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The mind needs attention:
What do humans want more than a sense of well-being? Is prosperity something other than being happy and satisfied in life? Contemporary humankind is seeking happiness on dead-end roads, assuming that money, power, or fame brings happiness, but failing to realize the true situation in which they truly feel fortunate.
We have crossed the borders of possibility, discovered the far reaches of the universe, and have reached a level of knowledge and technology that perhaps the people of past centuries could not imagine. But according to WHO, in 2019, 970 million people worldwide were living with a mental disorder, the most common of which were anxiety and depression and the Covid-19 pandemic has increased the prevalence of anxiety worldwide by 25%. So, the situation must be much worse now.
The question is, towards which destination is the contemporary progress of humankind going? I say the major intent or the hidden purpose is our curiosity about new things and willingness to find the truth. Curiosity that might get us into trouble. If we have these statistics now, it is because of our carelessness. Maybe we lost all our coins while searching for treasure. How often do we literally ask ourselves; how do I need to improve to finally be truly happy?
After the emergence of psychology as a science independent of philosophy in the late 19th century and rising specialties like psychology, psychiatry and attraction of people's attention to mental health, many diverse measures were taken at different levels to understand the psyche and its health. People realized that in current societies and with modern lifestyles that are full of stress and intertwined with speed (speed in preparing food, going to work, getting rich, communicating, etc.), they cannot just sit around and do nothing otherwise, their mental health will be crushed under the pressure of development.
Even I can comprehend it in my bones now when I see my stress and anxiety for this competition and writing this essay that caused me to pay less attention and kindness to my associates, talk less with them and keep saying that I’m short on time and I have to work faster. Ah! How much more speed do we expect from this world? Why does the ticking clock bother us?
Books, counseling, lectures, education and expansion of research and dedicating some technologies to mental health in recent decades are among the things that have been done to preserve human health and are still ongoing. Substance abuse, divorce and unsuccessful human relationships, withdrawal from school and society, suicide and many physical diseases are signs of mental health deterioration. The spread of these challenges has been so fast and unexpected that it has made people wonder how they can respond to it and stop it.
International organizations and worldwide meetings that have been created to guide the development of human societies and promote human health and well-being, etc., are the efforts of humans to know themselves and the path they are going and control its consequences properly. WHO, United Nations and WPA are examples of these organizations.
SDGs, seventeen colorful goals:
After the Millennium Development Goals (MDGs), which were eight international development goals for 2015, the United Nations proposed 17 SDGs in 2015 to be a guide for the sustainable development of societies for the next 15 years. In the old approach of traditional development, the focus was on giving resources to vulnerable societies to promote their health and welfare and preserve the environment. However, in the new worldview, the purpose is transformational development. (2) In other words, development is not a one-way path; all elements and phenomena in the world are interconnected and influence each other in some way. In fact, all production-consumption cycles and cause-and-effect cycles are related to each other. We should see the world as a system where all the people and the components of the environment affect each other and the progress of each component causes the progress of the whole system and the backwardness of one causes the backwardness of the others. Therefore, in addition to the North-South relationship, (donating resources to communities in need), the South-South relationship, which is the cooperation of two developing countries, and the triangular relationship, which is South-South under the supervision of a North, were formed.
If we want to categorize SDGs into three levels, we can divide them based on whether they support environmental, social, and economic sustainable development. Accordingly, we can put goals 6, 13, 14 and 15 in the environmental category, and consider goals 1,2,3,4,5,7,11,16 as social factors and 8,9,10,12 as economic goals. Goal 17, however, is generally related to all goals, and we can see its footprint in all these categories with its characteristics. Like a bracelet thread, it connects all the previous 16 goals.
