Subtheme D: Supporting Mental Health
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“A new United Nations publication indicates that 20% of youth experience a mental health condition each year. One of
every five; they are our family members or our friends.
The stigma associated with having a mental health condition can cause enormous problems for young people – from
jobs to relationships. Stigma leads to neglect and discrimination. It keeps governments from investing in services. It
leaves young people isolated, especially those who are already vulnerable as a result of homelessness, conflict or other
troubles.”
- Secretary General Ban Ki-moon, on World Mental Health Day
________________________________________________________________________
Sustainable Development Goals Pertaining to this Subthemei
Goal 1.
End poverty in all its forms everywhere
Goal 3.
Ensure healthy lives and promote well-being for all at all ages
Goal 4.
Ensure inclusive and equitable quality education, promote lifelong learning opportunities for all
Goal 8.
Promote sustained, inclusive and sustainable economic growth, full and productive employment
and decent work for all
Goal 10.
Reduce inequality within and among countries
Goal 11.
Make cities and human settlements inclusive, safe, resilient and sustainable
Goal 16.
Promote peaceful and inclusive societies for sustainable development, provide access to justice
for all and build effective, accountable and inclusive institutions at all levels
Note: For all bolded words, please see “Key Terms”
Introductionii
Virtually all countries are experiencing the move of populations from rural areas into cities. As of 2015, more
than half of the world’s population lives in cities. By 2030, this number will swell to 5 billion people.
More than 450 million people worldwide suffer from mental health conditions, such as depression, anxiety,
bipolar disorder, schizophrenia, and PTSD. It is estimated that one in four people will have some sort of mental
health condition during their lifetime. A study in the Indian Journal of Psychiatry states, “The range of disorders
and deviancies associated with urbanization is enormous and includes psychoses, depression, sociopathy,
substance abuse, alcoholism, crime, delinquency, vandalism, family disintegration, and alienation.”iii
The economic cost of mental health problems is vast, while reasonable investment in mental health can
ameliorate these costs. According to the National Institute of Mental Health, a new report estimates that the
global cost of mental illness was nearly 2.5 trillion dollars in 2010, with a projected increase to over 6 trillion
dollars by 2030iv.
Achievement of the SDGs will help alleviate mental health issues in many cases - as poverty, hunger, lack of
education, lack of work, poor physical health, and gender inequality can be contributing factors to ill mental
health.
Problem 1 – Depression
Depression is one of the most common mental disorders. According to the World Health Organization, more
than 350 million people suffer from depression globallyv. Suicides account for one million deaths annually, and
it is the third leading cause of death among young people.
Typically, depression occurs in higher rates in urban dwellers, as compared to their rural and suburban
counterpartsvi. People who suffer from depression often experience the following symptoms: lethargy,
agitation, apathy, anxiety, sadness, loss of interest, restlessness, self-harm, social isolation, obsessive thoughts,
and hopelessness. Depression can also lead to slowed thinking and body movements; feelings of worthlessness;
fixating on past failures; and trouble making decisions and remembering things.
To combat depression, many experts suggest going outside and exercising. A study in the Proceedings of the
National Academy of Science showed that people who exercised in nature, as opposed to in an urban landscape,
showed reduced activity in the subgenual prefrontal cortex – the brain area that is active when dwelling on
negative emotion.
Key Facts:
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80% of all people with clinical depression who have received treatment significantly improve their lives.
Women experience depression about twice as often as men.
The World Health Organization estimates that depression will be the 2nd highest medical cause of
disability by the year 2030, second only to HIV/AIDS.
People who are depressed are more prone to illnesses like colds than non-depressed people.
Success Stories In Sakai, Japan, the massive cliffs of Tojimbo claim thousands of lives every year. According to the World Health
Organization, in 2013 Japan’s national rate of suicide stood at 21.4 deaths per 100,000 people-well above that of
other high-income countries. This country is considered one of the most suicide-prone nations in the world.
Yukio Shige, a retired policeman, has started a significant campaign against suicide. He, and others he has
influenced, have made their mission clear: to stop suicides from taking place at the cliffs of Tojimbo.
