Voices Of A Silent Majority

Building on the first debate to accelerate progress towards the MDGs, the Skoll World Forum partnered with Johnson & Johnson, the United Nations Foundation, the Bill and Melinda Gates Foundation and the Huffington Post to produce another online debate--this time focused on critical issues that do not have enough of a spotlight in the discussions on how to achieve the MDGs or what should be in the next global development framework. As part of that discussion, we asked some of the world's leading experts what's not being discussed during UN Week this year about the post-2015 development framework, but should be? View the full debate here.

The agenda for the post 2015 development framework is gathering momentum. Five themes or transformative shifts have been articulated by the UN appointed eminent persons group as the driving force for this agenda: Leave no one behind, Put sustainable development at the core, Transform economies for jobs and inclusive growth, Build peace and effective, open and accountable institutions for all, Forge a new global partnership.

The thinking which is going into the making of a global development agenda has never 'sounded' more inclusive. This could be a great moment for putting mental health decisively into the post 2015 development agenda. The Global Burden of Disease (GBD) 2010 study has brought emphasis to the fact that mental illness is the largest contributor to disability and cannot be neglected anymore. The global mental health community is on alert to make sure that mental health is not given a miss again. A position paper being prepared by the Movement for Global Mental Health, The People's Charter for Mental Health by the World Federation for Mental Health and the World Health Organisation's (WHO) Comprehensive Mental Health Action Plan provide impetus.

In all this busy and heady build up it would be almost easy to miss the voices of a large silent majority - people who have been affected by a mental disorder, and who are also very poor.

That almost three quarters of those suffering from mental illness live in low and middle income countries is now well documented. Apart from an estimated 85% treatment gap, the close link of mental ill health with poverty is now being increasingly recognized as a tremendous challenge to development of nations and its peoples. Poverty brings with it heightened stress, social exclusion, malnutrition, violence and trauma, all of which contribute to mental illness. It is a vicious circle as those with mental illness experience widespread stigma and discrimination, suffer violence and abuse, and find it harder to get work, get an education or contribute to family and community. They are more prone to other forms of illness and disease, and find it more difficult to access health care.

So what do they, this majority, think? Are they happy they got an explicit mention in paragraph 87 of the UN report on the post 2015 development agenda? Do they know there's now a good chance they will be in the post 2015 development agenda? Simply put, will this change their lives, their needless suffering?

"Due to our ignorance of what mental illness is, my mother and I we underwent misery for many years. Our own relatives often ridiculed us and harassed us. Even at the hospital they ill treated us openly. We were not given a chair to sit."

"I wish to go to school like the others, but I'm afraid of being called awful names. I feel very bad, it pains me to hear such names."

"We have a really big problem of survival because we have to depend on daily wage labour...sometimes we only have half a stomach full to eat after giving food o our children. Sometimes I think God is angry with us to be giving us such problems."

There is no dramatic face to this global catastrophe so it has never been a priority. Those being devastated live their lives in silent relentless suffering; they are invisible. Is there a way in which they can be included in the post 2015 agenda debates? Can the voices of the people behind the big numbers come through?

This isn't some unrealistic 'romantic' notion of inclusiveness. Prominent international groups of affected individuals such as The World Network of Users and Survivors of Psychiatry (WNUSP), MindFreedom International have been vocal and articulate in voicing their views. But is it possible in low and middle income countries where a majority of the people who have mental illness are poor and have had no opportunity to get educated, informed?

BasicNeeds has done this, and successfully. Since the year 2000 we have directly consulted with 113,086 affected individuals in 12 countries, all low/middle income, and with their carers and families. We consult them before the start of a major field programme in their area, and once they join the programme they evaluate the quality of services they receive, and then use the evidence to advocate through community Self-Help Groups for more effective delivery of services.

"We were quite timid about how exactly the district chief executive was going to receive us but to our surprise he told us he knew about our group. He then gave directions that we be supported according to our request and we were provided with GHS 400 (about $185) which members made use of to manage their farms" Leader of the Sandema Self-Help Group, Northern Ghana

"I decided to join the self-help group in my area so as to join forces with people, lend a hand in farm production and raise awareness about mental health in my community. The group has changed the perception of people in the community regarding mental disorders and have shown the community that they are capable of improving lives.." Beneficiary, BasicNeeds Tanzania

The problem of mental illness has long been ignored. In the fast paced and complex world we live in, the time has now come that it cannot be neglected anymore. The efforts of the global community for pacing up the construction of a humane and just world order through the post 2015 development agenda is commendable. It would be even more laudable if it included the voices of this silent majority.