Mental illness is the giant elephant in the middle of the global health room. According to the WHO, depression will soon be the leading cause of disability worldwide – 3,000 people commit suicide every day (125/hour, 2/minute). And, of those that complete suicide, there are 20 more who attempt it but don’t complete it. A recent PLoS Medicine paper indicates that a third of suicides in developing countries are committed using agricultural pesticides. Finally, after recent gay-bashing incidents led to well-publicized suicides in the US, the Obama administration made a personal appeal to those who are being bullied to stay alive and to seek help. Given this tremendous toll, and the paucity of funding (at least in developed countries) for mental health issues, is there a role for technology to help?
One of the first interventions that springs to mind is mHealth. The use of cellular phones to connect people in remote locations with professional help seems like a critical facet of intervention. Beyond simply using the phone as a phone, are there possible diagnostics or screening that one might do with cell phones? Various attempts have been made (iPhone apps) but I find a lack of such programs in the development context. Even the UN Foundation/Vodafone mHealth report released recently does not use the word “mental” beyond a cursory mention of smoking cessation programs. There have been studies on the use of automated depression screening for pregnant women by cell phone, and certainly examples exist of computerized screening through cell phones or land-line phones. Where mHealth (as well as any other screening tool) may be limited is its ability to embed the results of screening into a health care system that can act on the information.
Even in developed countries, just because a test result indicates you might be depressed, there is no guarantee that a) you will get help for the condition or that b) the depression will be cured. The challenges of mental health intervention are therefore similar in some ways to, say, infectious disease, in that significant difficulty exists on the treatment end as well as the diagnosis end. However, where mental illness is different is in its multiplicative effects and on the costs associated with treatment. If a mental illness exists, it may make treatment of other ailments (like infectious diseases) more difficult. If the mental illness can be treated, it usually requires years and can require repeated hospitalizations (depending on the condition). The frightening part of some mental illnesses is the growing body of medical evidence that indicates that such conditions are immutable once initiated.
The good news, however, is that perhaps they can be prevented. There is ample evidence that markers of poverty and markers of mental illness are correlated, and so by addressing the issues of one, you can address the other as well. Therefore technologies useful in other areas of poverty reduction, including water purification, vaccines, and inexpensive diagnostics for infectious disease, can reduce mental illness. So, there is a compound benefit to addressing poverty using a multi-pronged approach, a conclusion that should surprise nobody but the effects of which will be profound.
