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A new study shows that the availability of care for serious psychiatric illnesses varies enormously around the world. No country comes out well. And not surprisingly, poor countries do worse than richer ones.
But as NPR's Joanne Silberner reports, there are things that even poor countries can do to help the mentally ill.
JOANNE SILBERNER: The study showing differences in care appears in the journal the Lancet. It's one of six reports aimed at increasing the availability of treatment for mental illness. Among the findings, in Africa there's one psychiatrist for every two million people, while in Europe there's one for every 10,000.
But mental illness exists in poorer countries at the same or greater rates. In the mid 1990s, psychiatrist Ricardo Araya surveyed people living in shantytowns in Santiago, Chile. Five percent were depressed. Araya wanted to do something about it.
International philanthropies don't focus on mental illness and the Chilean government didn't believe treatment was worth the cost. There was no public push either. He couldn't get any support.
Dr. RICARDO ARAYA (University of Bristol): I think the biggest hurdle, it was the pessimism, really. By far, it was so widespread.
SILBERNER: And many people seem to think that poverty was the root problem and until you alleviated the poverty, there was no way to get rid of the depression. Araya was offended by the attitude that there was nothing to be done.
Dr. ARAYA: Just to assume that because people are poor, they'll never going to feel better, we felt that it wasn't right. It wasn't right.
SILBERNER: He knew that untreated depression can make a poor person destitute.
Dr. ARAYA: It does not kill you, but it cripples you quite badly. You're unable to work. You're unable to enjoy life. You're unable to do your normal duties, look after your family, or whatever your role is in society. You know, it is somehow impaired.
SILBERNER: Finally he got some money from the National Institute of Mental Health in the U.S. He and others trained health workers to run group therapy classes for women. They got drug treatment to those who needed it and followed up to make sure patients continued the therapy.
At the end of a year, 70 percent of the women in the special treatment group were better, compared to 40 percent of other women. The cost per day was equal to a one-way fare on the local city buses. Now the Chilean government guarantees treatment for anyone with depression.
Dr. ARAYA: This is one of the few stories with a happy ending, I guess, in this field. We found that, yes, yes, if you give people the right treatment, they do recover, regardless of whether or not they are living under very poor condition.
SILBERNER: American psychiatrist Gregory Simon, a researcher with Group Health Cooperative in Seattle, worked with Araya on the study. He said there's a lesson there for poor and rich countries.
Dr. GREGORY SIMON (Psychiatrist): Providing effective treatment for depression isn't necessarily expensive. Health care workers can effectively treat depression with a relatively modest amount of training.
SILBERNER: Treating one person's depression can have a ripple effect, says psychiatrist Martin Prince of King's College, London.
Dr. MARTIN PRINCE (King's College London): We and some of our colleagues have carried out research in India and also in Pakistan.
SILBERNER: They looked at women who developed depression just before or after they gave birth and found their babies had a lower birth weight and didn't grow well. And depression can make other diseases, such as HIV/AIDS, worse.
Prince co-authored a paper as part of the Lancet series that calls for greater investment in mental illness treatment in poor countries.
Dr. PRINCE: Although 10 percent of the disease burden as coming from mental health conditions, at the moment only about one percent of the health budget is being spent on those conditions in those parts of the world.
SILBERNER: In some places the situation is desperate. He's seen people with schizophrenia, for example, chained inside their family's hut because there's no help available. Martin Prince says it's easy to ignore mental illness because in many countries, rich or poor, people with mental illness hide or are hidden away.
Joanne Silberner, NPR News.