A Tale of Two Diseases: Mental Illness and HIV/AIDS.

Abstract

There have been dramatic advances in the treatment of HIV/AIDS. Whereas HIV was once a dire diagnosis, today it is treatable, and individuals who receive early and consistent treatment can expect to live a normal lifespan. Why has the scientific community made the same strides with mental illness? When I was the Legal Director of the National Association of Mental Health in the United Kingdom in the 1980s, major mental illnesses were primarily treated with powerful antipsychotics, such as haloperidol, that carried the debilitating side effects of tardive dyskinesia -- involuntary movements of the tongue, lips, face, trunk, and extremities. When I first saw mental patients shuffling, tongues protruding, and physically shaking, I thought they exhibited symptoms of mental illness, but soon realized it was the treatment itself. Newer second-generation medicines cause metabolic syndrome, obesity, and cardiovascular disease. In other words, the therapeutic science of mental health has not come nearly far enough.Another indicator of the lamentable failure to meet the needs of persons with mental disabilities is the large number of vulnerable individuals warehoused in large, inhumane institutions, often for decades. While the de-institutionalization movement (a strained alliance between civil libertarians and fiscal conservatives) tore down sterile hospitals, today many individuals with mental illness are in prisons, nursing homes, or are homeless. Inadequacies of science and failures in policy might be overlooked if mental illness were not so prevalent, with enormous individual, family, community, and economic costs.Mental illness accounts for about 13% of healthcare costs globally, but only 3% of healthcare funding; many countries have no dedicated mental health budget. Despite a higher death rate, mental illnesses receive a fraction of the charitable donations made to combat cancer or HIV/AIDS. Moreover, the trained mental health workforce is pitifully small given the need. Mental health professionals account for just 1% of the global health workforce. HIV/AIDS and mental illness have common features. Both are complex intractable diseases affecting marginalized communities throughout the lifespan and both are shrouded in stigma and discrimination. Certainly the human suffering and social alienation caused by HIV/AIDS remains an urgent global threat. Yet, AIDS has changed the world. How did all these technological advances come about, and why did a particular disease, AIDS, forge a pathway toward unprecedented scientific discoveries while mental illness remains largely ignored? So much scientific progress has been made since AIDS first emerged. But today, persons with serious mental illnesses -- particularly in lower socioeconomic classes -- are no better off than they would have been if they were born decades ago. Their treatment, if they have access to any treatment, will be nearly as debilitating as the disease. They are likely to be in a prison or nursing homes, or just as problematic, living on the streets. Sadly, in 2015, the mentally ill remain the most stigmatized and isolated among us. How is that for scientific and social progress?