Poverty and the Mind

Vikram Patel is a psychiatrist and a Professor of Global Health who works tirelessly to improve the mental health of people living in low and middle income countries like India and Ethiopia.

His recent research has found that all countries are ‘developing’ countries when you look at the low proportion of the health-budget they spend on mental health. Some wealthy countries may have better systems of care for maternal and child health but overall, mental health remains universally, at the end of the queue.

At present, COVID has overtaken all other agendas. However, now more than ever before, there is a recognition of the two-way relationship between poverty and mental ill-health. This may be a historic opportunity to get this right.

The relationship between poverty and mental ill-health is a complex one. How can we distinguish a normal response to poverty from a disease process? Poverty can increase the risk of poor mental health via multiple pathways, for example, poor physical health, high levels of noise pollution, violent neighbourhoods, insecurity and humiliation.

Can an increase in income improve mental health? Yes. It can but it needs to be sustained.

The fact that having a mental illness may induce poverty is less well recognised. It may affect one’s education and hence, employment opportunities. In low and medium income countries, health care is paid for by people. Due to the length of time it takes to find an effective treatment, much effort and money is wasted in doctor-shopping. Depression is inequitably distributed in society but not recognised as such because wealthy individuals also get it. We accept that long term expensive therapies cannot be delivered to the poor, so what’s the point in studying them?

After nearly a year of job-losses, the number of people below the bread-line all over the world will increase by tens of millions. In India alone, the gains made in economic growth over the last decade are predicted to be wiped out this year. The historically disadvantaged will fare worse, suffer more.

We can expect a surge in mental health problems like we did after the 2008 global financial crisis, mainly led by suicide and drug misuse. Sir Angus S Deaton, a Nobel prize winning economist wrote extensively about these deaths of despair. Economists and global health experts warn that this one will possibly be far worse.

In India, while the state is spending all its energies on the pandemic, livelihood-based organisations are finding very poor mental health in their members. Taking a broad, multidisciplinary approach to depression and anxiety rather than viewing it through the lens of a medical specialty is the need of the hour. Policies all over the world need to de-medicalise the emphasis on specialists and empower front-line providers and communities to enable them to foresee, identify and address this problem.

The bi-directional relationship between mental health and finances means that appropriate mental health interventions can improve finances. Can we persuade policy-makers world-wide to listen to global health experts and economists, look at this fast-approaching  avalanche and steer policies to protect those who are being and will be hit by it?

Talk: Poverty and Depression (https://voxdev.org/topic/health-education/poverty-and-depression-how-improving-mental-health-can-help-economic-wellbeing) – this talk was available till last night but has since disappeared.

Research Papers:

  1. Angus Deaton on the Financial crisis and the well-being of Americans (June 2011):

https://www.nber.org/papers/w17128

2. Vikram Patel on Causal evidence and mechanisms of Poverty, Depression and Anxiety (May 2020):

https://www.nber.org/papers/w27157

Thank you, Rumi.

Welcome, unexpected visitor.

The Guest House

This being human is a guest house.
Every morning a new arrival.

A joy, a depression, a meanness,
some momentary awareness comes
as an unexpected visitor.

Welcome and entertain them all!
Even if they’re a crowd of sorrows,
who violently sweep your house
empty of its furniture,
still, treat each guest honorably.
He may be clearing you out
for some new delight.

The dark thought, the shame, the malice,
meet them at the door laughing,
and invite them in.

Be grateful for whoever comes,
because each has been sent
as a guide from beyond.

  • by Jalaluddin Rumi.

Who knows?

12 days ago I left my home and husband with a strange sense of ‘last-ness’. Si and I are familiar with that uncomfortable feeling.  We know that the whole world can change in one second. 12 days is a long time.

Melbourne, Australia, was my final destination when I left home to complete my Churchill fellowship. On the way, I broke my journey for a week in India. I find it impossible to fly over India to go to other places without stopping. There, I watched in horror how much India’s centre has moved to the right. It has gone so far that the words ‘liberal’ and ‘secular’ are now bad words. My closest friend there is a Muslim gentleman whom I have known for the last 23 years and have never thought of him as a Muslim. But now I fear for his safety. I fear for the safety of all my family as I know that when there is fire, some are damaged by flames but many more by smoke.

So, here I am, in Melboune, at a house, rented through AirBnB and so much has happened in these 12 days. I have never understood the need for 24-hour News Channels as they endlessly repeat themselves, induce panic and heighten pre-existing anxieties. Many people are petrified. They are understandably worried about themselves and their loved ones. The restrictions being imposed are causing more isolation and angst. Italian prison scenario is a very sad example.