Together, they have saved more than 222 people, a number that has made Mr. Shige a national figure. His
approach is simple and it starts with conversation. Depression in Japan is considered taboo, and suicide is not
looked at as a public health issue. Most of the people attempting suicide need someone to talk to, and that is
what Shige and his group does. He now has 77 volunteers patrolling the cliffs and providing food, lodging, and
assistance in finding jobs to those who need help.
In 2005, a nongovernmental organization, LIFELINK, came together with the Japanese parliament to coordinate
the very first forum on suicide. Their stance is that suicide is a preventable death, and the Committee of Health,
Labour and Welfare of the House of Councilors took a stand for extensive measures of suicide prevention. All of
these groups believe suicide should be taken as an extremely urgent matter. Japan’s Basic Act for Suicide
Prevention was written into law in June 2006.
Additional information:
http://www.who.int/mental_health/suicide-prevention/japan_story/en/
http://www.nytimes.com/2009/12/18/world/asia/18japan.html?_r=0
Problem 2 – Lack of Green Spaces
Goal 11 of the Sustainable Development Goals targets the provision of universal access to safe, inclusive and
accessible, green and public spaces. Ecosystems provide many of the material building blocks for human wellbeing. Although quantification and appreciation of such contributions have rapidly grown, our dependence upon
cultural connections to nature deserves more attention.
Encounters with nature help alleviate mental fatigue by relaxing and restoring the mind. Within built
environments, parks and green spaces are settings for cognitive respite, as they encourage social interactions
and de-stressing through exercise or conversation, and provide calming settings. Having quality landscaping and
vegetation in and around the places where people work and study is a good investment. Proximity to green
spaces restores the mind’s ability to focus. This can improve job and school performance, and help alleviate
mental stress and illnessvii.
Experiencing nature relieves the mind from the mental fatigue of everyday life, contributing to improved work
performance and satisfaction. Urban nature, such as parks, walkways and eco-integrated building design,
provides calming and inspiring environments and encourages learning, inquisitiveness, and alertness. Green
spaces provide necessary places and opportunities for physical activity. Exercise improves cognitive function,
learning, and memory. By extension, this improves mental health because, “physical activity and
exercise...provide a beneficial adjunct for alcoholism and substance abuse programs; improve self-image, social
skills, and cognitive functioning; reduce the symptoms of anxiety; and alter aspects of coronary-prone (Type A)
behavior and physiological response to stressors.” viii,
Outdoor activities can help alleviate symptoms of Alzheimer’s, dementia, stress, and depression by relaxing and
restoring the mind. Activity can also improve cognitive function in those recently diagnosed with breast cancer.
Participation in activities in natural environments is shown to lighten and help counteract mental fatigue before
and after breast cancer treatment or surgery. Contact with nature also helps children to develop cognitive,
emotional, and behavioral connections to their nearby social and biophysical environments.
Symptoms of ADD in children can be reduced through activity in green settings, thus “green time” can act as an
effective supplement to traditional medicinal and behavioral treatments.
Key Facts:
● Lack of access to green space raises blood pressure. A study of 10 year olds living in urban areas
revealed that low access to green space resulted in higher blood pressure than those with access to
green spacesix.
● Every 10% increase in green space is associated with a reduction in diseases equivalent to an increase of
five years of life expectancyx.
● A study of green spaces in the USA shows that the median percentage of green space in rural areas is
55%, in contrast to only 2.8% in central urban areasxi.
Success Story:
In the 1960’s, the southern Bronx area in New York was affected by a period of urban decay caused by
white flight, landlord abandonment, and the development of the Cross Bronx Expressway. Since then,
there has been a plague of chronic illnesses deriving from environmental changes, the decline of green
space, and pollution. However, plans to restore the Mott Haven and Port Morris neighborhoods of the
South Bronx have been announced by the New York Restoration Project (NYRP), a nonprofit that
transforms open community space. “Changes include visible street crossings, new bike and pedestrian
routes, improved access to the waterfront, the planting of 800 trees, and the installment of public art
in a network of trails”.