SDG contribution to mental health:
But now the question is, how can these seventeen goals promise us that we weren’t imprudent this time and, in our progress, we were aware of our mental health, this neglected topic, and with the achievement of these seventeen goals, mental health will also improve and in the end, we will be advanced and satisfied people? To answer this question and to investigate the relationship between SDGs and mental health, let’s start with social goals and first, the third goal, which has the most obvious connection, good health and well-being. This goal governments are obliged to provide health services, maintain and promote sanitation and prevent and treat diseases. Dr Brock Chisholm, the first Director-General of the World Health Organization (WHO), stated that “without mental health, there can be no true physical health”. So absolutely, one of the most important measures under this goal is to improve the mental health of communities and providing first, second and third level psychological services for screening and treating all kinds of mental disorders/illnesses.
But in my opinion, the scale of addressing mental health in goal 3 and also other SDGs is low compared to its importance as the key components of health. For decades, most of the global attention was on reducing maternal and infant mortality to zero, controlling infectious diseases and other physical diseases, that’s completely reasonable. But by reaching to more improvements all around the world compared to past decades and by raising up of new challenges due to more societies became developed, and on the other hand, based on the new approach of transformational development, which refers to growth of all components, it is valuable to pay more attention on psyche. There is a need for this issue to be more in the center of focus and maybe a separate goal will be set for it in determining the next sustainable development guideline.
About other social related goals, number 1, no poverty, and 2, zero hunger, are so connected with each other and so interlaced with mental health. Poverty and mental disorders are mutually related. People who are poor or have financial problems or debt, are under severe stress and anxiety and even have problems in their relationships with those around them. Isolation and depression, anger and suicide can be caused by financial pressure on a person. Living in a society with a poor economy and insufficient welfare can increase the risk of developing schizophrenia. This problem is exacerbated when a person suffering from mental illness who is not financially well off, refuses treatment in a community where access to psychological services is inadequate. On the other hand, a person who has a mental illness/disorder will have little income and suffer from economic problems due to quitting his job and low productivity. Hunger and malnutrition can affect the brain and many mechanisms of the body (such as the hypothalamus-pituitary axis) and during the fetal period it can cause disorders in the development of the brain and ultimately mental illnesses. For example, iodine deficiency in pregnant women causes fetal retardation (1). We all have the experience of getting angry when we are hungry, and we see how even this short-term hunger affects our mood.
Regarding the fourth goal, in an ideal and quality education system at all levels and ages, student’s health, especially mental health, should be a priority. From determining the educational curriculum to hiring professors and accepting students, the evaluation mechanisms and the system of rewarding, punishing and promoting, everything should be based on the capacities of individuals, according to their abilities, and should be completely evidence-based to keep people's spirits up. Psychological disorders can cause students to withdraw from going to school or reduce their productivity and cause academic failure. These are warning signs that we cannot have quality education if we do not have a program to help improve the mental health of students.
Goals 5 and 16 refer to gender inequalities and justice and peace, which are completely intertwined with human mental health. The inequalities that exist in societies, and most prominently the gender inequalities related to sexual minorities, women the LGBTQIA+ community, etc., greatly increase the risk of psychological harm in these people. Discriminatory behaviours that these groups sometimes suffer from the beginning of birth, humiliation and insults, exclusion from society, and not reaching the position and reward they deserve despite many efforts, all including heavy psychological trauma. There are things that these people have to endure. Injuries that are impossible to bear even one of them (4). By committing to the 16th goal, we seek to guarantee human rights, reduce oppression and injustice, stop war and violence, and all these long-standing human desires, that are the source of human happiness and prosperity.
Also, control of crises and natural disasters, improvement of the level of social welfare and improvement of urban infrastructure to ensure the welfare and health of the people have been emphasized in goal 11. Welfare services such as safe and modern transportation, waste management and sanitation, safe and standard buildings, creating centres for cultural growth and capacity building of citizens, access to clean and affordable energy (goal 7) etc. are all rights of citizens. Currently, half of the world's population lives in cities, and by 2050, two-thirds of the population will be urbanized. Imagine the day when your home's water is cut off in the morning, there is no electricity, you are stuck in traffic for hours to get to your workplace, or your car breaks down on unsafe roads, and after enduring these stresses due to lack of Urban amenities are not a place to have fun at the end of the day. Is it possible to be mentally healthy in such a situation?
