Sebastian Ruiz's Github repository for Data 150 at WIlliam and Mary
Word Count: 2085
The Pervasive Problem of Mental Illness in the Developing World
Adequate health care access is recognized as an important dimension of human development because individuals in developing countries cannot work, support their families, pursue an education, or attain rights and freedoms without being healthy. However, the human development subfield of mental health care access is an especially insidious problem for marginalized individuals in developing countries. More than 80% of people with mental illness are in developing countries, mental illness comprises of 8.8% and 16.6% of the total disease burden in low-income and lower-middle-income countries, and by 2030, depression alone is predicted to be the third biggest cause of the disease burden in developing countries. (Rathod et Al.) Bihar, an impoverished state in India where there are more people with schizophrenia than in all of North America, is an example that highlights the severity of developing nations' susceptibility to mental illness. Poor resource allocation and the stark underrepresentation of people with mental illness have made mental health services a luxury few can access.
Latin American citizens are especially vulnerable to mental services treatment gaps because increased economic investment in the region led to rapid urbanization during the second half of the 20th century. Urbanization has resulted in social, economic, and environmental factors including, poverty, alcoholism, crime, gender-based violence, and fear of evictions that contribute to higher rates of mental illness (Elsey et Al.). Impoverished people with untreated mental illness are less likely to increase their wealth or pursue an education. This results in a generations long poverty trap where the children of impoverished people with mental illness are unlikely to get help as well, especially because considering many mental illnesses are genetic. Latin America also has a negative cultural stigma of mental illness and wide-spread distrust evidence-based treatments that make it less likely that mentally ill individuals will get adequate treatment. As of 2019, Latin American governments spent very little, if at all, on mental health service with about 80% of people with depression receiving absolutely no treatment. (Jimenez-Molina et Al.) It is crucial to address the low provision of mental health services by collecting more data on people suffering from mental illness to make governments and humanitarian organizations aware of the importance of providing access to mental health services.
The advocacy for increasing mental health services in Latin America ties directly to Amartya Sen's definition of development as the expansion of access to freedoms. Latin America's mental health treatment gaps represent what Sen would refer to as "unfreedoms," obstacles to human development. Without the freedom of mental health treatment, people are unable to access economic and social freedoms since is more difficult for them to find employment, pursue higher education, and face stigmatization. Increasing mental health services most likely has an even bigger effect on the economic and social wellbeing of developing Latin American nations than it seems since the very little data is collected on the number of people with "non-communicable diseases" such as depression, and the data that does exist indicates that the vast majority of those with mental illness are not receiving treatment (Jimenez-Molina et Al.). Mental illness is an invisible evil that prevents people from function and drives many to suicide. Highly effective medications and treatments for conditions such as anxiety, PTSD, and depression exist but are scarce Latin American. Mental health services should be more readily available and advertised in developing countries because can help countless people prosper and save their lives that might not know they could get treatment otherwise.
The Greatest Challenges of Increasing Mental Health Treatment Access in Latin America
The first greatest challenge is poor resource allocation and lack of finances. Due to the lack of data on the number of individuals who suffer from mental illness, Latin American governments have not allocated adequate funding towards mental health services. A study conducted by Sage Journals found that Latin America has an especially large disparity between the money that governments spend on mental health services and large disease burden that mental illness has in the region (Jimenez-Molina et Al.). This paucity mental health treatment services is seen across other developing countries outside of Latin America as well: ratios of psychiatrists per 100 000 individuals in 7 developing countries in Asia and Africa, ie, India, Pakistan, Nigeria, and Ethiopia, Chad, Eritrea, and Liberia, found that these developing countries on average have just 1 psychiatrist per 100 000 people (Jimenez-Molina et Al.). Psychiatrists and medications are very costly and there is little supply of both in Latin American countries even though the need for them is high. The psychiatrists they have are inequitably based along wealthy areas were only the privileged can access them with ease. Developing countries in Latin America with financial issues perceive mental illness as unimportant and not something worth spending funds on.
