World Mental Health Day 2021: inequalities in an unequal world

Message of the Prefect of the Dicastery for Promoting Integral Human Development for World Mental Health Day, 10 October 2021


World Mental Health Day is celebrated on 10 October. This year’s theme is Mental Health in an Unequal World, and aims to draw attention to the inequalities that exist in the treatment and care of people with mental illness.

In low- and middle-income countries, between 75% and 95% of people with mental disorders cannot access mental health services, and in high-income countries the situation is no better! [1World Federation for Mental Health (WFMH), 2021 World Mental Health Global Awareness Campaign, in]

One of the most neglected dimensions in the broad universe of health is mental health, which is often accompanied by stereotypes, lack of knowledge about specific issues and misinformation. Worldwide, many human rights violations are committed against people with mental disorders: men and women of all ages who already suffer from the stigma and discrimination to which they are subjected, leading to isolation and marginalisation. In about half of all cases, mental disorders start before the age of 14, so much so that suicide is the second leading cause of death among 15 to 29 year olds.

Current situation

It is estimated that before the Covid 19 pandemic, almost one billion people worldwide suffered from mental disorders. As the health emergency unfolded, the social restrictions imposed by the first phase of the emergency led to an increase in the abuse of alcohol and other psychotropic substances, as well as the exacerbation of various forms of addiction, including gambling. It is precisely the measures taken to combat the Covid 19 virus that have been a further cause of loneliness for people with mental disorders: the impossibility of carrying out their usual activities and cultivating their usual relationships has worsened their already distressing condition of marginalisation, especially for people who are housed in social assistance institutions and psychiatric hospitals. [2 World Health Organization (WHO), 148th Session Executive Board, Report by Director General “Mental health preparedness and response for the Covid-19 pandemic” in https:/ files/EB148/B148 20- en.pdf.]

In reality, the onset of the pandemic, with profound consequences for the entire world population, is only the precipitating factor in a multi-dimensional crisis rooted in inadequate social, health and economic policies. Policies that have often generated new poverty and marginalisation, and which continue to create conditions of injustice and unfairness in the distribution of resources, to the detriment of millions of people. A crisis fuelled by a widespread weakening of spiritual values, of the sense of responsibility and of the value of solidarity. The gap between rich and poor has widened. With the health emergency, new poverties have emerged, adding to the already known social fragilities, mainly due to the lack of work. [3Dicastery for Promoting Integral Human Development, “Accompanying people in psychological distress in the context of the COVID-19 pandemic”, November 2020, in]In particular, in the most vulnerable countries more and more people are losing their jobs, entering a condition of poverty; it is especially women who suffer most from the consequences of the pandemic and social inequalities. [4 Dicastery for Promoting Integral Human Development, “Accompanying people in psychological distress in the context of the COVID-19 pandemic”, November 2020, in]

Evidence shows that poverty and inequality affect a person’s mental development and mental health. Social disadvantage – which begins before birth and increases throughout life – has a significant impact on an individual’s mental health as a critical factor: the physical and social environment in which one lives, as well as access to health services and education, are all social determinants that have a profound effect on mental health.

In order to reduce the incidence of mental disorders associated with social inequalities, it is therefore necessary to adopt policies aimed at improving the physical and social environment of the unborn child, as well as living conditions during early childhood, school age, the period when family plans and professional ambitions are being realised, and in later life. In particular, it has been observed that ensuring optimal living conditions for children from the outset offers a greater likelihood of wellbeing, including mental wellbeing, in adulthood, with direct benefits for the community to which they belong. [5World Health Organization (WHO), Report on “Social determinants of mental health” (2014) “Disadvantage starts before birth and accumulates throughout life”[iv], in]

In fact, we note that, in every culture, when mental health is lacking, there is a triple fragility: the fragility of any illness that confronts us with a personal limitation; the fragility that arises from a dissolution of one’s own identity, which leaves people “without a face”; the social fragility that is the result of the lack of integration in one’s own community and of the rejection of those who are frightened by mental illness and do not know how to integrate it, welcome it, treat it. Stigma and discrimination can affect more widely and deeply than wounds to the body and mind, and involve not only the person with the disorder but also his or her family. I therefore appeal for action to be taken to put an end to this personal and family stigma by tackling the causes that lead to rejection and isolation.

The role of the care community

In the face of this, we are all called to be close to our brothers and sisters with mental illness, to fight against all forms of discrimination and stigma against them.

As Pope Francis reminds us, “a truly human and fraternal society will be capable of ensuring in an efficient and stable way that each of its members is accompanied at every stage of life. Not only by providing for their basic needs, but by enabling them to give the best of themselves, even though their performance may be less than optimum” [6 Pope Francis, Encyclical Letter Fratelli tutti, no. 110.] Indeed, “only when our economic and social system no longer produces even a single victim, a single person cast aside, will we be able to celebrate the feast of universal fraternity” [7 Pope Francis, Message for the event “Economy of Francesco” (1 May 2019): L’Osservatore Romano, 12 May 2019, p. 8.] The Holy Father’s words tell us that the logic of discarding and rejection is a logic that subverts social justice in the world. The words of the Holy Father tell us that the logic of rejection and waste is a logic that subverts social justice in the world.

This underlines the need to abandon the current paradigm of development in order to adopt a cultural model that restores human dignity to the centre and promotes the good of individuals and of the whole of humanity. It is time to return to caring for the fragility of every man and woman, every child and every elderly person, with the attentive attitude of solidarity of the Good Samaritan [8 Pope Francis, Encyclical Letter Fratelli tutti, no. 79.].

A caring community is a community of Good Samaritans

Our thoughts then turn to the many “hidden Samaritans”, the professionals, volunteers and workers at all levels who take care of those suffering from mental distress with professionalism and competence, and who often operate in difficult conditions due to the absence or scarcity of adequate facilities for treating these illnesses and assisting the sick person and his or her family. It is therefore hoped that the health system will be strengthened to protect mental health, not least by supporting organisations engaged in scientific research into mental illness and promoting models of social inclusion. It is important to involve the community in which the mentally ill person lives, to ensure presence and affection [9 Pope Francis, Message to participants in the National Conference on Mental Health, 14 June 2021.].

It is in this direction that the efforts of the Dicastery for Promoting Integral Human Development and the Vatican Covid 19 Commission, which the Holy Father established on 20 March 2020, within the Dicastery itself, to express the Church’s concern and love for the entire human family in the face of the pandemic, are moving. Drawing on a wealth of expertise from local communities, global platforms and academic experts, the Commission seeks broad and bold changes: dignity at work, new structures for the common good, solidarity at the heart of governance and nature in harmony with social systems. The aim is not only to alleviate immediate suffering, but also to initiate the transformation of hearts, minds and structures towards a new model of development that prepares a better future for all.

Cardinal Peter Kodwo Appiah Turkson