NYRP’s executive director, Deborah Marton, has found that recent studies connect chaotic
environment to poor brain development in children, diabetes, poor air and tree quality, and a decline
of economic vibrancy. “If people have green space, they can live a better live” she stated. Lack of green
space impairs mental wellbeing by preventing indulgence of the outdoors. The NYRP organization
wants to improve the surroundings for residents who have long believed that they’re neglected by
design rather than accident.
Additional information:
http://thinkprogress.org/health/2015/07/10/3678834/green-space-in-south-bronx/
Problem 3 – Childhood Mental Health
Children and adolescents are the key to sustainable development. As such, their well-being is imperative. The
world has paid close attention to their protection and physical needs such as food, water, and shelter; however,
the mental health care of children and adolescents has been neglected. The lack of attention to children’s
mental health may lead to mental disorders with lifelong consequences. This undermines compliance with
health regimens and reduces the capacity of societies to be safe and productive.
Maltreatment of children contributes to their mental health in a variety of negative ways. According to the
World Health Organization, child maltreatment is the abuse and neglect that occurs to children under 18 years
of age. It includes all types of physical and/or emotional ill-treatment, sexual abuse, neglect, negligence and
commercial or other exploitation, which results in actual or potential harm to the child’s health, survival,
development or dignity in the context of a relationship of responsibility, trust or power.
Studies have shown that poor conditions during childhood can have lasting effects. Developing brains can be
adversely impacted and can create mood issues into adulthood. These changes lead to problems dealing with
stress over a lifetime, and even several lifetimes. Early life stress can cause epigenetic changes meaning that
genes can be altered and these alterations can be passed onto future generations.
Key Facts:
• Worldwide about 10% of pregnant women and 13% of women who have just given birth, experience a
mental disorder, primarily depression. In developing countries this is even higher, 15.6% during
pregnancy and 19.8% after child birth. In severe cases mothers’ suffering might be so severe that they
may even commit suicide. In addition, the affected mothers cannot function properly. As a result, the
children’s growth and development may be negatively affected as well.xii
• Worldwide 10-20% of children and adolescents experience mental disorders. Neuropsychiatric
conditions are the leading cause of disability in young people in all regions. If untreated, these
conditions severely influence children’s development, their educational attainments and their potential
to live fulfilling and productive livesxiii.
• Worldwide up to 20% of children and adolescents suffer from a disabling mental illness.
• Worldwide suicide is the 3rd leading cause of death among adolescents.
• Major depressive disorder (MDD) often has an onset in adolescence, across diverse countries, and is
associated with substantial psycho- social impairment and risk of suicide.
Success Stories:
In Canada, approximately 1 in 5 children and adolescents experience some form of mental disorder. Most major
mental disorders begin prior to the age of 25, making adolescence a critical time for the promotion and
treatment of mental health problems.
In order to combat these problems – a collaboration of mental health professionals, students, officials, parents,
and members of the public have joined together to create Evergreen. Evergreen is a Youth Mental Health
Framework. The framework has been developed with leading scientific information to create a multifaceted
approach to teen mental health.
Evergreen works to demystify and destigmatize mental health issues through a network of mental health
professionals, programs, peer to peer exchanges, social media campaigns, story sharing, emergency help, and
more.
In addition to working with Canadian teens, the group has also developed Broadcast Mental Health (BMH).
BMH is an initiative that combines interactive radio programs for youth, school curriculum materials about
mental health, and evidence based adolescent mental health care approaches that help address youth
Depression and other mental illnesses in African countries.
Learn more here –
http://teenmentalhealth.org/new-initiatives-posts/evergreen-youth-mental-health-framework/
http://teenmentalhealth.org/wp-content/uploads/2015/06/Broadcast-Mental-Health-Proposal.pdf
Problem 4 - Terrorism
For well over a decade, violent extremism has plagued countries all over the world. Since 2001, terrorist
fatalities have increased fivefoldxiv. An increase in the prevalence of psychiatric disorders is one consequence of
terrorism. Even emotional and behavioral changes that do not reach the level of a diagnosable disorder may
contribute significantly to the overall health burden resulting from terrorist attacks.xv
Sadly, there has been a wealth of research on the impacts of terrorism on society. In studies of New York (after
9/11), Israel, and Northern Ireland, it has been shown that society at large is relatively resilient. In days after
attacks, there is a spike in mental stress on the general population. After just a few months, the percentage of
mental health issues returns to near pre-attack levels.
