The Honorable Minister of Health Dr. Leslie Ramsammy's Address to the Sixth World Conference

Let us make a difference together

Mahalia Jackson sang these words and inspired millions around the world: Lord, give me strength not to move mountains but to climb them.

In the continuing story of humanity to create a just and equitable world, we have failed too many people everywhere, and poverty, expressed through persistent inequities and social injustices, remains our major failure as humanity. In this poverty story, mental disorders, with its story of economic hardships to those living with mental illnesses and their caregivers and families, play a critical role in the evolution and persistence of poverty.

Sisters, brothers, in the next few years, not as an option, but an imperative, we need to climb some mighty mountains, mountains that will test our resolve and our mettle as we intensify our efforts to eradicate poverty.

But let me state unequivocally at the very start, I believe we have the capacity and we have the ability to climb these mountains. We must climb these mountains because it is for children everywhere, for our parents and our grandparents, it is for us all. It is for a better world. It is for a kinder, gentler world in which people everywhere can live long, productive, disability-free lives and have a chance to pursue their lives’ potentials.

I address you today against the background of persistent poverty in our world, a world which even now has the resources to end poverty. Poverty has always been the world’s most debilitating cause of humanity’s under-development. As it was in the last century, the greatest development challenge of this century remains the pursuit of the dream to reduce and eliminate poverty, to guarantee citizens everywhere of a chance to reach their lives’ potentials, to live long, productive and disability-free lives, lives in which their fundamental human rights are respected and honoured.

Inequity of opportunities to live long, productive and disability-free lives remains at the very heart of our global struggles to reduce and eliminate poverty. One of the great tenets of our time is that development is not possible without health. Indeed, health is seen as integral to development. In 1978, at Alma Ata, we embraced the concept that health is development by proclaiming Health for All by 2000.

The problem is that we keep ignoring the well-known fact – there is no good health without good mental health.

Mental illnesses affect the lives of a large number of persons, impact the quality of their lives and have enormous socioeconomic costs for families, communities and countries. There are missed educational opportunities, lost productivity and unemployment, increased crime and incarceration, inappropriate use of hospital emergency departments and premature deaths, including suicide. People with mental and psychosocial disabilities are among the most marginalized groups in any country, particularly in developing countries. There are too many populations around the world without access to basic mental health services.

The truth be told – we have always known that Health for All is impossible without mental health, that mental disability is one of the major determinant of poverty. Almost a half a billion people are affected by mental and neurological disorders and these illnesses account for almost 15% of the disease burden story of the world. But this knowledge has never prompted us to promote mental wellness among our populations and we have essentially neglected and marginalized those with mental and psychosocial disabilities.

This neglect of our responsibility to promote mental health, to prevent mental illnesses, and to treat and care for those living with mental illnesses, is wrong and represents a major social and economic injustice and constitutes a grave human rights emergency. Indeed, our vaunted pillar for freedom and the right to pursue our inalienable rights cannot be attained because our world has not been able to provide even basic mental health services for the vast majority of our populations. We must remedy this anomaly. We must bring justice to the hundreds of millions who have been and who will be condemned to lives of vulnerabilities and poverty, and premature deaths and who will never reach their lives’ potentials. We face a growing and not an emerging calamity. This is a genuine developmental emergency.

To know what is right and not to do it is the worst cowardice – Confucius told us this many centuries ago.

The great Indian Freedom Fighter, the Mahatma Gandhi put it this way: To believe in something, and not to live it, is dishonest.

I came here, therefore, to join you in a new determined proclamation that we will change the paradigm of Mental Health Neglected and we will promote a new dispensation in which mental health is promoted, where there are strong programs for the prevention of mental illnesses and where there are treatment and care and the guarantee of human rights for those persons living with mental and psychosocial disabilities.

“There is no health without mental health’ - we all know this to be the truth. Recently, the Lancet papers brilliantly demonstrated the truth of this statement. The Caracas Declaration 20 years ago made it clear that Health for All is impossible without mental health. The WHO in its 2001 World Health Report boldly declared that we cannot deliver and guarantee Health for All and address the issue of social justice and under-development unless we are able to promote mental health and prevent mental disorders. What has happened since the 2001 World Health Report?

The World Health Report 2001 – Mental Health: New Understanding, New Hope brought mental health to center stage and called upon nations to prioritize mental health as an integral component of health. The World Health Report 2001 recommended the following actions: to provide treatment in primary care and the community; to make psychotropic drugs available; to educate and involve the public, communities, families and consumers; to establish national policies, programs, and legislation; to develop human resources and link with other sectors; to monitor community mental health and to support continued relevant research.

I would consider it a grave omission and an injustice were I not to address the issues of domestic violence and sexual abuse, particularly of young children, in the context of mental health. Public health, and especially mental health, must be visible in taking a place around the table in tackling these major social ills. Substance abuse, colleagues, is a major determinant of domestic violence and sexual abuse, social issues we (in public health and in mental health) have been too timid to enter as major players to bring greater attention, greater action and bring about change. Some persons have questioned public health’s and mental health’s legitimacy in the fight against domestic and sexual violence, putting the responsibility upon social services and security sectors. I posit we have strong legitimacy in demanding a place at the table in tackling these social issues. These are Health for All issues. And mental health figures prominently in the equation.

It is against this background of persistent neglect of mental health in our health and development agenda that I have come here to highlight the continuing plight of the world’s most marginalized population – those living with and at risk for mental illnesses. Addressing the continued scandalous plight of the people living with mental and psychosocial disabilities and those at risk because of the absence of mental health promotion and prevention of mental illnesses programs must be a cause we pursue as an emergency.

