In a recent article in Science Translational Medicine, former NIMH Director Steve Hyman explores possible reasons for the policy failure to prioritize treatment of mental disorders worldwide, even when evidence and cost-effective interventions are available and validated.
Hyman notes a number of potential factors, loosely falling into four categories.
1) Stigmatization challenges;
- Fear of the severely mentally ill
- Superstitions about the causes of mental illness
- Attribution of imagined moral flaws or weaknesses to sufferers or their families
- Belief that mental health professionals are in the profession because they are similarly troubled
2) Scientific challenges;
- Relatively slow scientific progress and translation of discoveries into clinically useful diagnostics and therapeutics
3) Advocacy challenges;
- Diminished ability of the mentally ill to advocate effectively for themselves
- Low commercial advocacy due to difficultly in discovering marketable treatments
4) Flaws in reasoning;
- A tendency to focus on saving lives versus improving them – a problem that puts most non-lethal disabilities at a disadvantage in priority setting
- A tendency to distinguish mental disorders from other “biologically based” disorders that we do not control, due to the subjective experience of one’s own (healthy) mind
Though none of the categories above are without normative dimensions, the last category raises two clear points worth mentioning just now.