The second greatest challenge is the absence of inclusive legislation and planning. Most developing countries in Latin America do not have legislation to support individuals with mental illness and to direct mental health services. This is due to more than just a lack or recognition, Sage found that "family and user associations are present in [developing countries] but do not have a strong influence in the development of policy and procedures." This is problematic because the majority of people with mental illness in Latin American countries are supported by a "large family unit." (Rathod Et Al.) Sage found that even the World Health Organization's existing guidance for implementing mental health legislation does "not detail how [they] can be contextually relevant to a particular culture." Furthermore, the absence of mental health-oriented legislation in Latin American countries is not the only problem, researchers at Sage found that even legislation that is about mental health should strive not endanger the mental health of any of their residents. (Rathod Et Al.) For example, a policy in China once denied rural residents housing and medical benefits that it provided to urban residents. This was found to make residents in urban areas more susceptible to mental illness. Therefore, "to what extent do the policies promote integration with…justice, social care, and development of services to ensure a more comprehensive and holistic approach to the delivery of mental health services is important." (Rathod Et Al.) Machine Learning provides superior methods of data collection that are key to showing countries and mental health organizations the importance of implementing mental health-oriented legislation and revising their existing legislation to ensure it's inclusive.
The third greatest challenge is the widespread stigma of mental illness in Latin America. Gender based discrimination, perceptions of mentally ill people of inferior, and disbelief in mental illness are aspects found in Latin American cultures that contribute towards the stigmatization of mental illness. Even if there is access, many are unwilling to seek treatment for mental illnesses because they do not believe they exists, distrust prescribed medications, or are afraid as being perceived as inferior (Elsey et Al.). Increasing recognition and representation of mental illness in government provided healthcare services can combat this stigma and encourages more individuals with mental illness to seek treatment. Sage found that the stigmatization of mental illness has led to a problematic trend in developing countries where "people are more comfortable seeking help from agents that normalize their experiences, such as community leaders," leading to pseudo-scientific "non–evidence-based interventions" being commonly used as alternatives to evidence-based treatments for patients. However, studies have indicated that governments can adapt mental health treatments to local cultural beliefs in order to get more people to treat their mental illness; "using collaborative approaches with wider communities, psychotherapeutic principles, theories, and techniques…adapted to countries to make them more user-friendly and acceptable while improving outcomes for mental disorders." (Rathod Et Al.) More data on the population individuals with mental illness can signal to governments the benefits of implementing culturally adapted mental health services. For example, various states in India have paired mental health services along physical health services within their healthcare systems so that people can seek treatment without worried that they will be stigmatized for seeking mental health treatment (Elsey et Al.).
The fourth greatest challenge is the privation of evidence-based psychotherapeutic interventions for mental health treatment in Latin American countries. The primary reasons for this problem are the lack of adequate training for treatment and the cultural stigma against mental healthcare treatment found in a country's religion and political landscape that undermine the legitimacy of treatments. For example, although cognitive behavioral therapy is one of the most effective treatments for mental illnesses, it is often the most underutilized treatment in developing countries. Surveys conducted in India reported that "82% of respondents felt that principles underlying cognitive behavioral therapy conflicted with their values and beliefs: 46% relating to their cultural or family values and 40% relating to their religious beliefs." (Rathod Et Al.) Governments can expand the use of evidence-based psychotherapeutic interventions for mental health treatment by providing it within their healthcare system and educating their citizens on the misconceptions and benefits of mental health treatments. However, the lack of data on mental health gives governments little incentive to do this.
Data Science Offers Promising Solutions
Although data science has been adapted by the healthcare industry with numerous applications developed, there exists very little data science applications geared towards creating beneficial outcomes in mental healthcare. The biggest reason for this gap in research is that there is little existing data on mental illness in developing countries and many countries do not collect data on mental illness at all (Elsey et Al.). Therefore, expanded data collection and superior modelling of individuals with mental illness is the most important step that can be taken to address mental health treatment gaps and increasing the physical, social, and economic wellbeing of citizens with mental illness in Latin American countries. Accurate data can reveal the areas and population size of marginalized people suffering from mental illness. The enables governments and humanitarian organizations to better allocate their resources and develop culturally treatments and data science driven healthcare technologies.
