Mental health and women’s health: Eyeing the ‘treatment gap’

Originally published on Devex

Mental health has attracted little attention considering the huge size of the problem. Ranging from mild depression to major psychosis, it is estimated that one in four people suffer from a mental illness, and estimates from the World Health Organization state that around 400-500 million people worldwide are affected.

Among sufferers, many go undiagnosed and untreated. In developed countries, the “treatment gap” can be as high as 50 percent, while in developing countries it can skyrocket to 90 percent. The dearth of medical attention can be traced to a lack of awareness, a fear of the stigma attached to mental illness, or barriers to treatment such as access or finances.

Within these astonishing figures, another little-discussed fact is that women are at greater risk for certain mental health issues. Partly attributed to biological factors, but also partly because of sociocultural factors — including a lower social status than men and different cultural expectations — women suffer from a higher risk of anxiety, depression and eating disorders.

In addition, women are at risk of gender-specific afflictions such as post-partum depression. Intimate partner violence, sexual assault or sexual abuse, which women experience more frequently than men, are also risk factors for developing mental illness later in life.

Image c/o Adi Sujiwo
Image c/o Adi Sujiwo

The ramifications of mental illness extend beyond the individual. Women — often having a greater role in child rearing — suffer additional stress and the responsibilities of parenting can take its toll on mothers. While some studies have found that parenthood can act as a balancing force for individuals, others show that adding mental illness on top of the stress of parenting presents unique challenges.

One case worker described the difficulty of balancing treatment with child care, saying, “I’ve seen a lot of mothers go into crisis, needing hospitalizations and debating which should come first, their mental health or child care, because they had no one in the community that could help them.” Another described the guilt mothers go through when feeling stressed by parental duties, or by witnessing behaviors in their children that they worry is hereditary mental illness, or a sign of failure in their own parenting.

Further compounding the issue is that many — on some level — assume that mental illness is a condition that can be willed away or cured by logical thinking. This fallacy shames sufferers into silence — often with fatal results.

Suicide, often the tragic final outcome of these diseases, is one of the leading causes of death globally: more than 800,000 people a year die by suicide, or one every 40 seconds. Women are two to three times more likely than men to attempt suicide, though men are four times as likely to die from it. Among suicides, a disproportionate number of the victims are found to have a mental illness, most commonly depression or a mood disorder.

With such a profound effect, mental health in both men and women deserves greater attention and resources. More urgently, it requires an eradication of the stigma that prevents most people from seeking help. A greater focus on raising awareness and channeling resources could have a profound positive effect for men as well as women, as well as the families who rely on them.

Join Girl’s Globe’s #HealthyMeans Twitter chat today, November 13th at 11:00 EST to discuss how neurological and psychiatric disorders impact women and girls. To learn more about mental illness or how to help a loved one who suffers, please visit the National Alliance on Mental Illness. Read more on how gender disparities impact mental health at the World Health Organization.

Want to learn more? Check out the Healthy Means campaign site and tweet using #HealthyMeans.

Healthy Means is an online conversation hosted by Devex in partnership with Concern Worldwide, Gavi, GlaxoSmithKline, International Federation of Pharmaceutical Manufacturers & Associations, International Federation of Red Cross and Red Crescent Societies, Johnson & Johnson and the United Nations Population Fund to showcase new ideas and ways we can work together to expand health care and live better lives.

My Life With Epilepsy

They run in my family. My cousin has them, my sister had them, I have them.

Seizures.

My first one was in sixth grade. Then two more in high school. Four more my freshman year in college. And nearly ten in the past two years.

Yes, I am one of the 50 million people around the world who suffer from epilepsy, a chronic non-communicable disorder of the brain. In the United States, nearly 3 million people live with epilepsy, making it the fourth most common neurological condition and more prevalent than cerebral palsy, multiple sclerosis, Parkinson’s disease and autism – combined. Although recognized by the World Health Organization as one of the world’s oldest medical conditions, compared to other non-communicable conditions like cancer and diabetes, epilepsy is seldom discussed and often ignored, thereby limiting awareness and knowledge about the disorder and enabling societal stigmas to flourish.

