We are all too well aware that there is a link between poverty and mental health in the Western world, which can work in two directions: those with low incomes are more likely to suffer from poor mental health; and people with mental health problems are more likely to experience poverty. In this issue, we consider the link between poverty and mental health from the perspectives of the Caribbean, East Africa and Mexico. In each situation, the relationship between them is complex and dynamic.
Fred Hickling challenges us to consider the possibility that the legacy of colonial rule in the Caribbean has led to a political and economic system that ignores the potential contribution of its most talented citizens, and which engenders a sense of helplessness and hopelessness that can lead to violent crime and mental disorder. Those who escape from this legacy (the so-called Caribbean Diaspora) find little comfort in their hoped-for paradise in Europe or the United States, and are at greater risk of developing mental illness there than is the indigenous population. He concludes that ‘poverty has become too costly to maintain for any society’ – a challenging view indeed.
Fred Kigozi and Joshua Ssebunnya draw our attention to the troubles of East Africa (that cluster of countries around Lake Victoria). In an area of 130 million km2, there are fewer than a dozen psychiatrists. The population is growing rapidly and poverty is increasing. In the countries comprising this region, there have been and continue to be terrible wars and internal conflicts – especially in Rwanda and Uganda. To make matters worse, refugees from beyond their borders are coming in. Not surprisingly, many of these refugees have major mental health problems associated with their experiences and the trauma of dislocation. Objective evidence of post-traumatic stress disorder affecting more than half the adult population in some areas of East Africa has been adduced. How to begin to cope with that mental health burden is an urgent question for those countries affected and for the international community of psychiatrists with an interest in the region. What resources are available, or could be made available, to alleviate the suffering of these people? Dr Kigozi is involved in a mental health and poverty project that has produced a detailed account of services and need in Uganda, in collaboration with the WHO (see http://workhorse.pry.uct.ac.za:8080/MHAPP/public/index_html); it is to be hoped similar reports – serving as the basis for action in adjacent countries – could be prepared too.
Finally, we move across the Atlantic to Mexico and the concerns expressed by Shoshana Berenzon and colleagues that the extreme inequity of income distribution in Latin America is responsible for engendering mental health disorders. After Brazil, Mexico has the largest economy in Latin America and is undergoing rapid development, yet one in six of the population lives in extreme poverty, without easy access to sanitation or drinking water, and many of these people are in urban areas. The reason for much mental illness, according to the surveys reviewed by the authors, is the relative socioeconomic status of the sufferer, who feels unable or unwilling to seek professional help – even if that help is potentially available. The authors point out that there may be quite a discrepancy between the perceived needs of the population suffering from the consequences of extreme poverty and the relatively academic approach to the assessment and treatment of mental illness by professionals. This is, of course, an issue that is not peculiar to Mexico, and bears on a critical aspect of the theme addressed by all our contributors.