How an individual responds to terrorism depends on a number of key factors. These include factors such as
genetic makeup, social contexts, past experiences, and future expectations, which work together to produce a
psychological response. Close proximity to the event, severity of exposure, low levels of social support, previous
psychiatric illness, history of trauma, and ongoing negative life events may also all influence the onset and
course of psychiatric illness. Suffering physical injuries as a result of an attack was strongly associated with
increased psychological trauma - the more serious the injuries, the more serious the trauma. Survivors of
terrorist attacks show high levels of Post-traumatic Stress Disorder (PTSD). xvi xvii
Children are especially vulnerable to the psychological effects of terrorism. Children are at risk for experiencing
mental health difficulties after an act of terrorism if: they are live near the event; they witness the attack; they
lose loved ones as a result of the attack; and/or if they watch coverage of the event on television. The mental
impact can be compounded if the children have already experienced stressors such as parental divorce, loss,
health issues, or hospitalization of a family member. xviii
Key Facts:
 Terrorism caused 130,000 deaths worldwide between 2006 and 2013.
 Middle Eastern countries, including Iraq, Afghanistan, and Pakistan, experience the highest number of
fatalities due to terrorist attacksxix.
 Almost one year after the Oklahoma City bombing, 50% of local elementary school children reported
clinical levels of PTSD, and one half reported being concerned about the safety of their family.
 Rates of mental disorder tend to double after emergencies.
 Low-income countries have 0.05 psychiatrists and 0.42 nurses per 100,000 people. The rate of
psychiatrists in high income countries is 170 times greater and for nurses is 70 times greater.
Success Story:
Violence and terrorism have been a part of life in Pakistan in recent years. Along with the growing violence has
come a growing need for mental health care. In the wake of the attacks on the Army Public School in Peshawar,
a team of volunteer psychologists and psychiatrists provided psychological help to the survivors – who were
mostly students. During the four-day assessment, the team uncovered a complex picture of mental health
damage that will affect the children, as well as the parents, teachers, policemen and military officers at the
scene.
Some of these survivors will join the 10% of Pakistanis who suffer from some form of mental illness. According
to WHO figures, in developing countries like Pakistan, one percent of the population suffers from severe and
10% from mild mental disorders. xx Many Pakistanis display trauma from the violence that surrounds them,
magnifying tensions and anxieties created from difficult family conditions, lack of money, or the everyday stress
of uncertain access to water or electricity. In a country of 180 million people, only about 340 psychiatrists are
working today — one for every 333,000 people.
One man, Karachi-based psychiatrist Dr. S. Haroon Ahmed, has taken up the mantel of mental health and
created the Pakistan Association for Mental Health (PAMH). The Association conducts awareness camps in
Karachi’s slums and working-class neighborhoods. Attendees learn the signs of mental illness, and people with
symptoms are urged to seek psychiatric or psychological treatment at a clinic. “We have a responsibility to
protect the mentally ill,” says Dr. Ahmed. “They suffer sometimes silently, and sometimes violently.”xxi
In addition to the camps, PAMH operates a Free Mental Health Clinic, runs awareness campaigns, offers training
workshops, and produces mental health publications.
Learn more here - http://pamh.org.pk/
Key Terms:
Mental Health and Poverty: people with mental and psychosocial disabilities are living in poverty, poor physical
health, and are subject to human rights violations. Poor mental health is both a cause and a consequence of
poverty, compromised education, gender inequality, ill-health, violence and other global challenges
Depression: Depression is a common mental disorder, characterized by sadness, loss of interest or pleasure,
feelings of guilt or low self-worth, disturbed sleep or appetite, feelings of tiredness, and poor concentration.
