Global mental health
1 The global burden of disease 2 Treatment gap 3 Interventions 4 Prevention 5 Stakeholders
5.1 World Health Organization (WHO)
6 Criticism 7 See also 8 References 9 External links
The global burden of disease
Disability-adjusted life year
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). 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
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.
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.
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
Despite the acknowledged need, for the most part 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.
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.
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
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 the WHO Assessment Instrument for Mental Health Systems (WHO-AIMS), 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. NIMH or the National Institute of Mental Health has over 400 grants. 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:
Action in and support to countries to improve mental health, such as the WHO Pacific Island Mental Health network (PIMHnet) Mental health policy, planning and service development Mental health human rights and legislation Mental health as a core part of human development 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.
Another prominent critic is Ethan Watters, author of Crazy Like Us: The Globalization of the American Psyche. See also
^ Patel, V; Prince, M (2010). "Global mental health: A new global
health field comes of age". JAMA. 303 (19): 1976–7.
doi:10.1001/jama.2010.616. PMC 3432444 .
^ Suman., Fernando, (2010). Mental health, race and culture (3rd ed.).
Basingstoke, Hampshire: Palgrave Macmillan. ISBN 9780230212718.
^ Ethan., Watters,. Crazy like us. London. ISBN 9781849015776.
^ a b Watters, Ethan (January 8, 2010). The Americanization of Mental
Illness. The New York Times.
^ Suman,, Fernando,.
Mental health worldwide : culture,
globalization and development. Houndmills, Basingstoke, Hampshire.
ISBN 9781137329585. OCLC 869802072.
^ a b Mills, China. Decolonizing Global Mental Health: The
Psychiatrization of the Majority World. Retrieved October 17, 2014,
^ Movement for Global Mental Health Newsletter. May 2014.
^ Prince, M; Patel, V; Saxena, S; Maj, M; Maselko, J; Phillips, M. R.;
Rahman, A (2007). "No health without mental health". Lancet. 370
(9590): 859–77. doi:10.1016/S0140-6736(07)61238-0.
^ Saxena S, Thornicroft G, Knapp M, Whiteford H (2007). "Resources for
mental health: Scarcity, inequity, and inefficiency". The Lancet. 370
(9590): 878–889. doi:10.1016/S0140-6736(07)61239-2.
^ "Scale up services for mental disorders: A call for action". The
Lancet. 370 (9594): 1241–1252. 2007.
^ World Health Organization. Global burden of disease. Geneva, WHO
Health statistics and health information systems. Accessed 15 March
^ World Health Organization: Mental Health and Development: Targeting
People with Mental Health Conditions as Vulnerable Group. Accessed 15
^ World Health Organization:
World Health Organization: Mental Health
Project Atlas: Resources for Mental Health and