Mental health programs and services

Current focus

EB130 (Jan 2012)

At the request of a Member State, a report (Document EB130/9) has been prepared on the current global situation with regard to mental health, outlining the main challenges and priorities in this area and the possible approaches to meeting them. The Board’s further guidance is requested.

The report summarises the magnitude of the global health problem presented by mental health.  It refers to the GBD associated with MH diagnoses; the mortality risk including the risk of suicide; the particular risks associated with humanitarian emergencies; the inequalities in access to services; the social impact of mental illness (including homelessness, unemployment, reduced productivity, human rights violations, poverty). 

The report summarises WHO's advice to member states regarding Mental Health and summarises the activities of the Secretariat in this field including the Mental Health Gap Action Program which encompasses advocacy, information and surveillance, policy law and human rights, service development and humanitarian emergencies.

The Board is invited to provide further guidance.    

Background

Burden of mental illness

Mental illness constitutes one of the major causes of disability in terms of global burden of disease. See 2004 revision of WHO Global burden of disease estimates.

See also: Mathers and Loncar (2006) Projections of global mortality and burden of disease, 2002-2030 (PLoS)

UN General Assembly resolution 65/95 on global health and foreign policy recognises the prevalence of mental illness and its negative effect over the individual, family and society, and the associated socioeconomic cost.

WHO Mental Health and Development Report depicts the vulnerability faced by people living with mental illness.  

See Prince et al (2007) No health without mental health (Lancet)  

Availability of programs, services and protections

There is wide gap in the availability of resources and services for Mental Health.  WHO's Mental Health Atlas concludes that:  

1. RESOURCES TO TREAT AND PREVENT MENTAL DISORDERS REMAIN INSUFFICIENT 
   • Globally, spending on mental health is less than two US dollars per person, per year and less than 25 cents in low income countries.
   • Almost half of the world's population lives in a country where, on average, there is one psychiatrist or less to serve 200,000 people. 
2. RESOURCES FOR MENTAL HEALTH ARE  INEQUITABLY D ISTRIBUTED
   • Only 36% of people living in low income countries are covered by mental health legislation. In contrast, the corresponding rate for high income countries is 92%. Dedicated mental health legislation can help to legally reinforce the goals of policies and plans in line with international human rights and practice standards. 
   • Outpatient mental health facilities are 58 times more prevalent in high income compared with low income countries. 
   • User / consumer organizations are present in 83% of high income countries in comparison to 49% of low income countries. 
3. RESOURCES FOR MENTAL HEALTH ARE INEFFICIENTLY UTILIZED
   • Globally, 63% of psychiatric beds are located in mental hospitals, and 67% of mental health spending is directed towards these institutions.
4. INSTITUTIONAL CARE FOR MENTAL DISORDERS MAY BE SLOWLY DECREASING WORLD WIDE 
   • Though resources remain concentrated in mental hospitals, a modest decrease in mental hospital beds was found from 2005 to 2011 at the global level and in almost every income and regional group

MH remains untouched in the the millennium development goals (MDG). See  Miranda & Patel (2005) MDGs & Mental Health (PLoS Article)  

What WHO is doing 

See EB130/9.  See also Mental Health Gap Action Program

See: Patel et al (2004) Treating Depression in the Developing World (Trop Med & Int Hlth)].

Other initiatives and commentaries

The Movement for Global Mental Health "aims to improve services for people with mental disorders worldwide. In so doing, two principles are fundamental: first, the action should be informed by the best available scientific evidence; and, second, it should be in accordance with principles of human rights. The Movement is a global network of individuals and institutions who support this mission." 

See: Jenkins et al (2008) Foresight Mental capital and Wellbeing Project: Mental health future challenges (UK Government office for Science)  The aim of the Foresight Project on Mental Capital and Wellbeing (www.foresight.gov.uk) is to advise the Government on how to achieve the best possible mental development and mental wellbeing for everyone in the UK in the future.

WHO Euro (2005) Mental health: facing the challenges, building solutions

Patel and Kleinman (2003) Poverty and mental health in developing countries

The Lancet series on Global Mental Health.  "Mental health disorders represent a largely hidden, if not substantial proportion of the world's disease burden. They can often be neglected, especially in low and middle-income countries, many of which have no resources to tackle mental-health concerns.  The Lancet series on Global Mental Health draws together leading experts from the Institute of Psychiatry, Kings College London, UK, The London School of Hygiene and Tropical Medicine, UK, and, WHO to highlight the gaps in mental-health services worldwide, and to formulate a clear call to action."