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12th January 2016

Ignorance is not always bliss

The stigma and misunderstanding that surround mental illness in developing countries leads to humiliation and hardship.

Maurilia’s family had tied a rope around her neck to restrain her after a series of aggressive outbursts. Once a healthy and active girl, her mental and physical health was in decline. She was weak, disorientated and bit constantly on her fingers. By the time a team of human rights activists found her, Maurilia’s quality of life had collapsed and there was little hope of improvement.

Her story, captured here by photojournalist Prometeo Lucero, is a harrowing case study in how poverty, neglect and a lack of understanding can breed misery.

Living in a poor indigenous community in Mexico, Maurilia’s family lacked the resources and knowledge needed to recognise and care for her illness.

Stigma

One in four people in the world will be affected by mental or neurological disorders at some point in their lives, according to the World Health Organisation (WHO). Right now, as you read this, around 450 million people are suffering from mental health conditions.

However, even in developped countries where mental health problems are well known and treatment is normally available, only one third of those affected get help. This has a profound effect on individuals, families and wider society: disability caused by mental disorders costs around three percent of GDP.

In poor countries, the situation is much worse. Most people do not receive any care whatsoever. Worse than that, they face discrimination and loss of dignity.

One of the biggest problems when it comes to improving the lives of people with mental health problems is stigma. Mental illnesses are often confused with something else or seen as a sign of personal failure.

Awareness is very low and securing a diagnosis – let alone accessing treatment – is rare because mental health services are not well funded and there are too few medical specialists.

Where good care is on offer, it sometimes comes at a financial price too high for many of those who need it.

New tests

One of the challenges with diagnosing mental illness is that, until now, we have relied mainly on the assessment of medical professionals – with blood tests sometimes used to exclude thyroid problems. In many parts of the world there are too few doctors; in others diagnoses are subjective and inconsistent.

But researchers have been searching for ‘biomarkers’ that can offer an objective assessment of mental health problems. New tests promise to scan a single drop of blood for a range of markers which can quickly diagnose serious problems such as depression.

What’s more, these tests can be used to independently check whether treatments are working. For example, scientists have used blood tests to examine whether cognitive behavioural therapy changes the levels of biomarkers in depressed patients.

For some, blood tests show significant improvements after therapy but others fail to respond to treatment. This means that the presence or absence of biomarkers could not only diagnose depression but may even help doctors to choose the best treatment for their patient. Indeed, knowledge is power.


Meanwhile in Mexico, Maurilia’s fate is unknown. After human rights workers found her, she was brought by ambulance to receive treatment.

The photojournalist who documented her story is unable to return to the region due to security concerns but has heard rumours that Maurilia has since died. Yet her story lives on as an illustration of the hardship endured by people living with mental illnesses in developing countries.

Photos of Maurilia and others have been included in an exhibition by the Mexican office of Amnesty International, with permission from the Tlachinollan Human Rights Center