I am here, ladies and gentlemen to stand up for the almost 1M persons who lose their lives each year because of suicide, for the millions who live lives of misery because of depression and various forms of psychosis, for the growing number of elderly whose lives have become intolerable because of various forms of dementia, for the growing number of young persons who are addicted to various substances. I am here to stand up for the millions of women who suffer post-partum depression. I am here for the millions of children who suffer from post disaster stresses and for the millions around the world who are homeless because of their mental conditions. I am here sisters and brothers to raise my voice for the 600M children in developing countries who are living in the most disfiguring, grinding poverty imaginable – their lives in its stranglehold, their potential wasted, their hopes crushed by a world that condemns half of its children to failure even before their life’s journey has begun.

Through your efforts, the herculean efforts of the WHO and of many agencies around the world, we know that mental and psychosocial disabilities represent a major cause of disease burdens, of deaths and of disabilities. Just examine the picture of deaths and disabilities due to suicide around the world. Look deeper into the causes of deaths and disabilities because of violence and accidents. What about the contribution of mental disorders in the negative outcomes from other diseases?

The fact, ladies and gentlemen, is that we are unable to meet the mental health needs of people, almost everywhere in the world, but most especially among the poorest countries, because national governments everywhere and donors and development agencies have failed to invest in metal health. We know the statistics – most countries invest less than 1% of the health budgets for mental health programs and the overall development aid in health have also invested less than 1% for mental health.

This lack of investment and appalling lack of interest in promoting mental health and preventing mental disorders is one of the major factors in the persistence of poverty in most settings.

The investment in developing medicines and commodities for mental health lags far behind those for other areas.

There is an almost total lack of human resources for mental health in most developing countries and this compounds the problem.

Our collective failure to promote mental health and to prevent mental and behavioural disorders contributes significantly to the vicious cycle of poverty, deprivation and hopelessness and should shame us indeed. But it is this shame that must serve as an impetus that challenges us to act. We must act to end the stranglehold of despair resulting from mental and behavioural disorders.

This brings me to the subject of how we can correct the lack of interest in mental health and how we must ensure that mental health becomes a part of the development story, of the story of poverty reduction and eradication.

In 2000, the world came together and discussed a way forward to reduce poverty and bring better health to people. The historic meeting of heads of states resulted in the MDGs – the Millennium Development Goals. It was a powerful Instrument for Poverty Reduction and an Instrument that sought better health for millions around the world.

But there was a fatal flaw – it did not consider the impact of the NCDs and Mental and Behavioral Disorders on poverty and well-being. It must be incomprehensible to any sensible person that the causes of the most significant amounts of disease burden and of deaths and disabilities - the NCDs and Mental and Behavioral Disorders – could be left out from consideration by the UN. Together, the NCDs and Mental Health account for between 70 and 80% of all deaths in the world. It was then and still unfathomable to me why a Poverty reduction Tool and Treaty found it possible to omit the major causes of deaths and disabilities.

It was for this reason that while applauding the MDGs, I was urging in 2001, the addition of indicators for the MDGs for the NCDs and Mental Disorders. I had at the time called the adjustment the MDG+.

The struggle for almost ten years was mostly a struggle with few voices, particularly in the early years. In the last several years, however, an avalanche of voices has joined the call for recognition of the NCDs as a critical contributor to under-development in the world. The result was the formation of the NCDNet and other coalitions. Led by Caribbean countries, the UN has passed a resolution earlier this year, giving recognition to the significant threats of the NCDs and has agreed to a high-level meeting at the UN in September 2011.

This is a great victory. But again, there is a flaw – mental health is being overlooked and ignored again. I am told that mental health would be taken into consideration as part of the NCDs. This is a betrayal and unless we ensure that the summit would be one addressing the NCDs and mental health, mental disorders will again be placed in a disadvantageous position and will continue to be an invisible problem in international development initiatives.

There are some who would say that the cards have been dealt and that we cannot now place mental health on the development and health agenda for 2011. Let me remind you that once the NCD summit is held and considering the great advocacy for funding which now has gotten a commitment of about $100B annually by 2020 for climate change adaptation and mitigation programs, it would be long after our lifetime we could hope to get attention being paid to mental health.

For those among us who have been campaigning that we should stay away from the NCD surge, and have our own campaign, I say shame on you for that time will not come in our life time. We must be a part of the 2011 Summit.

It will not be easy. But let me remind you that in 1962 faced with many difficulties and wanting to go to the moon, the American President, John Kennedy, explained to his people:

We chose to go to the moon in this decade and do other things, not because they are easy, but because they are hard, because that goal will serve to organize and measure the best of our energies and skills, because that challenge is one that we are willing to accept, one we are unwilling to postpone, and one which we intend to win, and others, too.

I do believe we must do everything in our power, we must create a unified force and we must find inclusion in the UN High-Level Meeting in September 2011 so that we can place mental health firmly on the health and development agenda.

We can make a difference together.

We can do it and if we succeed, the legacy will be a world described so beautifully by the great philosopher:

I see tress of green, red roses too
I see them bloom for me and you
And I think to myself, what a wonderful world!
I see skies of blue and clouds of white
The brightness of day, the darkness of night
And I think to myself what a wonderful world.

I am sure you recognized the wisdom of the great Satchmo Armstrong. Like the Beatles, I challenge you: Imagine.

Dr. Leslie Ramsammy
Minister of Health, Guyana
November 18, 2010