Agent Based modeling can account for unrepresented groups of individuals with mental illness and predict the areas and populations that are more susceptible to mental illness. A 2018 paper published by BMJ Journals titled Improving household surveys and use of data to address health inequities in three Asian cities: protocol for the Surveys for Urban Equity (SUE) mixed methods and feasibility study tests novel cluster sampling methods in three Asian cities, including enumeration using open-access maps developed by GIS systems and grided population sampling, to improve the representation of individuals in urban areas that are more susceptible to mental illness (Elsey et Al.). Researchers additionally measured the appropriateness of existing survey questions' ability to measure residents' mental health. This study indicates that novel data collection methods are superior to conventional methods of government surveying, such as census taking, in accurately accounting for people with mental illness. Researchers used existing data scalars that were previously not used by governments to measure mental health such as education level and family composition to create their predictive models.
Predictive modelling is a particularly difficult endeavor in the human development subfield of mental health. This is due to the complex nature or mental illness that make them difficult to identify even by a patient, cultural stigmas against mental illness that make patients not want to identify themselves, and the fact that those who are most susceptible are often members of others marginalized groups such as religious minorities, drug addicts, and the most impoverished individuals that are already ignored by their own governments. However, using more appropriate questioning in surveys and using existing geographic and demographic data to predict mental health outcomes in developing countries prove to be effective in predicting mental health outcomes in different regions (Elsey et Al.).
Many developing countries in Latin America still lack the finances or resources to provide people with mental health services. However, solutions to this problem exist in the form technologies that connect individuals with mental illness in developing countries with psychiatrists and other services. (Jimenez-Molina et Al.). A systematic review article titled Internet-Based Interventions for the Prevention and Treatment of Mental Disorders in Latin America: A Scoping Review of from 2019 found that these technologies and data applications are able to close the mental health treatment gap in Latin America by expanding access to low-cost mental healthcare. (Jimenez-Molina et Al.). The real problem is that these technologies are not widely utilized enough in developing countries evidently because little data exists on the burden that marginalized individuals in developing countries face from mental illness. Data collection is crucial to signal to organizations that mental health services and technologies are needed in Latin America.
Bibliography
Elsey H, Poudel AN, Ensor T, et alImproving household surveys and use of data to address health inequities in three Asian cities: protocol for the Surveys for Urban Equity (SUE) mixed methods and feasibility studyBMJ Open 2018;8:e024182. doi: 10.1136/bmjopen-2018-024182
Jiménez-Molina Á, Franco P, Martínez V, Martínez P, Rojas G and Araya R (2019) Internet-Based Interventions for the Prevention and Treatment of Mental Disorders in Latin America: A Scoping Review. Front. Psychiatry 10:664. doi: 10.3389/fpsyt.2019.00664
Martínez V, Rojas G, Martínez P, Gaete J, Zitko P, Vöhringer PA and Araya R (2019) Computer-Assisted Cognitive-Behavioral Therapy to Treat Adolescents With Depression in Primary Health Care Centers in Santiago, Chile: A Randomized Controlled Trial. Front. Psychiatry 10:552. doi: 10.3389/fpsyt.2019.00552
Poor mental health, an obstacle to development in Latin America. (2015, July 13). World Bank. https://www.worldbank.org/en/news/feature/2015/07/13/bad-mental-health-obstacle-development-latin-america
Rathod, S., Pinninti, N., Irfan, M., Gorczynski, P., Rathod, P., Gega, L., & Naeem, F. (2017). Mental Health Service Provision in Low- and Middle-Income Countries. Health Services Insights. https://doi.org/10.1177/1178632917694350