Let's move to the category of economic growth factors. Goal number 8, 9 ,10 and 12 which are addressing sustainable development through decent work and economic growth, industry, innovation and infrastructures, reducing economic inequalities and responsible consumption and production. Green economy is defined as poverty eradication and employment whilst maintaining the healthy function and the earth's ecosystem. Real development which is along with people’s well-being, can be achieved with capacity building and evidence-based economic strategies in the world; in such a way that health, especially mental health, is guaranteed either directly by equity in the workplace or indirectly by preserving the ecosystem and financing for welfare and health services. Studies have shown that children who grew up in an unhealthy environment faced brain development disorders, increased risk of memory disorders, and learning and behavioural problems (5). Or those who were exposed to air pollution, in the long term the risk of anxiety and in the short term the risk of suicide increased. (6) Access to clean water and sanitation (goal 6), healthy air and suitable environment by preventing climate change (goal 13), protecting oceans and waters (goal 14) and taking care of the earth and other creatures on earth (goal 15) not only guarantees our health but our life on this planet.
Didn't we say that we are all connected? So, it is quite understandable why the 17th goal is like the thread of the necklace, linking the other SDGs together. The difference between the progressive world and the backward world is that in the former, elements and groups that have a similar goal and direction find each other and form a cooperation network together, and each strengthens the other. Many times, to solve a problem, if our thinking is only limited to one area and we don't think broadly, we cannot evaluate the roots of the problem and use creativity to solve it. Health and especially mental health are among the issues that are tied to every aspect of human life, and if we cannot have relative control over all aspects and forget some, like a pool that has a hole and is never filled, our efforts will always be wasted. It goes to waste.
Therefore, the world should be seen as a system and by considering the effect of the elements of this system on each other, try to form human networks and interdisciplinary collaborations. A network consisting of various mental health stakeholders such as psychologists, psychiatrists, NGOs, the private sector, people with psychological disorders or illnesses, governments, international organizations such as WHO, UN, WPA, etc. With these collaborations, the challenges that exist in improving people's mental health, such as stigma, lack of funding or human resources, or lack of knowledge and technology, can be reduced. The presence of institutions related to economy, job and education in this network increases their awareness and encourages them to determine protocols to maintain and promote mental health in their work/ education environment. Psychologists, experts and researchers can help in determining these standards by conducting studies and producing science.
The presence of people's representatives, non-governmental organizations, and social support organizations in this network can help to express the existing problems and create a correct understanding of the existing conditions. Also, with the help of social media activists, artists and writers, education for destigmatization can be transferred to society. Certainly, in the current world where technology, internet and artificial intelligence form a very important part of human life, it is not possible to improve mental health and solve its challenges without using technology. So, with these words and all these emphasis on the role of many factors on mental health, governments should adhere to the SDGs as much as possible when making their national development plan, so that their actions won’t become ineffective because of neglecting a problem. This idea of a national development program was proposed in 1992 and called National Sustainable Development Strategies (NSDS), and in 2002, 85 countries had created their own strategies, which differed in nature and effectiveness.
Despite all the progress or failures in achieving the sustainable development goals so far, it is necessary to pay more attention to the global statistics of mental disorders in the next evaluation of global success, because the available data is not enough and it is necessary to better evaluate the current situation. Also, in futuristic attitudes, more attention should be paid to the effects of emerging phenomena such as new technologies on human morality and well-being. As Noam Shpancer , a psychologist said, “Mental health... is not a destination but a process. It's about how you drive, not where you're going.”
By Bahar Fazel, Winner of the 2024 WPA Medical students’ essay competition, 5th-year medical student at Ahvaz Jundishapur University of Medical Sciences in Iran