Achieving the Millennium Development Goals: Does Mental Health Play a Role?

T he Millennium Development Goals (MDGs) have captured the attention of the international health and development community in recent years [1–6], and in 2003 two world reports—the Human Development Report and the World Health Report—concentrated specifi cally on these goals [7,8]. The MDGs provide a vision for development in which health and education are squarely at the centre [1,9]. Three of the eight goals, eight of the 16 targets, and 18 of the 48 indicators relate directly to health [9,10]. Health is also an important contributor to several other goals. Intriguingly, the health goals almost entirely ignore noncommunicable diseases, including mental disorders. Yet there is compelling evidence that in developing countries mental disorders are amongst the most important causes of sickness, disability, and, in certain age groups, premature mortality. Mental health–related conditions, including depressive and anxiety disorders, alcohol and drug abuse, and schizophrenia, contribute to a signifi cant proportion of disability-adjusted life years (DALYs) and years lived with disability (YLDs), even in poor countries [11]. Apart from causing suffering, mental illness is closely associated with social determinants, notably poverty and gender disadvantage, and with poor physical health, including having HIV/ AIDS and poor maternal and child health. Yet mental health remains a largely ignored issue in global health, and its complete absence from the MDGs reinforces the position that mental health has little role to play in major development-related health agendas. This article seeks to question this assumption. Using evidence on mental health in developing countries, we argue that addressing mental health problems is an integral part of health system interventions aimed at achieving some of the key MDGs. Below, we consider the evidence linking mental health with three MDGs: eradicating poverty, reducing child mortality, and improving maternal health. However, the relevance of mental health is not limited to these goals alone. For example, a major reason why children are not able to either enrol in schools or complete primary education (MDG 2) is related to developmental and mental disorders, for example, learning disabilities [12]. There are several areas of confl uence between HIV/AIDS (MDG 6) and mental health [13]—for example, people with HIV/AIDS are much more likely to suffer mental health problems, and these problems in turn can affect their overall health outcomes. Goal 1: Eradicate extreme poverty and hunger. Stressful life experiences such as exposure to violence and poor physical health, which are well-recognized risk factors for mental …