Tuberculosis is a disease of poverty, and tuberculosis and mental health conditions share common risk factors (homelessness, HIV, alcohol/substance use, migrant status, incarceration etc.) It is shown that patients from lower socioeconomic and educational backgrounds are less likely to adhere to treatment, more likely to suffer depression and psychological distress, and more likely to be heavy alcohol users. Gender is another pronounced factor; women have consistently shown to have significantly poorer mental health outcomes than men. A tuberculosis diagnosis is associated with a loss of self-esteem, fears of rejection and fears of infecting the family. Studies have shown that mental health disorders, especially depression, can be as high as 50% among individuals with tuberculosis.

In many tuberculosis high burden countries, awareness about mental health is limited, there is a lot of stigma and self- stigma, and access to mental health care services is poor. In these settings, we have experience with community-based screening for depression and anxiety, with the option to refer the more severe cases to specialized care. For others, counselling and meeting people that understands their situation, and experiencing a sense of community, can be very valuable. Many of the volunteers in our projects are trained in mental health, inclusion and health communication, and are providing support for people with mental health needs, people who use drugs, and people in prison.