We Are at the Beginning of a Global Mental Health Revolution

This op-ed by Rosalynn Carter and Bill Jallah was published by CNN.com.

Access to mental health services has never been more critical -- no matter where you live. Mental health disorders are increasing globally, and depression is the leading cause of disability in the world. One in four of us will experience a mental illness at some point in our lives, according to the World Health Organization.

And many more are indirectly affected by disorders experienced by someone we love.

My interest in mental health started more than 50 years ago in front of a cotton mill in Atlanta. It was 1966, when my husband, Jimmy Carter, was running for governor. I stood outside the entrance of the factory early in the morning, waiting to give people brochures as they left the night shift. An older woman came out, looking weary from work. When I asked if she would be able to get some sleep, she told me she hoped so, but that she had a daughter who had a mental illness and needed care while the woman's husband was at his job.

That conversation would start me on a lifelong crusade for better treatment and policies for people living with mental illnesses. A lot of progress has been made since then, but government response in the United States and globally is not yet on par with the toll mental illnesses take on families.

In the United States, mental disorders among children and adolescents have reached a crisis level, with the country experiencing its highest suicide rate in 50 years.

Internationally, mental disorders -- ranging from something more common like depression to a more complex illness like schizophrenia -- affects hundreds of millions of people.

And in areas where people have experienced a national crisis, the toll can be devastating.

For example, in the West African country of Liberia, where my co-author, Rev. Bill Jallah, helps to lead the advocacy for mental health awareness, the impact of the Ebola outbreak of 2014 and the legacy of the civil war, which ended in 2003, exacerbated psychological problems among citizens who were already facing a major shortage of mental health resources, according to the World Health Organization.

Looking at these two countries side by side, there are drastic differences. The United States is considered one of the wealthiest countries, while Liberia is considered one of the poorest.

Still, both experience lasting harm when the basic human right to mental health care is denied -- dispelling the myth that people who are financially secure are somehow immune to experiencing mental illnesses.

In both countries, silence and neglect contribute to the burden. People who speak plainly about needing treatment for or living with a mental health condition risk social isolation, discrimination at work, and in some cases violence or unjust imprisonment. The stigma surrounding these illnesses creates needless suffering and negatively impacts quality of life. In Liberia, myths and misconceptions about the causes of mental illnesses, the validity of evidence-based treatment, and the ability of people with these illnesses to be productive and engaged citizens exacerbate the suffering and exclusion in society. The silence typically caused by stigma has slowed the growing movement among people of both countries to demand equitable treatment for mental health disorders.

We need to end the silence and put pressure on governments and the private sector to prioritize mental health care reform. And the reform process needs to be guided by informed decision-making that includes the voices and stories of people with lived experience.

In the United States, the Georgia Mental Health Consumer Network is a leading voice for those who have been affected by mental illnesses and an exemplary provider of peer support services, while in Liberia, Cultivation for Users' Hope is an advocacy group based in Liberia's capital city, Monrovia. In 2017, Cultivation for Users' Hope, which is run by mental health service users and is allied with The Carter Center, helped Liberia's Ministry of Health pass its first law to improve health care for people with mental illnesses and prevent discrimination against them.

Both organizations ensure that the views of people living with mental illnesses are included in efforts to decrease discrimination and improve access to care.

Input from people with mental disorders is an essential part of advocacy for health insurance parity in the United States. More than 10 years after Congress passed the Mental Health Parity and Addiction Equity Act (MHPAEA), a law requiring that insurers treat mental health and substance use disorders on par with other illnesses, many states still do not comply with the law. A 2018 study released by The Kennedy Forum, The Carter Center, and the Well Being Trust, issued a "failing grade" to 32 states for not fulfilling statutes of the law.

The Carter Center works with organizations such as the Kennedy Forum to call for compliance and encourage public participation in the forum's "Don't Deny Me" campaign, a consumer-driven movement to demand accountability from lawmakers and insurance commissioners.

During this month, which is dedicated to mental health awareness, Speak Your Mind, a global civil society campaign was launched at the annual World Health Assembly in Geneva, as health and government leaders gathered. Bringing together people with firsthand experience of mental health conditions, experts and organizations, the campaign demands governments immediately act to invest, educate and empower for better mental health.

We are at the beginning of a mental health revolution in the United States, in Liberia and globally. As we seek to normalize these disorders and recognize the truth about how many people are affected by them, we need a chorus of authentic, united voices of people who understand these conditions to push for urgent action, funding, legislation, and beneficial policies.

Speaking up about this subject can be difficult. But the time has come for people who have lived with mental health disorders to make sure their voices are heard.