October the 10th marks World Mental Heath Day. This, often invisible, challenge is now arguably better understood than at any time in history. However, the world is failing to tackle a mental health crisis, from epidemics of anxiety and depression to conditions caused by violence and trauma, according to a review by experts in the Lancet that estimated the rising cost will hit $16tn (£12tn) by 2030.
The stresses of everyday lives – work, family, 24-7 news and social media connectivity can lead to mental health problems whilst more extraordinary, but sadly all too common, issues of war or displacement have their own unique consequences.
Studies from humanitarian actors and academics have revealed more knowledge of the issue of ‘toxic stress’ that is particularly prominent in conflict zones. Whilst more research is needed to more fully understand this phenomenon, what is known so far is that protracted conflicts can lead to a constant dump of ‘fight or flight’ hormones into the body. This creates a hypervigilance that, whilst useful for surviving a warzone, can have a host of effects for later life including higher risks of heart disease and hypertension.
Prof Vikram Patel of the Harvard Medical School claims that “mental health problems kill more young people than any other cause around the world”. One example is the Palestinians in Gaza that are facing a mounting mental health crisis with the WHO estimating that up to 20% of Gaza’s population, half of whom are children, is likely to have serious mental health problems. Meanwhile in 2017, the number of psychiatric patients visiting government-linked mental health clinics was up nearly 70% on the year before.
Countries like Palestine, Syria and Yemen also suffer from low numbers of mental health specialists to help address the huge scale of the challenge. According to the WHO there are 8 mental health workers per 100,000 people in the Middle East, compared to 50 workers per 100,000 people in Europe.
There are also the more traditional issues of stigma around mental health issues that continue to make it harder to address them effectively. Unlike the blast wounds that tear limbs from bodies, blind or deafen people who consign them to a lifetime of physical recovery, the weapons of war leave scars that are sometimes invisible yet can be equally destructive.
The wider trends in conflict are towards longer, more complex wars that are increasingly fought around urban civilian populations. For these civilians the prospects of sudden death from the air, land or sea unsurprisingly causes more toxic stress. For children living in these conflicts the symptoms can range from bedwetting and nightmares to more complex impacts in how they show empathy, understand violence or build relationships.
Another challenge of mental health for children in conflict is the distinct absence of safe spaces. Homes are not safe, neither are schools or hospitals. In Syria the scale and intensity of bombing over the last seven years has forced some children into basements or makeshift bunkers in order to receive an education.
People have been encouraged to wear yellow to mark World Mental Health day which is designed to put the issue into the mainstream of health discussions, challenging stigmas that force people to suffer in silent, worried about what opening up will mean for their jobs or friendships.
There is also a wider discussion taking place in the public realm about how to better protect your mental health. These lessons apply to everyone, although in the pyramid of need those in conflict zones may be closer to requiring a clinical response rather than one that is based on using sport, breathing exercises and art to cope with stress or avoiding negative coping mechanisms such as drugs and alcohol.
The scale of the challenge in the hundreds of millions of people who are or will experience some form of mental health issue, means that increasingly psychological first aid will need to be something that is a common feature of the workplace, of schools or of all levels of governance policy. The Middle East is an area of critical need and one in which robust evidence and new approaches to the issue of mental health can flourish.
Disclaimer: Views expressed by writers in this section are their own and do not necessarily reflect the views of 7Dnews.