatment. In other words, if you live in a poor country, you are just as likely to suffer a mental disorder, but you are far less likely to be provided with treatment to help you cope with it. Mental health problems are not first world problems. They are global problems present in addition to, not in spite of, poverty, in addition to poor housing and insufficient access to clean water, in addition to the stress of living in conflict zone or under a corrupt government.
This year, the focus of World Mental Health Day is depression. Not everyone is happy with that; I know that some people with more stigmatised diagnoses feel a bit squeezed out this year. Normally I have a bit of issue with anything that suggests mental health = depression = mental health. But it’s hard to deny that depression is a bigger issue for countries, employers, and healthcare providers than any other mental health condition. The World Health Organisation believes that more than 350 million people suffer from clinical depression – that’s the equivalent of every single resident of the USA and Canada combined. Futhermore, depression features as an element of other mental health conditions, including bipolar and schizophrenia. The WHO notes that depression is no respecter of age or wealth, occurring across all communities. But it also highlights that despite the fact that effective treatments are available, “access to treatment is a problem in most countries and in some countries fewer than 10% of those who need it receive such treatment.” Whether or not you like this year’s focus, that’s a massive weight of suffering which is affecting hundreds of millions of people’s ability to work, to parent, to develop, to grasp opportunities. And where there are fewer opportunities to be grasped, the impact is still greater.
I don’t like having bipolar. And I don’t like the meds that I take to try and address it. But at least for today, I’m going to remember to be thankful that I have a specialist doctor working with me. That I have prescribed medication. That I can afford my medication, even though I resent paying the prescription charge, and that I know that the medication I am given will be pure and in date. That I’m sick, but that at least the “silly stuff” of my bipolar life isn’t in addition to wondering where I can sleep or whether can I eat tonight. Because mental health problems are whole world problems.