Urgent to Address Mental Health

Mental health has been a neglected health reality for decades, despite its consequence on every aspect of human life, stigma surrounding mental health is still a reality. Mental health importance relies on how this single factor impacts how people feel, think and act, it determines how stress is handled and how personal and soil decisions are made. According to the CDC, mental and physical health are equally important components of overall health. “Mental illness, especially depression, increases the risk for many types of physical health problems, particularly long-lasting conditions like stroke, type 2 diabetes, and heart disease.”

According to WHO, mental health is an essential component of health as well-being involves stress management, productive work, contributing to the community and also the realization of a person’s capabilities. To date, mental health is still one of the most neglected areas of public health, despite over 1 billion people living with a mental disorder, 3 million people a year dying as a result of drug or alcohol abuse and a person committing suicide every 40s. Besides substance abuse, per year, mental health disorders cause the death of 8 million people globally. CDC explains that although the terms of poor mental health and mental illness are often used interchangeably, they are not the same thing. According to Medical News Today, anxiety, mood disorders and schizophrenia are the most common types of mental illness.

At some point their life, most people are bound to suffer from some kind of mental disorder. These affect how people think, feel and behave. Many factors contribute to these issues, among them:

• Biological factors, such as genes or brain chemistry
• Life experiences, such as trauma or abuse
• Family history of mental health problems
• Continuous social and economic pressure

Poor mental health is associated with rapid social change, stressful work conditions, an unhealthy lifestyle, poor physical health and human rights violations. Other factors such as gender, age and ethnicity are linked to mental health issues, as these are the cause of many social inequalities that can damage mental health and later develop into serious conditions. Socially vulnerable groups are also considered vulnerable to suffer from mental disorders as they are exposed to unfavorable health situations due to normative, cultural, social and economic hierarchies.

Mental Health in Mexico

A study published by FunSalud exposed how, in many countries, members of marginalized communities are more likely to suffer from a mental disorder and less likely to have access to services. The study points at women, migrants and indigenous populations, in particular. Despite these conditions, mental health remains a lagging issue worldwide and does not even figure on the political agenda of some nations. In addition, there is low access to mental health services due to the shortage of specialists and their centralization in urban areas. While nearly one in 10 people worldwide has a mental health disorder, only 1 percent of the health workforce focuses on mental health treatment. In Mexico, the rate of psychiatrists per 100,000 inhabitants is 0.67, according to FunSalud, which is lower than that recommended by the WHO. There are 49 psychiatric hospitals, 13 psychiatric units in general hospitals and 11 residential care centers across Mexico. Meanwhile, neuropsychiatric disorders represent the fifth largest disease burden in the country.

Mental health is prioritized until the third level of care and only 2 percent of the public budget for the sector is allocated to mental health, while WHO recommends a rate of 5 to 10 percent. Of this budget, 80 percent goes to psychiatric hospitals, which widens the gap at the primary level. Of the 49 psychiatric centers in the country, 12 are in Mexico City, which also represents an obstacle for people in rural communities. Moreover, the budget for mental health has been reducing between 2015 and 2020, going from MX$3.257 billion to MX$2.932 billion.

According to the National Survey of Psychiatric Epidemiology in Adults, 28.6 percent of Mexicans between 18 and 65 years of age have suffered, at least once in their life, from a mental disorder. However, only one in five patients receives specialized treatment. At least 17 percent of people in Mexico have at least one mental disorder and one in four will suffer from develop one at least once in their lifetime. At least 15 percent of the national population struggles with depression and even before the COVID-19 pandemic it was foreseen than by 2020, this would be the primary mental disorder among young people and adults in developing countries.

Neglected mental health issues can end up in suicide. In Mexico, suicide has been increasing every year. In 2017, 6,559 cases of suicide were registered. According to the National Household Survey, in that same year, 32.5 percent of people aged 12 or over expressed having feelings of depression.

According to the UN, women are more likely than men to suffer from depression and anxiety. In Mexico, from 2013 to 2019, women attended, on average, 19.8 percent more than men to first-time consultations related to mental health and 5.3 percent more times to subsequent consultations. In 31.3 percent of the cases, women sought out therapy due to violence. Among men, violence represented only 2.8 percent of the consultations.

Metal Health Promotion and Attention

WHO explains that mental health promotion involves actions that improve psychological well-being, fostering an environment that supports mental health and that respects and protects basic civil, political, socio-economic and cultural rights. Without the security and freedom provided by these rights, it is difficult to maintain a high level of mental health. Mental health promotion efforts involve both the public and private sector in the creation of support policies that should consider education, labor, justice, transport, environment, housing and well-being.

WHO enlists key policies to approach mental health and to prevent risks for vulnerable groups:

• Early childhood interventions and support for children
• Socio-economic empowerment of women
• Social support for elderly populations
• Programs targeted at vulnerable people, including minorities, indigenous people, migrants and people affected by conflicts and disasters
• Mental health promotional activities at schools
• Mental health interventions at work
• Housing policies, poverty reduction and social security for the poor
• Anti-discrimination laws and campaigns
• Promotion of the rights, opportunities and care of individuals with mental disorders

Government Actions

During an interview with MBN, Oliva López, Minister of Health of Mexico City, said mental healthcare is available at primary care hospitals, especially at larger health centers. “We also have 32 units that offer medical specialties where we provide care and addiction prevention.” According to López, SEDESA created policies to approach violence, drug use and addiction. “Prior to the pandemic, we recruited a significant number of psychologists to strengthen this area. These programs have continued throughout the pandemic, albeit with reduced intensity.”

