Take one of the most deeply 'unfashionable,' 'no-go' topics of our time, add a quagmire of financial recession, unfathomable geographical areas and a penchant for 'charity starts at home' mentality and ultimately the recipe produces ... well, a distinct lack of funding or recognition for the vast problem of mental illness and epilepsy in low and middle income countries.
This is a travesty, really, considering that of the 450 million people suffering from mental illness and epilepsy in the world, over 75 percent of them live in the developing world. Insecurity, illiteracy, rapid social change and the trauma of violence are all proven to increase the presence of mental illness and yet in countries where these factors are the norm, people are 170 times less likely to be able to access a psychiatrist than in the developed world- and even there it's not always easy. If you live in Laos PDR for example -- where, incidentally, there is no specific mental health budget listed at all in the national health plan -- you'll have to battle with approximately 6.6 million other inhabitants if you want to see either of the country's two psychiatrists. No doubt this shortage of trained professionals contributes to (although by no means is responsible for) the fact that of the circa one million people that commit suicide every year, 85 live in low and middle income countries.
This complete lack of recognition of Mental Health at a national level then translates into subsequent ignorance at a societal level so that Human Rights Abuses are routinely documented against people with Mental Illness and Epilepsy -- we've witnessed individuals chained to logs, beaten, locked in cages and routinely tortured. If 'lucky' enough not to suffer from this brutality, patients are unlikely to escape the stigma that surrounds Mental Illness and Epilepsy. In Myanmar, for example, nearly three quarters of the population would object to their child marrying somebody with epilepsy. India and China go further and view it as a perfectly valid excuse for marriage annulment. But how many of these people also know that up to 80 percent of people can be seizure-free when treated with simple, inexpensive anticonvulsants?
So what are you going to do if you know a situation needs addressing urgently but donors and investors hesitate to fund it, global governing bodies won't prioritize it, and Joe Public won't even talk about it? Well, according to Chris Underhill, Founder of BasicNeeds, you develop a model of low-cost community based treatment, which you know works even in the poorest of poor countries, you package it and create a digitalized training programme for it, and then you sell it to existing in-country healthcare providers to implement on the ground. This Social Franchise concept provides a double whammy of results -- it creates a sustainable long-term business model out of what was once a 'hand-to-mouth' charity, and -- most importantly -- it ensures treatment to the maximum number of beneficiaries in sometimes the hardest to reach places at no added cost to them.
Obviously, in practice it's never quite this straightforward; there's plenty of hurdles to jump such as the inevitable question of where the potential franchisees get their funding from, how to ensure that quality and performance remain consistent, how to align monitoring systems to continue tracking the number of beneficiaries that both the franchisees and us reach, not to mention the task of quantifying effectiveness of both parties on the ground. The list goes on, but to date BasicNeeds works in 12 countries and has reached over 600,000 affected people and their families in 14 years. By developing this franchise opportunity we are aiming to reach 1.5 million by 2018 -- a significant increase and one, sadly, that was unlikely to happen quite so meteorically by charitable donations alone.
This innovative approach to providing Mental Health and Epilepsy care in low income settings has led to Chris Underhill being awarded one of the prestigious Schwab Social Entrepreneurs of the Year awards, which gives BasicNeeds access to the World Economic Forum. Therein lies the glimmer of hope on the horizon: conversion of the topic into monetary terms. A report by the World Economic Forum and the Harvard School of Public Health estimates that the macro-economic effect of the primary non-communicable siseases (such as cardiovascular disease, chronic respiratory disease, cancer, diabetes and mental health) represent "a cumulative loss of $47 trillion over the next two decades" (Mental Health alone costing 16.1 trillion). To put this figure into perspective; $47 trillion was 75 percent of total global GDP in 2010 and $47 trillion would be also enough to "eradicate the two-dollar-a-day poverty among the 2.5 billion people in that state for more than half a century."
This figure may sound shocking but shouldn't; There is an unquantifiable truth in the adage that there is "no health without mental health," so it figures that anybody suffering mental health problems may well also suffer physical problems, will be more likely to gain an addiction to drugs or alcohol, many will be unable to work. Even if the facilities existed, they still wouldn't be able to obtain the diagnosis or subsequent medication they need because they can't afford it. Then the ripple effects; their family members can't work because they are caring for them, their children go hungry and cannot go to school because they have to go out to earn for the family. Society out casts the family, afraid of witchcraft or 'bad curses', making it even harder for them to work and survive. Stressful living conditions put the family members at a higher risk of developing mental illness. The circle continues and time and time again, mental illness and epilepsy envelops its captors in this fashion and pulls them back into the sticky sump of poverty.
Although a few select institutions and donors have been wise to the dystopian vision of a society with an ever increasing burden of mental disorders, mental health is not an easy sell. It's either too frightening or not frightening enough. It's often seen as an individual's 'choice' or 'frame of mind.' It's discarded as 'trivial' -- a luxury but not a necessity. To those who think like that; please understand that there are far, far wider reaching implications to it, and that until we trumpet mental health and epilepsy on the global agenda, developing countries may never be able to fully pull themselves out of the legacy of debt that these illnesses leave behind.
Until then, or until funders and policy makers see the price of what happens if we don't tackle this problem over the coming years, franchising of a low cost treatment model may be the only way to make any headway in this vast and gaping hole of healthcare disparity.