Millions of people are currently living with the disabling consequences of Neglected Tropical Diseases (NTDs) and mental disorders are widespread among people living with these diseases. Breaking the silence and promoting mental health reduces the burden of NTDs and the suffering of the inflicted.
According to UNDP’s Human Development Index Report 2021-2022, 1 in 8 people worldwide suffer from poor mental health. This hampers human development, since mental suffering impedes people’s ability to transform resources into achievements, to realise their full potential and to lead lives whose value is based on sound arguments.
In low- and middle-income countries, illnesses such as depression are a direct consequence of suffering from an infectious disease. While progress has been made in addressing the mental health consequences for people affected by HIV and tuberculosis, psychological support for people suffering from any of the 20 NTDs is often non-existent.
Addressing neglected diseases beyond the biomedical approach
The last decade has seen an extraordinary increase in attention to NTDs. The WHO’s global commitment and the commitment of hundreds of organisations working to control and eliminate these diseases is bearing fruit. Still, there is much work to be done with the impact these diseases have on the lives of the people who suffer from them.
Programmes that fight NTDs are often targeted towards a biomedical model of the disease. Clinical symptoms are usually identified and treated, but they do not focus on the wider impact of the disease on people’s lives. There are gaps in how to address the disabilities generated by these diseases as well as the stigma, discrimination and psychological impact that these disabilities have on the people who suffer from them.
NTD programmes should provide saneness services to enhance the well-being of people living with NTDs, as advocated by the WHO itself in its “Mental Health of People with NTDs” report. According to this report, it is estimated that less than €1.5 per person could provide mental health care in low- and middle-income countries affected by NTDs.
Mental health, disability and stigma: a challenge to overcome
NTDs programmes should broaden their focus in the next decade to include disability, mental health and stigma, increasing their benefits to people living with NTDs and disabled people at risk of developing them.
The path from health problem to exclusion is not the same for everyone. It is shaped by personal factors, such as wealth, social support and education, and by structural factors, such as the existence of laws that protects rights or the availability of support mechanisms.
If we take this approach to disability, it is clear that most of the 20 major NTDs can cause impairments and thus disability.
Trachoma and onchocerciasis can cause blindness; cutaneous leishmaniasis, leprosy, chikungunya, yaws, lymphatic filariasis, Buruli ulcer, Chagas disease and African trypanosomiasis can cause physical impairment; and soil-transmitted helminths and schistosomiasis are associated with physical and mental developmental delay and developmental disabilities.
Several NTDs, such as leishmaniasis, leprosy and lymphatic filariasis, cause facial and body changes, or disfigurement, resulting in pain and distress. Exclusion due to physical and sensory impairments can worsen mental balance. Perhaps most importantly, stigma causes both exclusion and poor mental health.
Disabilities associated with NTDs can therefore lead to exclusion from education and learning, reduced employment and economic productivity, and poor well-being for those inflicted with the condition.
How do we take care of mental stability of people with a NTD?
Mental health support for people with disabilities associated with NTDs should be incorporated into their treatment. The WHO is developing practical guidelines to include this dimension, but mental health needs to be addressed beyond health care settings. Education and social participation and the establishment of self-help groups can promote empowerment and break down stigma.
In fact, there are already a number of proven strategies to reduce stigma, which focus mainly on demystifying NTDs through awareness-raising events, education and media campaigns.
In Ghana, for example, a qualitative study was conducted on 18 mental ilness self-help groups of people with mental health issues. With the cooperation of five local non-governmental organisations, community mental health nurses and administrators from the Ghana Health Services, the groups fostered better acceptance of people with mental health issues by their families and communities. They also provided social, economic and practical support to people with mental health issues and their caregivers. It was further concluded that self-help groups could be core components of community mental health programmes in low-resource settings.
Participation in self-help groups reduces the use of inpatient facilities, enhances the social lives of people with mental health issues and reduces the burden on caregivers.