To further address the matter, Congress approved a reform to the General Health Law to prioritize mental health and addiction in all health policies implemented by the government. The main goal of this reform is to restructure the health system, from one that currently isolates mental health issues and addiction, to one that provides a sense of community and that paves the way to universal healthcare and equal access to health services, reported El Economista.

To ensure the basics of this policy, the reform proposes all public institutions should provide access to mental health and addiction services, especially for those in vulnerable situations. These services must always promote the participation of families and/or support groups and organizations. The reform targets people with attention deficit, autism and Asperger's syndrome. It also includes conditions such as depression, bipolar affective disorder, anxiety, panic, stress, schizophrenia, epilepsy, seizures, dementia and substance use.

Corporate Wellness

Mexico began playing closer attention to emotional well-being and human development at work in 2016, after the Ministry of Labor and Social Security released a book detailing the country’s challenges on the subject. In 2019, a reform to NOM-035 established the elements that make it possible to identify, analyze and prevent psychosocial risk factors, promoting a favorable organizational environment in the workplace to guarantee the well-being of employees. This norm was a breaking point for corporate wellness programs within companies, especially considering that Mexico tops the list of countries with the highest work stress levels, according to WHO figures. Mexicans report a 75 percent of work stress, just above China with 73 percent and the US with 59 percent.

Global trends and International Labor Organization standards were also key to build new wellness programs. However, other challenges emerged. “These programs seem imposed by the company on their employees, so collaborators perceive it as extra work and not as an empowerment tool. Sometimes, companies see it as part of the job, too, because by law, they must comply with regulations related to the psycho-emotional well-being of their employees,” said Victor Saadia, Founder and Director General of Alive Wellness Consulting, during an interview with MBN.

Mental Health During COVID-19

“COVID-19 is not creating a new mental health crisis. It is expanding and pulling into the spotlight the existing mental health issues, highlighting that we do not have the resources and breadth of effective treatments we need to deal with them,” stated WELLCOME Organization.

Loneliness, depression, harmful substance abuse and self-harm have become a concern for WHO amid the pandemic. According to the organization, physical isolation is likely to trigger some of those reactions, coupled with feelings of fear, worry and stress. Likewise, the economic crisis brought by the pandemic put even more stress on mental health. In Mexico, the economic crisis has meant the loss of employment for 1,025,194 people, according to IMSS figures. Meanwhile, OAS found that, from a gender perspective, confinement has caused an increase in the workload of women due to household and work activities. Furthermore, many women are also at risk of suffering violence.

During an MBN interview, Marcos Pascual, Commercial Director of ANAFARMEX, explained that patients that have overcome COVID-19 also face mental health issues related to virus complications. According to Pascual, UNAM’s statistics show that nearly 16 percent of COVID-19 patients are experiencing memory loss, 13 percent experience anxiety and 12 percent experience depression. “These numbers reflect in the supply for new customers. PAMO doctors are referring these patients to specialists and prescribing drugs that can support their condition,” said Pascual. Additionally, the government has created exclusive mental health lines for COVID-19-related issues and a series of support videos for people in need.

“This is one issue that is still not getting enough attention; it is a crisis that has emerged due the many things generated by the pandemic,” said Graciela Teruel, Director of EQUIDE-IBERO to MBN. “One of our studies found that one in three Mexicans now suffers from severe anxiety.” According to Teruel’s statement, this is already impacting productivity and absenteeism, “not to mention suicides.” Still, Mexico destined 0.08 percent less budget to mental health in 2021.

The academic sector is picking up some of the slack, according to Eduardo García Luna, Vice Chancellor of Health Sciences at UDEM. In an interview with MBN, García Luna said UDEM has also developed virtual attention programs, as well as presential programs following all sanitary measures to support its community. The program was open for anyone in need. UDEM already offered these services but the university focused on reinforcing them remotely by creating direct lines of attention for the internal and external community. “We even put these services at the state’s disposition as we saw the struggles the pandemic was generating among the population,” he said.

Mental Health for Frontline Health Workers

It is also key to keep in mind health workers, who have been under significant stress for over a year now. According a study by the INPS, during the COVID-19 pandemic in Mexico, suicidal thoughts among healthcare workers were more frequent than among the general population. These thoughts could grow worse if untreated and/or as a result of increased burnout, PTSD and compassion fatigue expected in the next phase of the COVID-19 pandemic in Mexico. According to the study, the Mexican government did intensify mental health monitoring and treatment among frontline healthcare workers.

Further analysis among healthcare workers, according to professional group, revealed higher frequencies of burnout among medical residents and nurses, which suggests that the pressure on them may be especially overwhelming during this crisis. An active strategy to schedule rest periods for medical staff will be developed and implemented during the next phase of the pandemic in Mexico.