PTSD: PTSD, or Posttraumatic Stress Disorder, is a psychiatric disorder that can occur following the experience or
witnessing of a life-threatening events such as military combat, natural disasters, terrorist incidents, serious
accidents, or physical or sexual assault in adult or childhood
Human Right: human rights are Universal and inalienable, interdependent and indivisible, Equal and nondiscriminatory, Both Rights and Obligations. See more: <http://www.un.org/en/documents/udhr/>
Neuropsychiatry Conditions: neuropsychiatry involves the interface area of psychiatry and neurology. This is a
specialist medical discipline involving the behavioral or psychological difficulties associated with known or
suspected neurological conditions such as epilepsy, head injury, attention deficit disorder, dementia, tardive
dyskinesia, atypical spells, irritability and any organic mental disorder. Neuropsychiatric conditions are the
leading cause of disability in young people in all regions.
Infrastructure: Refers to the fundamental facilities and systems serving a country, city, or area, including the
services and facilities necessary for its economy to function
Sustainable Development: Development that meets the needs of the present without compromising the ability
of future generations to meet their own needs.
White flight: The large-scale migration of whites of various European ancestries from racially mixed urban
regions to more racially homogeneous suburban or exurban regions.
Additional Resources:
UNICEF: The Gatehouse Project:<http://www.rch.org.au/cah/research/The_Gatehouse_Project/>
WHO:
Humanitarian Intervention Guide <http://www.who.int/mental_health/publications/mhgap_hig/en/>
Children and adolescents mental health <http://www.who.int/mental_health/maternalchild/child_adolescent/en/>
“Longitudinal Effects on Mental Health of Moving to Greener and Less Green Urban Areas”
http://pubs.acs.org/doi/abs/10.1021/es403688w
An Urgent Challenge: Adolescent Mental Health
http://www.unicef.org/sowc2011/pdfs/Adolescent-mental-health.pdf
Mental Health of Children Facing Adversity
http://www.academia.edu/1260563/The_mental_health_of_children_facing_collective_adversity_Poverty_hom
elessness_war_and_displacement
WHO Fact Sheet(s) on Mental Health
http://www.who.int/mediacentre/factsheets/fs220/en/
http://www.who.int/topics/mental_health/factsheets/en/
Movement for Global Mental Health
http://www.globalmentalhealth.org/events
Poverty – Mental Health in US
https://www.psychologicalscience.org/index.php/publications/observer/obsonline/childhood-poverty-linkedwith-worse-mental-health-in-emerging-adulthood.html
Poverty – Mental Health in Scotland
http://www.bbc.com/news/uk-scotland-32715463
i
Sustainable development goals. Retrieved from http://sustainabledevelopment.un.org/focussdgs.html
WHO Mental Health, Poverty & Development (why mental health matters)http://www.who.int/mental_health/policy/development/1_Breakingviciouscycle_Infosheet.pdf
iii Indian Journal of Psychiatry - http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2738359/
iv http://www.un.org/disabilities/default.asp?id=1545
v http://www.who.int/mediacentre/factsheets/fs369/en/
vi http://www.theguardian.com/cities/2014/feb/25/city-stress-mental-health-rural-kind
vii
Wolf, K.L., and K. Flora 2010. Mental Health and Function - A Literature Review. In: Green Cities: Good Health
(www.greenhealth.washington.edu). College of the Environment, University of Washington
viii US National Library of Medicine, National Institutes of Health- http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1424736/
ix http://www.ncbi.nlm.nih.gov/pubmed/24886243
x http://www.eea.europa.eu/articles/forests-health-and-climate-change/
xi http://activelivingresearch.org/sites/default/files/ABM2013_ArticleSummary_Wen.pdf
xii http://www.who.int/mental_health/maternal-child/en/
xiii http://www.who.int/mental_health/maternal-child/en/
xiv http://www.theguardian.com/uk-news/2014/nov/18/fivefold-increase-terrorism-fatalities-global-index
ii
http://www.psychiatrictimes.com/disaster-psychiatry/psychiatric-and-societal-impacts-terrorism#sthash.3t270Hwn.dpuf
http://www.aaets.org/article216.htm
xvii
http://bjp.rcpsych.org/content/190/2/94
xviii
http://www.apa.org/about/gr/issues/cyf/disaster.aspx
xv
xvi
xix
xx
http://www.statista.com/topics/2267/terrorism/
http://jpma.org.pk/full_article_text.php?article_id=1386
xxi
http://www.nytimes.com/2015/02/20/opinion/bina-shah-aiding-pakistans-mentally-ill.html?_r=0