The status of global mental health
How a new report sheds light on some of the problems we are up against as a world
Years ago I was able to spend some time with global mental health leaders in Johannesburg, South Africa. We took a trip to a local community mental health clinic, which looked like a small apartment complex, located just outside the downtown area. Most people receiving care at this clinic also lived here because, and in the words of our tour guide, “The community is not willing to accept them.” So this clinic served as a temporary home for those looking for treatment. There was an intimidating looking locked gate you had to pass through to get into the facility, which was quickly forgotten when you saw the beautiful courtyard filled with all kinds of thriving plants and trees. If you didn’t know where you were, you might just consider this to be another apartment complex in a neighborhood. All the doors opened into the main courtyard, and a couple of the rooms were dedicated for staff to hold various therapeutic activities.
There was one room that was specifically for medication. This room was heavily locked, with massive bars on the windows. While I get why you want to keep medication safe, this felt like an over the top level of safety precautions so of course, I inquired as to why the need to make this room so secure. Apparently, every weekend, some people from the surrounding area would raid the clinic taking anything they could to resell on the streets. Medications being of the highest value, were often the first item sought. It was horrifying and sad to think of this and what those patients and staff must go through every weekend.
While conditions can vary depending on where you live, mental health is something that is felt worldwide. It’s a part of all of us, albeit expressed in different ways depending on your culture, where you live, and more. And don’t forget, certain mental health conditions like depression remain the worldwide leading cause of disability! What I have always thought particularly interesting are the trends across the world - where are some mental health issues more prevalent than others? How do countries compare to another?
Recently, a new report released by Sapien Labs offers some data on the “Mental State of the World.” It’s a wonderful playground for the curious to explore and see some of the trends that emerge from the data. Their report, The Mental State of the World offers data from 64 countries around the world. Using the MHQ assessment in multiple languages, data provides an aggregate metric of mental well-being as well as data on other critical social related factors. Over 400,000 people completed the MHQ for this report!
The MHQ or the Mental Health Quotient is made up of 47 elements of mental function. You can read an article here on how it was created and validated and even take it online yourself. The MHQ scores put people on a spectrum from “Distressed to Thriving”, with a range of scores from −100 to +200. As one might surmise, a negative score indicates how a person’s mental well-being status negatively impacts their life and ability to function. In addition, because of the real time nature of data collection in the MHQ, new questions can be added to give a bit more information on timely topics.
I’ve been following this work for a couple of years now and find it absolutely fascinating. The latest report uses data from 2022 and has a ton of interesting themes in it that are worthy of exploring. While I have grabbed some of the topics I found most useful, I’d encourage you to take a look at the whole report, which can be found here.
COVID-19’s effects are still felt: COVID-19 had a major impact on us all in a variety of different ways. With this as our backdrop, the MHQ scores appeared largely unchanged between 2022 and 2021, which is not a great thing as you can see below. A significant amount of us continue to struggle with our mental health. The good news? A healthy number of us are indeed thriving (38%), but these data vary based upon where you live. For example, the report highlights that “mental well-being was highest in Swahili-speaking Sub Saharan Africa, French-speaking North Africa, and English-speaking South East Asia, and lowest in the Core Anglosphere, English-speaking South Asia and Portuguese Latin America.”
There are pretty big generational differences: Perhaps not surprising, there are significant generational differences across the world. One MHQ question asked how close people were to their family and family members. Worldwide, the percentage of individuals who reported being close to numerous family members decreased for the younger generation. On average, young adults aged 18-24 were close to their families only 22% of the time, while the oldest generation aged 75+ were 44% of the time, indicating a two-fold difference. In contrast, 10% of the 18-24 age reported not getting along with any family members, compared to only 3% of the 75+ generation.
The report also highlighted how young adults aged 18-24 across all regions and language groups are 5x more likely to report mental health challenges. “Social Self,” a metric used to help highlight how a person sees themselves, saw a decrease in 2022. What’s interesting is how this report quantified the diminished bonds of family and friendship as another way to understand why there are lower scores on the Social Self metric.
Family matters: Sadly, friendships and family relationships appear to be disintegrating. And when you consider how the lack of close family and friends is linked to low mental well-being, the data are even more concerning. The report found that younger adults are 3x more likely than older adults to not get along with family members, report increasingly higher rates of family instability, conflict, and lack of love and emotional warmth during childhood. And those with poor family relationships and no close friends? They are 10x more likely to suffer from significant mental health challenges. For example, 45% of those who reported family instability and emotional distance showed signs of mental health challenges compared to just 11% of those from stable and loving homes.
There’s another graph in the report, too large to post here, that shows MHQ scores from all the countries who participated. It’s striking to see how differ we vary across the globe, and how some countries report much more serious problems than others. I see these data as yet another opportunity to share with leaders how much we need to be rethinking what we are doing for mental health. It’s no longer sufficient just to acknowledge the problem; no, we need radical solutions that are tailored specifically to our local communities (or in this case, our respective countries).
I applaud reports like this, and companies like Sapien Labs, for putting out more useful data on mental health. Not only are they using data to help inform our real time dialogue on mental health, they are also allowing the data to be available for others to analyze. Take a look and see what trends stand out to you. No matter which way you cut it, this report and these data are yet another call to action for us all to do more for mental health.
Thanks, Ben, for sharing this report and your reflections on it. I know we're such a highly relational species -- it's no wonder that lack of relationships and our loneliness are are such big -- and literal -- SOCIAL determinants of (mental) health.
I wonder what it will take to bring the question of daily nature dosage into this conversation -- I can't help but wonder if you overlay the country-by-country data with routine time outdoors if you might see some correlations (I know causality would be tough to prove here). There are physicians pushing this with NatureRx, prescribe-a-park, prescribe-a-bike -- and an effort led by Dr. Melissa Sundermann to make "daily exposure to nature/fresh air" the 7th pillar of Lifestyle medicine.
Could nature-access be featured in the next "Mental State of the World" data collection and report?
How might we better redress the wicked problem of mental health inequities? Where are the best scalable solutions?