“With 55 million affected in the world, dementia is one of the greatest public health challenges”

Many mental disorders are inevitably associated, among other causes, with the aging of the population. What is being done and with success by the WHO or the World Federation of Psychiatry and other relevant organizations?

Among the different mental health conditions that affect the aging population, dementia is one of the world’s biggest public health challenges. Currently, with a global estimate of 55 million people living with dementia, dementia has not only entered the top 10 causes of death worldwide, but it is also ranked the 3^rd leading cause of death in the Region of the Americas. In 2019, it was reported that 10.3 million people lived with dementia in the Americas.

In 2017, The WHO launched the Global action plan on the public health response to dementia 2017-2025 for Member States and strategic partners to work towards a world in which dementia is prevented and people living with dementia and their caregivers are supported. As the burden of dementia continues to rise in the Region of the Americas, PAHO aims to collaborate with Member States in aligning their goals and implementations to the global dementia action plan.

What are, in your opinion, the main gaps and obstacles?

In many countries in the Americas, dementia continues to be stigmatized [a typecasting of these people that is very difficult for them to get rid of] and misunderstood. People living with dementia, their families and caregivers continue to experience discrimination. Countries are called to increase public awareness and understanding of dementia, and to develop dementia-inclusive environments. 

There are currently active voices against the stigmatization of the mentally ill. At a time when the disorders seem to have increased, what evolution do you see?

Stigma is a major barrier for people to access the mental health care they need. Stigma is responsible also for poor quality physical care for people with mental illness. It deeply affects help-seeking behaviors.

In order to fulfill our objectives to scale up mental health care and make it available as close as possible to where people live, we all need to fight stigma. Talking about mental issues is one-way, mental health is part of our health as a whole. That’s why we say there is no health without mental health.

Do you think that what we have experienced will make governments, organizations, civil society and, individually, do more to take care of mental health and promote inclusion, for example?

Despite all the bad things that have happened since the pandemic began, I believe it has contributed to bring mental health and the importance of protecting ones mental health to the top of the agenda. This had not happened before.

But unfortunately, that alone is not enough to decrease stigma by itself.

Stigma is probably gradually decreasing but in order to fight stigma in a much stronger way, one important step that countries need to take is to develop anti stigma strategies that incorporate people with lived experiences of mental health problems in their design, development, implementation and evaluation.

Promoting social contact with people with lived experience helps to disconfirm stereotypes, decrease anxiety, increase empathy, establish personal connections, and improve understanding of recovery. There is much more that we can do on that.

We have seen that COVID has exacerbated, for example, the risk factors associated with suicidal behaviors, so its key people feel free to talk about their issues, and seek helps without barriers, without discrimination.

People can also contribute to fight stigma against mental health issues. You can talk about your own mental health if you feel comfortable, join mental health campaigns and also advocate for increased access to mental health care. And health workers are also key. We need health care setting free of stigma, open to diversity so that people with mental issues, that can be any of us at some point in our lives, feels they can talk about it and ask/look for help.

What other ways and innovative solutions can help foster the integration of these people? 

There are many innovative solutions all around the world on integrating people with mental health conditions and helping them fully exercise their rights that are clearly stated in the Convention on the Rights of People with Disabilities:

• Respect for inherent dignity, individual autonomy including the freedom to make one’s own choices, and independence of persons.
• Non-discrimination.
• Full and effective participation and inclusion in society.
• Respect for difference and acceptance of persons with disabilities as part of human diversity and humanity.
• Equality of opportunity.

The recent guidance document on community mental health services: promoting person centered and rights based approaches (Guidance on community mental health services: Promoting person-centred and rights-based approaches) provides a detailed description of person-centered and human rights-based approaches in mental health, and summary examples of good practice services around the world. 

It describes the linkages needed with housing, education, employment and social protection sectors, and presents examples of integrated regional and national networks of community-based mental health services. Specific recommendations and action steps are presented for developing community mental health services that respect human rights and focus on recovery. I would really recommend everyone to read it.