During the 17th century Salem witch trials, many of the women accused of witchcraft and burned alive are believed to have suffered from epilepsy and community members misinterpreted seizures as demonic possession. Up until the 1970s in America and the United Kingdom respectively, it was legal to deny people with epilepsy entrance to public buildings and to forbid people with epilepsy to marry. Today, in both China and India, epilepsy is still commonly regarded as a legitimate reason to prohibit marriages.

FullSizeRender (1)Growing up, I certainly felt the stigma – at least I perceived there to be a stigma. Looking back, it was probably all in my head. I hardly ever mentioned my disorder to anyone besides my close friends because I feared I would be labeled as “the girl who has seizures.” I didn’t want people to think differently of me, to pity me, to think I couldn’t when I knew I could. It was not until only two years ago that I finally went public about my condition, lifting a huge weight off my shoulders and raising nearly $1,500 for the Epilepsy Foundation’s Epilepsy Therapy Project to run the 2012 Philadelphia Marathon.

In addition to social stigmas, epilepsy also inflicts a wide array of physical and economic consequences ranging from an increased risk of fatal car accidents and dangerous head injuries from falling to a decreased likelihood of attending school or finding employment – a particularly hard hitting consequence for women and girls.

For women and girls in developing countries, those who already bear the brunt of social inequities, epilepsy only serves as an additional barrier to empowerment. By lacking access to medication and treatment, women and girls with epilepsy inevitably suffer an increased number of seizures. These continuous and uncontrollable seizures create a domino effect in which girls experience an even lower likelihood of attending school, thereby limiting employment opportunities further, and dooming women and girls to a lifetime of poverty.

Approximately 75 percent of people who suffer from epilepsy in developing countries fail to receive proper treatment due to anti-epileptic drugs’ (AEDs) inaccessibility, unavailability, and unaffordability – not to mention the condition’s severe social stigma. As a result, the mortality rate associated with epilepsy is much higher than in less impoverished nations. Although many cases of epilepsy (like mine) are simply a matter of genetics, the disorder can also be caused by brain damage stemming from birth complications (particularly affecting women without access trained midwives) and untreated brain infections (i.e. meningitis, encephalitis, neurocysticercosis), health problems more commonly found in developing regions. In fact, nearly 80 percent of epilepsy cases are found in developing regions. In Africa, nine out of ten people with epilepsy go untreated and that figure is even higher in India, where nearly 95 percent of people with epilepsy are left untreated.

Image c/o Tumblr
Image c/o Tumblr

For me, a major economic consequence was the growing hole in my bank account upon graduating from university. I no longer was covered by either my parents’ or school’s health insurance and my employer (a law firm) did not offer benefits. I needed to buy my own insurance – a task much harder than it sounds. In the days before the Affordable Care Act, insurers were allowed to discriminate against those with a ‘pre-existing condition’ and therefore, allowed to discriminate against me. As a high-risk client, private health insurance companies lacked the economic incentive to cover my health costs, causing the frantic search for adequate health insurance to drag on for weeks. Meanwhile, without insurance, I was forced to pay hundreds of dollars out-of-pocket every month in order to fill my prescription and, essentially, in order to live my life without a dangerously high risk for seizures.

However, I am one of the lucky ones. I am happy to say that I am now covered by a quality health insurance policy and have easy access to AEDs and neurologists. Had this not been the case, my life and my future would look completely different.

In the post-2015 agenda, all of us – global leaders, medical professionals, young and old, men and women – we must all raise a collective voice and shine a spotlight on the importance of ensuring access to proper healthcare for those living with epilepsy, particularly women and girls. For too long, neurological health has gone ignored in the global conversation. When 50 million people suffer from epilepsy, a population equivalent to that of South Korea, don’t you think it’s time we paid attention?

Learn more:

In the United States, November is National Epilepsy Awareness Month. Join the Epilepsy Foundation’s #DareTo campaign to spread awareness. Additionally, from November 10 – 14, join Devex’s #HealthyMeans digital rally and raise your voice about advancing the dialogue of the future challenges and opportunities in global health, particularly for those living with epilepsy.

Cover image c/o Flickr Creative Commons