Emily Hewlett, OECD Health Division
Winston Churchill famously called it the ‘black dog’. “It is that absence of being able to envisage that you will ever be cheerful again. The absence of hope. That very deadened feeling, which is so very different from feeling sad,” said JK Rowling. “I don’t want to see anyone. I lie in the bedroom with the curtains drawn and nothingness washing over me like a sluggish wave… I am inadequate and stupid, without worth. I might as well be dead” wrote Margaret Atwood, in Cat’s Eye.
They were talking all about depression.
Across the world, millions of people are struggling with their own black dog. The OECD estimates that one in two people experience a mental illness in their lifetime, and some 20% of the working-age population is experiencing mental ill-health at any given time[i]. According to the WHO, depression is now the leading cause of ill-health and disability worldwide; globally, more than 300 million people are living with depression[ii]. While some people experience depression only briefly, others find themselves battling the black dog for long periods, or find it returning again and again. And when people are suffering from a mental disorder, it has big consequences across their lives: when people are living with mental ill-health they have poorer educational outcomes and a higher risk of dropping out of school[iii]; they are more likely to be dismissed from work and 2-3 times more likely to be unemployed[iv]; and in serious cases depression can lead to people harming themselves, or even dying from suicide[v].
The good news is that there are some very effective ways to help prevent mental illness and promote mental wellbeing, to treat depression and other disorders, and to support people who are living with mental ill-health. For instance, actions to prevent depression and anxiety can bring life-long economic benefits to mothers and children, while certain workplace interventions could reduce the cost of lost productivity – notably sickness absence and presenteeism – by up to a third[vi]. We know, too, that evidence-based services – like psychological therapies, early intervention approaches, or pharmacological therapies – can facilitate and speed-up recovery from depression. And we know that if employers and workplaces can provide a supportive environment, and thoughtfully facilitate return to work after a sickness absence for depression, then this can be good for the individual’s mental health and good for workplace productivity.
However, places where these effective, evidence-based policies have been rolled out are the exception, not the norm. People with depression too often face unsupportive or disengaged schools or workplaces, find inadequate treatment provision or long-waits to get help, and are still weighed down by a heavy burden of stigma. Today, on World Health Day, policy makers across the world must commit to putting care for depression and mental illness at the centre of their health systems, and their health policy priorities. More needs to be done.
We need better information, to understand what works, and where countries are falling short; at OECD, we are particularly keen to further improve, international benchmarking of data and policies so as to drive improvements across countries. We need innovation to find the effective, novel, adaptable and affordable policies that work, for depression and for all mental disorders. And we need implementation, so that better policies for depression can already start transforming peoples’ lives.
More needs to be done, and we should start today.
[i] OECD (2015), Fit Mind, Fit Job: From Evidence to Practice in Mental Health and Work, Mental Health and
Work, OECD Publishing, Paris. http://dx.doi.org/10.1787/9789264228283-en
[v] OECD (2015), Health at a Glance 2015: OECD Indicators, OECD Publishing, Paris. http://dx.doi.org/10.1787/health_glance-2015-en
[vi] OECD (Forthcoming, 2017), Understanding Effective Approaches to Promoting Mental Health and Preventing Mental Illness.