Global mental health

Global mental health is the international perspective on different aspects of mental health. It is 'the area of study, research and practice that places a priority on improving mental health and achieving equity in mental health for all people worldwide'.^[1] Taking into account cultural differences and country-specific conditions, it deals with the 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 care needs in order to develop cost-effective interventions to meet those specific needs.^[2][3][4]

There is a growing body of criticism of the global mental health movement, where some see it as a "neo-colonial" or "missionary" project and as primarily a front for pharmaceutical companies seeking new clients for psychiatric drugs.^[5]

The global burden of disease

Disability-adjusted life year for neuropsychiatric conditions per 100,000 inhabitants in 2002.

  no data

  less than 10

  10–20

  20–30

  30–40

  40–50

  50–60

  60–80

  80–100

  100–120

  120–140

  140–150

  more than 150

Mental, neurological, and substance use disorders make a substantial contribution to the global burden of disease (GBD).^[6] This is a global measure of so-called disability-adjusted life years (DALY's) assigned to a certain disease/disorder, which is a sum of the years lived with disability and years of life lost due to this disease within the total population. Neuropsychiatric conditions account for 14% of the global burden of disease. Among non-communicable diseases, they account for 28% of the DALY's – more than cardiovascular disease or cancer. However, it is estimated that the real contribution of mental disorders to the global burden of disease is even higher, due to the complex interactions and co-morbidity of physical and mental illness.

Around the world, almost one million people die due to suicide every year, and it is the third leading cause of death among young people. The most important causes of disability due to health-related conditions worldwide include unipolar depression, alcoholism, schizophrenia, bipolar depression and dementia. In low- and middle-income countries, these conditions represent a total of 19.1% of all disability related to health conditions.^[7]

Treatment gap

It is estimated that one in four people in the world will be affected by mental or neurological disorders at some point in their lives.^[8] Although many effective interventions for the treatment of mental disorders are known, and awareness of the need for treatment of people with mental disorders has risen, the proportion of those who need mental health care but who do not receive it remains very high. This so-called "treatment gap" is estimated to reach between 76–85% for low- and middle-income countries, and 35–50% for high-income countries.

Despite the acknowledged need, for the most part there have not been substantial changes in mental health care delivery during the past years.^[9] 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.^[10]

In 2011, the World Health Organization estimated a shortage of 1.18 million mental health professionals, including 55,000 psychiatrists, 628,000 nurses in mental health settings, and 493,000 psychosocial care providers needed to treat mental disorders in 144 low- and middle-income countries. The annual wage bill to remove this health workforce shortage was estimated at about US$4.4 billion.^[11]

Interventions

Information and evidence about cost-effective interventions to provide better mental health care are 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 WHO's World Health Report 2001,^[12] which focused on mental health:

1. Provide treatment in primary care
2. Make psychotropic drugs available
3. Give care in the community
4. Educate the public
5. Involve communities, families and consumers
6. Establish national policies, programs and legislation
7. Develop human resources
8. Link with other sectors
9. Monitor community mental health
10. Support more research

Based on the data of 12 countries, assessed by the WHO Assessment Instrument for Mental Health Systems (WHO-AIMS),^[13] 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 US$0.30 – 0.50 per person per year. The total expenditure on mental health would have to rise at least ten-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.

Prevention

Prevention is beginning to appear in mental health strategies, including the 2004 WHO report "Prevention of Mental Disorders", the 2008 EU "Pact for Mental Health" and the 2011 US National Prevention Strategy.

Stakeholders

World Health Organization (WHO)

Two of WHO's core programmes for mental health are WHO MIND (Mental health improvements for Nations Development) and Mental Health Gap Action Programme (mhGAP).

WHO MIND focuses on 5 areas of action to ensure concrete changes in people's daily lives. These are:

1. Action in and support to countries to improve mental health, such as the WHO Pacific Island Mental Health network (PIMHnet)
2. Mental health policy, planning and service development
3. Mental health human rights and legislation
4. Mental health as a core part of human development
5. The QualityRights Project which works to unite and empower people to improve the quality of care and promote human rights in mental health facilities and social care homes.

Mental Health Gap Action Programme (mhGAP) is WHO’s action plan to scale up services for mental, neurological and substance use disorders for countries especially with low and lower middle incomes. The aim of mhGAP is to build partnerships for collective action and to reinforce the commitment of governments, international organizations and other stakeholders.

The mhGAP Intervention Guide (mhGAP-IG) was launched in October 2010. It is a technical tool for the management of mental, neurological and substance use disorders in non-specialist health settings. The priority conditions included are: depression, psychosis, bipolar disorders, epilepsy, developmental and behavioural disorders in children and adolescents, dementia, alcohol use disorders, drug use disorders, self-harm/suicide and other significant emotional or medically unexplained complaints.

Criticism

One of the most prominent critics of the Movement for Global Mental Health has been China Mills, author of the book Decolonizing Global Mental Health: The Psychiatrization of the Majority World. Mills writes that, "This book charts the creeping of psychology and psychiatry across the borders of everyday experience and across geographical borders, as a form of colonialism that comes from within and from outside, swallowed in the form of a pill. It maps an anxious space where socio-economic crises come to be reconfigured as individual crisis – as ‘mental illness’; and how potentially violent interventions come to be seen as ‘essential’ treatment."^[14] Another prominent critic is Ethan Watters, author of Crazy Like Us: The Globalization of the American Psyche.^[15]

See also

• Global health
• Mental health in China
• Mental health in Southeast Africa
• Mental health in the Middle East
• Parity of esteem

References

External links

• World Health Organization: Mental Health
• Project Atlas: Resources for Mental Health and Neurological Disorders
• World Health Organization. (2001) World health report 2001—mental health: new understanding, new hope. Geneva, WHO Press