Mental illnesses, such as major depression and anxiety disorders, are one of the leading global causes of disability and are responsible for nearly 20 percent of the total years lived with disability (YLD) worldwide. In addition to the disabling effects of mental illness, people with major depression, as compared with the general population, have a 40–60 percent greater chance of suffering from premature death. And despite the high prevalence and efficacy of currently available treatments for mental illness, treatment uptake has historically been low. One 2012 study found that of nearly 25,000 people who completed an online depression screening, 67 percent screened positive for a current major depressive episode, but only 25 percent were receiving treatment. This low rate of treatment uptake is attributable to the numerous barriers to access faced by the mentally ill, including cost, inconvenience, lack of treatment availability, and stigma. Treatment uptake is particularly low in nonmetropolitan areas where there is limited access to trained mental health professionals.
There is a well-known relationship between poverty and mental health. Typically, when we consider the health effects of poverty, we think of communicable diseases and malnutrition. Yet impoverished areas have higher rates of mental illness as well because poverty is both a cause and a consequence of poor mental health. This relationship is particularly pronounced in children—according to a study from the United Kingdom, children in the poorest households are three times more likely to have a mental illness than are those in the most privileged households.
Barriers to accessing treatment are especially pronounced in impoverished areas, where seeking treatment comes at the important opportunity cost of income generation. There is, moreover, still considerable stigma around mental illness, even among upper-income people with high levels of health literacy, and this stigma is considerably worse in poorer areas, where it can manifest as discrimination and even violence against the mentally ill. Finally, there is limited access to trained mental health professionals.
The implications of high mental illness rates are profound. The reduced productivity and workplace
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