Removing the Barriers to Effective Mental Health Care: A View from Turkey

By Ozturk, M. Orhan | Bulletin of the World Health Organization, April 2000 | Go to article overview

Removing the Barriers to Effective Mental Health Care: A View from Turkey


Ozturk, M. Orhan, Bulletin of the World Health Organization


WHO's new agenda for mental health makes it abundantly clear that mental health problems have grown to be a major part of the global burden of disease and that mental health has to be considered a priority not only in health planning but also in the overall development plans of any country (1). Similar statements have been made in the past, however, though probably not with such authority or with burden of disease figures to support them, but for the most part they have fallen on deaf ears among policy-makers, and even among health professionals. The essential question is why this is so, and why problems of mental health persist while there have been so many and such unprecedented improvements in other areas of health.

Setting the WHO agenda summarizes the best evidence for the prevalence, prevention, diagnosis and treatment of mental disorders, and makes sound recommendations for WHO's mental health activities. Further recommendations are needed, however, on how to deal with the historical, social, cultural, professional and political barriers to designing and activating cost-effective mental health projects. We need to know more about these barriers if WHO is to overcome them in pursuing its agenda for mental health, and convincing the authorities of culturally diverse nations and communities that concerted action is possible.

Stigma is commonly blamed for the failure to recognize, accept and deal with mental health problems. Although much is now known about the history, and causes of stigma and how it impedes cultural development, this knowledge can also be used to condone the deficiencies of health systems which maintain negative medical attitudes and detrimental institutions for the mentally ill in many parts of the world. An investigation on pathways to psychiatric care in Ankara has shown that mental patients and their families, many of whom are from rural areas, prefer to take their problems to mental health specialists rather than general practitioners (2). This finding and my experience of the last 45 years suggest that where adequate health services are delivered and where the patient is seen as a human being rather than a mentally deranged person, the stigma factor is diminished radically.

Another impediment is the idea of priorities, which dictate that mental health can be considered only after solving such problems as malnutrition and infectious disease. While this may be true in many cases, it is also true that many of these serious problems are often caused by parental schizophrenia, depression, alcoholism or other types of mental suffering. Conversely, devastating earthquakes, such as those that occurred recently in Turkey, and other such disasters, can cause mental health disorders or disabilities. Such events may lead to immense and persistent mental suffering which is easily overlooked in tragic physical conditions. It is understandable that visible external suffering receives more immediate attention than suffering which is invisible and internal, but this can lead to neglect which allows mental trauma to turn gradually into life-long tragedy. …

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