Publication Details

04 December 2024

Mental health is usually discussed in relation to healthcare or social services, not in the security realm.[i] The security field has predominantly prioritized tangible and immediate threats such as wars, terrorism, and natural disasters, which are easily quantifiable and have direct physical impacts.[ii] Mental health, which often involves complex, unseen, and long-term effects, does not fit neatly into this traditional framework, and has mostly been ignored in security strategies.

We are currently suffering through a mental health crisis, according to the Journal of the American Medical Association, which reported that the number of people receiving care for emotional problems has skyrocketed by 38% since 2020.[iii] This crisis can be attributed to many factors, including the economic, social and political impact of the world’s reaction to the Covid-19 pandemic. Government reactions to the COVID-19 pandemic such as lockdowns and shutting down the world economy had widespread effects, including social isolation, economic instability, and general uncertainty. The result has been a large-scale mental health crisis. Experts are now seeing how this can undermine societal stability, productivity, and overall quality of life.[iv]

Redefining Security: Integrating Mental Health into Security Paradigms

There is a growing call by some security experts and policymakers to integrate mental health into the global health security agenda. When particular health issues are labeled as security threats rather than mere developmental challenges they are politicized, which increases the amount of attention they get. This heightens the urgency of the issue, sparks debate, and tends to lead to more resources allocated to solutions.[v]

The HIV/AIDS epidemic stands as a pivotal chapter that redefined global health as a security issue. Initially identified in the early 1980s, HIV/AIDS rapidly emerged as a global pandemic, prompting international alarm, and necessitating urgent action from security, health, and political sectors.

The global health security agenda has as of late focused primarily on emerging and re-emerging infectious diseases and biosecurity.[vi] In recent years we have witnessed a shift in how mental health is perceived and integrated into public health policies, driven by international institutions such as the World Health Organization. Programs such as the WHO’s Mental Health Action Plan 2013-2030 and the WHO Special Initiative for Mental Health (2019-2023) aim to expand access to quality mental health services, ensuring universal health coverage and integrating mental health care into primary health systems. 

Coming out of the Dark: The Destigmatization of Mental Health

One of the primary reasons for the neglect of mental health in security discussions is the stigma associated with mental illnesses. Historically, mental health conditions have been misunderstood and even feared. This stigma has often resulted in discrimination against those suffering from mental health issues, further pushing these concerns to the peripheries of public and policy discourse.[vii] The societal view of mental health as a personal weakness rather than a medical issue has significantly hindered its recognition as a matter of public health and safety.

Society’s views on mental health are changing. More and more people recognize that mental health has a significant impact on overall health outcomes, societal stability, and economic productivity. The concept of human security is also evolving, with more of an emphasis on the protection of individual freedoms and well-being.[viii] These factors have helped elevate mental health from a purely medical concern to a broader societal issue.

Advances in psychology and medicine in recent decades have illuminated the complexities of mental health disorders. The lack of scientific and medical consensus on mental health issues contributed to their exclusion from health and security policies. Without a clear understanding of the causes, impacts, and treatments of mental disorders, policymakers have been slow to recognize their significance in the context of national and global security.[ix]

Economic considerations have also played a role in the neglect of mental health as a security issue. Mental health programs often require substantial long-term investment in healthcare infrastructure, professional training, and public education. In many regions, particularly in lower-income countries, resources are scarce, and immediate physical health crises and economic development priorities take precedence.

Demographic Destiny: The Struggle to Cope with an Aging Population

Aging is often accompanied by a decline in cognitive function. This cognitive decline can significantly affect an individual’s mental health, leading to feelings of frustration, loss of independence, and depression. Conditions such as dementia, Alzheimer’s disease, and Parkinson’s disease are all diagnosed at a higher rate in older demographics. Concurrently, physical health issues such as chronic pain and disabilities that increase with age can exacerbate stress, anxiety, and depression, further impairing mental health.

Older adults often experience increased social isolation and loneliness due to significant life changes such as the loss of a spouse, retirement, or the diminishing of social circles. These factors can lead to severe mental health issues, including depression and anxiety. The loss of societal roles and the confrontation with mortality can also lead to a reduced sense of purpose and identity crises, impacting emotional well-being.

The deterioration of the mind and body are not novel to our era. What is new, however, is the demographics of populations in the developed world. Approximately one in four people aged 65 and over are active in the United States workforce, and this number is expected to rise, making older workers the fastest-growing segment of the labor force. By 2050, the global population aged 60+ is expected to exceed two billion, yet only a small percentage of businesses are prepared for this demographic shift. To ensure the well-being and productivity of this growing segment of the population, it is important to integrate mental health into security paradigms.