This is a good time to observe the effect news has on you, pay attention to your feelings and take a break when you need to, from the constant ranting of various media. I am doing that. I am keeping myself informed, connected and calm. I am not willing to allow the situation to affect my mind too much. I am taking all the precautions as advised and that is the best I can do. WHO sensibly says let’s look after our bodies and minds.

I suspect that death rates from this virus are being hugely exaggerated. They are based on projections from those who have been tested, but many people, all over the world have had a cold or flu over Jan and Feb and have not been tested. So, where does the truth lie?

No one knows. That is the answer. No one knows.

Day 938

Oooops! Sorry!

If a previously healthy man recognises that he is a huge risk to himself. If he takes himself to a mental health facility and pleads for help. If they admit him and then classify him as ‘low risk’ and leave him unsupervised. If he then goes on to end his life in the hospital within hours of being there. This has got to be wrong. One would think this to be nearly impossible. It isn’t. It happens.

A Canadian study published in 2014 on inpatient suicides concluded that “It is possible to reduce suicide risk on the ward by having a safe environment, optimising patient visibility, supervising patients appropriately, careful assessment, awareness of and respect for suicide risk, good teamwork and communication, and adequate clinical treatment.”

Recently, a Coroner’s report on an inpatient suicide found the same things that came out in Saagar’s case:
-Risk of suicide was not properly and adequately assessed and reviewed
-Transfer of verbal and written information was poor
-Risk assessment and quality of observation was poor
-Adequate and appropriate precautions were not taken to manage the risk of suicide
In addition, they found that previous recommendations on risk and environmental factors were not implemented adequately. This means that similar deaths had occurred before but nothing had changed.

How many people need to be sacrificed before something changes?
Ed Mallen, 18, died while he was on a waiting list.
Many thousands are still waiting!

Ruby is a lovely young lady who shares the joys of being on a waiting list, among other things. Here’s the link. This time it’s 18 minutes.
Thank you Ruby! We wish you well!!!

Day 916

Twenty again?

IMG_4763

At my age it’s hard to remember what life was like when I was twenty. I was in medical school, forming strong friendships, working hard, playing harder and worrying about exam results. The last one made me swear that I would never ever take an exam again after finishing medical school but like many others, this resolve too, dissolved.

The upside – one can drink, have sex, travel, dip into the bank of mum and dad, live at home and be a kid when it suits and be an adult when it suits. The insecurities – Am I the person I want to be? Will I be able to establish my place in the world? What will become of me? Will I make my parents proud? Will I achieve ‘success’? How many years will it take? Will I meet Mr Right and will he continue to be Mr Right for a long time?

The biggest advantage of passing years is the gradual evaporation of all these concerns, the ability to follow one’s dreams with lightness and self-belief, to be able to laugh at oneself and not take life too seriously.

Would I like to be twenty again? Nope.
What would I tell my twenty-year old self? Relax.
Things have a way of working out.

What would you tell your twenty-year old self?

Ref:

http://trendom.co/struggles-of-being-20-years-old/

Day 779

Psilocybin is the active hallucinogenic compound in ‘magic mushrooms’. It was banned in the 1960s but recent preliminary research has shown that it may have potentially beneficial effects in patients with anxiety and depression. The subjects for this research were cancer patients, 40-50% of whom will have a diagnosis of anxiety and/or depression.

A team at Johns Hopkins in Baltimore conducted studies where patients were randomly administered the drug or a placebo. They were then encouraged to focus on their internal experience. Those who received Psilocybin had a significant improvement in depression, anxiety and mood disturbances. They also showed a higher level of optimism, a better quality of life and acceptance of death.

The main feature of the experience was a feeling that everything is connected. People felt they’ve learnt something that is of deep meaning. It caused a change in their value systems, in how they approach life and interact with other people. Some patients described the experience as a spiritual awakening.

The single feeling of connectedness with everything is the key to well-being. Many spiritual practices aim to manifest this feeling of oneness with all creation. My beloved spiritual leader Sri Sri Ravi Shankar says, ‘From somebody become nobody and from nobody become everybody.’

Ref:https://www.drugs.com/news/magic-mushroom-compound-triggered-positive-personality-change-study-33958.html (ps: This study is far from conclusive and does not wish to encourage the use of hallucinogens. )