Friday, November 1, 2013

The Need to Change Minds in Bolivia

Around 450 million individuals worldwide suffer from mental health disorders at some point in their lifetime; with disorders such as depression, anxiety and dementia accounting for over 13% of the global burden of disease (Kohn et al., 2004; Prince et al., 2007). Furthermore, mental health issues are the largest contributor to disability (GBD, 2010). Despite this, mental health care appears to have comparatively low priority within overall healthcare. Only 5.1% of the world’s healthcare budget is spent on mental health, with this figure only accurately representing high-income countries such as the UK. For low-and-middle-income (LAMI) countries, the proportion of the healthcare budget allocated to mental health can be as low as 0.5% (WHO, 2011). This decline in priority to mental health treatment is also reflected in the human resources allocated to treatment in LAMI countries, with only 0.5 psychiatrists per 100,000 people (in comparison to 8.59 in high-income countries (WHO, 2011)).

This severe lack of mental health resources becomes a double-edged sword for individuals in LAMI countries, who are subject to many more risk factors associated with mental health disorders. This can create a dangerous cycle of poverty and poor mental health unless affordable and accessible mental health care and/or preventative measures are put in place. Risk factors for mental health problems include: malnutrition, poor educational achievement, gender inequalities, financial concerns, bereavements, lack of social status, chronic physical illness, social stigma and poor access to healthcare (Murali & Oyebode, 2004); all of which are more prominent in LAMI countries. Furthermore, oppressive stigmas surrounding areas such as sexuality, women and mental health are still prevalent in many LAMI countries, especially in rural communities, which can cause further problems for those suffering from mental illnesss (Kumar, 2002).

In Bolivia 36% of the population live in extreme poverty. This, combined with less than 0.2% of the healthcare budget allocated to mental health, compounds the problems associated with the everyday stresses associated with poverty (WHO, 2008). It is estimated that there are 1.06 psychiatrists, 0.34 psychiatric nurses, 0.46 psychologists and 0.25 social workers per 100,000 people in Bolivia, a figure far below that of Europe, the US or Latin America as a whole (Alarcón, 2003; WHO, 2011).

With impoteus provided by the Movement for Global Mental Health, the recent Global Burden of Disease (GBD) study (GBD, 2012) and the World Health Organisation’s (WHO) Mental Health Action Plan 2013-2020 now could be a great moment to put global mental health on the Post-2015 Development Agenda. However, the ‘silent majority’ of those suffering from mental health problems are still unlikely to have their voices heard in the midst of research agendas and statistics (Underhill, 2013).

There is evidence of policies being introduced in Bolivia to improve mental health care throughout the country (MSD, 2013), however these plans appear to be politicised in association with the approaching elections making it unclear as to whether they will actually be implimented. Currently, no specific program exists in Bolivia to deal with the mental health of it’s population (WHO, 2011).

The story of the ‘silent majority’ with mental health issues (Underhill, 2013) is the same in Bolivia as it is in most LAMI countries around the world. Due to stigma and prejudice, those with mental health problems are often hidden within their families and communities. Parents may abandon and forget any children who develop mental health or developmental problems rather than seeking help for them. Furthermore, the lack of access to mental health care means individuals are unable to control or improve their condition, often losing their jobs, friends and family and descending further into the cycle of poverty and mental health (La Razón, 2011).

Research and advocacy in the area of global mental health is growing, and a wealth of charities, non-governmental organisations (NGOs) and other groups are working towards the Movement for Global Mental Health. However, it is important to ensure that work is done on a local level to change attitudes towards mental health and to listen to the voices of those experiencing mental health issues.

Written by Steph Hovey


Alarcón, R. (2003) Mental health and mental health care in Latin America, World Psychiatry, 2 (1): 54-56.
Global Burden of Disease (2012). Global Burden of Disease Study 2010. Lancet.

Kohn, R., Saxena, S., Levav, I. & Saraceno, B. (2004). The treatment gap in mental health care. Bulletin of the World Health Organisation, 82, 858-866.

Kumar, A. (2002). Mental health in India: issues and concerns. Journal of Mental Health and Aging, 8 (3), 2555-260.

La Razón (2011). Bolivia no tiene una politica de salud mental. La Razón.

Ministerio de Salud y Deportes (2013) Promoción de la Salud Para Vivir Bien.

Murali, V., Oyebode, F. (2004). Poverty, social inequality and mental health. Advances in Psychiatric Treatment, 10, 216-224.

Prince, M., Patel, V., Saxena, S., Maj, M., Maselko, J., Philips, M.R., & Rahman, A. (2007). Global mental health 1: No health without mental health. Lancet, 370, 859-877.

Underhill, C. (2013) Voices of a silent majority. Huffington Post.

WHO (2008). Informe sobre el sistema de salud mental en Bolivia.

WHO. (2011). Mental Health Atlas. Switzerland: WHO Press.

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