As more citizens enter old age, the ratio of retirees to working-age individuals, defined as the “dependency ratio,” increases, putting pressure on pension systems and healthcare infrastructure. Older people tend to have more health problems, many of which require extensive testing and expensive treatment. These costs put an economic burden on the working population. Cognitive decline and mental health issues can also lead to decreased productivity for the increasing number of people who remain in the workforce beyond typical retirement age.[x]

The capacity of health systems to manage the growing needs of an aging population is a critical component of societal security. As mental health issues become more prevalent with aging, health systems that are not adequately prepared can become overwhelmed. This overload can compromise the overall health security of a society, reducing its ability to respond to other health crises. The strain on the healthcare system is beginning to show. The shortage of long-term care workers is currently 13.6 million worldwide, according to the United Nations Report Leaving No One Behind in an Aging World, issued by the Department of Economic and Social Affairs.[xi]

Case Study: A Growing Problem in the Land of the Rising Sun

While these issues are particularly pronounced in the U.S., similar trends can be observed in many Western European nations, as well as developed Asian countries. The prevalence of dementia in Japan, for example is estimated to be between 8% and 10%, and has become a critical area of concern for health services and policy makers​. The stigma surrounding mental health in Japan is profound, resulting in limited research and data collection that could inform better practices and policies. This stigma affects not only the general population but is particularly acute in the aging population, who may suffer silently from conditions like depression and anxiety.[xii]

The societal impact of these mental health challenges is severe, with Japan historically experiencing one of the highest suicide rates among industrialized nations. This rate is notably high among the elderly, who often face social isolation in addition to their health issues. Recent efforts to address mental health more openly are a step toward mitigating this crisis, but much work remains to be done to change public perceptions and improve mental health services​.

Moreover, the societal norms that pressure individuals to continue working into older age without adequate support for mental health exacerbate these challenges. Japan’s approach to mental health care is evolving, with an increasing focus on integrating mental health care with primary health services and community support. However, the implementation of such integrated care models is slow and faces numerous hurdles due to the existing healthcare structure and cultural attitudes towards mental health and aging​.

Conclusion

The securitization of mental health represents a progressive expansion of security studies, reflecting a more nuanced understanding of threats that are not only immediate and physical but also insidious and psychological. By integrating mental health into security frameworks, societies can better mobilize resources, enhance policy responses, and develop preventative measures to address the root causes of mental distress. This holistic approach not only enhances the security of individuals but also the stability and resilience of societies at large.

The expansion of security studies to include non-traditional threats such as climate change, gender issues, and health invites a redefinition of what constitutes a security issue. Mental health, with its profound impact on societal functioning and stability, fits naturally into this expanded framework.[xiii]

[i] Public Health Movement (2018) 'Framing of Health as a Security Issue', D6.pdf (phmovement.org)

[ii] Stoeva P. ‘Dimensions of Health Security-A Conceptual Analysis.’ Glob Chall. 2020 Jul 28;4(10):1700003. doi: 10.1002/gch2.201700003. PMID: 33033624; PMCID: PMC7533848.

[iii] Insel, Thomas, ‘America’s Mental Health Crisis’, December 8, 2023, Pew Trusts, America's Mental Health Crisis | The Pew Charitable Trusts (pewtrusts.org)

[iv] Kirk, Jessica (2023) ‘Health’, in: Paul Williams and Matt McDonald eds. Security Studies. An Introduction. 4th edition. Routledge, pp.615-630

[v] Hagmann, J., Hegemann, H., & Neal, A. (2018). ‘The Politicisation of Security: Controversy, Mobilisation, Arena Shifting’, European Review of International Studies, 5(3), 3–29. https://www.jstor.org/stable/26593813

[vi] Hough, Peter (2021) ‘Health and Security’, in: Peter Hough, Andrew Morgan, Bruce Pilbeam and Wendy Stokes eds., International Security Studies. Theory and Practice. 2nd edition. Routledge, pp. 258-269

[vii] Ip Eric C., Cheung D. ‘Global Mental Health Security—Time for Action.’ JAMA Health Forum. 2020;1(6): e200622. doi:10.1001/jamahealthforum.2020.0622 

[viii] Ip Eric C., Cheung D. ‘Global Mental Health Security—Time for Action.’ JAMA Health Forum. 2020;1(6): e200622. doi:10.1001/jamahealthforum.2020.0622 

[ix] Staglin, Garen (2022). ‘The Decade of Healthy Aging Cannot Ignore Mental Health of Older Workers’, August 4, 2022, Forbes,

The Decade of Healthy Aging Cannot Ignore Mental Health of Older Workers (forbes.com)

[x] Goidea, Teodora (2021) ‘Why is mental health not a security issue yet? A just securitization of mental health’, Department of Political Science, Kobenhavns Universitet, March 2021

https://www.academia.edu/89591915/Why_is_mental_health_not_a_security_issue_yet_A_just_securitization_of_mental_health

[xi] United Nations (Department of Social and Economic Affairs) Leaving No One Behind in an Aging World. World Social Report 2023. 2023wsr-chapter5.pdf (un.org)

[xii] Hisashi Eguchi, Koji Wada, ‘Mental health of working-age populations in Japan who provide nursing care for a person at home: A cross-sectional analysis’, Journal of Occupational Health, Volume 60, Issue 6, November 2018, Pages 458–466, https://doi.org/10.1539/joh.2017-0295-OA

[xiii] Kirk, Jessica (2023) ‘Health’, in: Paul Williams and Matt McDonald eds. Security Studies. An Introduction. 4th edition. Routledge, pp.615-630