Global Mental Health

The World Health Organization (WHO) defines mental health as a 'state of well-being in which every individual realizes his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to her or his community'.

The term Global Mental Health refers to the international perspective on different aspects of mental health. Taking into account cultural differences and country-specific conditions, it deals with epidemiology of mental disorders in different countries, their treatment options, mental health education, political and financial aspects, the structure of mental health care systems, human resources in mental health and human rights issues among others.The overall aim of the field of Global Mental Health is to strengthen mental health all over the world by providing information about the mental health situation in all countries and identifying mental health needs in order to develop cost-effective interventions to meet those specific needs.

Mental Health and Global Burden of Disease

Mental disorders make a substantial contribution to the Global Burden of Disease. This is a global measure of so-called disability adjusted life years (DALY's) assigned to a certain disease, which is a sum of years lived with disability and years of life lost due to this disease. Neuropsychiatric conditions account for 14 % of the global burden of disease. Within non-communicable diseases, they account for 28% of the DALY's and thereby more than cardiovascular disease or cancer. The most important contributions to this number have unipolar depression, alcohol-use-disorder, schizophrenia, bipolar depression and dementia. However it is estimated that the real contribution of mental disorders to the global burden of disease is even higher, amongst others due to complex interactions and co morbidity of physical and mental illness.

Treatment gap

Up to 30% of all people worldwide has a mental disorder, and although interventions for the treatment of mental disorders are available, the proportion of those people with mental disorders who would need treatment but who do not receive mental health care is very high. This so-called treatment gap is estimated to reach about 76-85% for low and middle-income countries, and still 35-50% for high-income countries. Even those who are treated are often treated inefficiently or in an inhumane way.

Interventions

Information and evidence about cost-effective interventions to provide better mental health care is available. Although most of the research (80%) has been carried out in high-income countries, there is also strong evidence from low- and middle-income countries that pharmacological and psychosocial interventions are effective ways to treat mental disorders, with the strongest evidence for depression, schizophrenia, bipolar disorder and hazardous alcohol use.

Recommendations to strengthen mental health systems around the world have been first mentioned in the World Health Report 2001, which focused on mental health:

# Provide treatment in primary care
# Make psychotropic drugs available
# Give care in the community
# Educate the public
# Involve communities, families and consumers
# Establish national policies, programs and legislation
# Develop human resources
# Link with other sectors
# Monitor community mental health
# Support more research

Based on the data of 12 countries, assessed by WHO-AIMS (World Health Organization Assessment Instrument for Mental Health Systems), the costs of scaling up mental health services by providing a core treatment package for schizophrenia, bipolar affective disorder, depressive episodes and hazardous alcohol use have been estimated. Structural changes in mental health systems according to the WHO recommendations have been taken into account.For most countries, this model suggests an initial period of investment of $ 0.30 – 0.50 per person per year. The total expenditure on mental health would have to rise at least 10-fold in low-income countries. In those countries, additional financial resources will be needed, while in middle- and high-income countries the main challenge will be the reallocation of resources within the health system to provide better mental health service.

Barriers

Although awareness of the need for treatment of people with mental disorders has risen, there have not been substantial changes in mental health care delivery during the past years. Main reasons for this problem are public health priorities, lack of a mental health policy and legislation in many countries, a lack of resources – financial and human resources – as well as inefficient resource allocation.

References

* Prince M, Patel V, Saxena S, et al. No health without mental health. Lancet 2007; published online Sept 4. DOI:10.1016/S0140- 6736(07)61238-0.
* Saxena S, Thornicroft G, Knapp M, Whiteford H. Resources for mental health: scarcity, inequity, and inefficiency. Lancet 2007; published online Sept 4. DOI:10.1016/S0140-6736(07)61239-2.
* World Health Organization. World health report 2001—mental health: new understanding, new hope. Geneva: WHO, 2001. http://www.who.int/whr/2001/en/
* World Health Organization. World Health Organization assessment instrument for mental health systems (WHO-AIMS). Geneva: WHO, 2005. http://www.who.int/mental_health/evidence/AIMS_WHO_2_2.pdf
* World Health Organization. Global burden of disease project. Department of Measurement and Health Information. December, 2004: http://www.who.int/healthinfo/bod/en/index.html
* World Health Organization. Atlas, mental health resources in the world 2005. Geneva: WHO, 2005.
* Lancet Global Mental Health Group. Scale up services for mental disorders: a call for action. Lancet 2007; published online Sept 4. DOI:10.1016/S0140-6736(07)61242-2.
* Saraceno B, van Ommeren M, Batniji R, et al. Barriers to improvement of mental health services in low-income and middleincome countries. Lancet 2007; published online Sept 4.

Further reading

* Atkinson, J. (2006) Private and Public Protection: Civil Mental Health Legislation, Edinburgh, Dunedin Academic Press