PS005 - Making Mental Health a Global Priority: Scaling Up Services

Mental, neurological and substance use (MNS) disorders represent a huge global burden in terms of disability, morbidity and mortality. According to the WHO (World Health Organization), uni-polar depressive disorders alone were the leading cause of disability in the year 2000. Perhaps these results can be explained by the proportion of national budgets allocated to mental health: even high income countries only allocated 6.89% of their total health budget. There is also a correspondence between lower national income levels and proportionally lower mental health budgets. As a result, there is a serious gap between the number of people in need of mental care and the number of people receiving it.

The WHO Mental Health Gap Action Programme (mhGAP) plans to scale up the MNS care capacity of developing countries by reinforcing the commitment of stakeholders to allocate funding and resources in the priority areas of depression, schizophrenia and other psychotic disorders, suicide, epilepsy, dementia, disorders due to substance use, and child mental care. WHO spokesman, Dr. Benedetto Saraceno, explained that it is not sufficient to think in terms of clinical intervention - we have to think of all the services that make health care possible from the doctor that prescribes pills, to the centre he works for, to the bus that delivers pills to the centre, etc. Political commitment is essential to scale up these services. In order to encourage investment and promote implementation of mental care it is crucial for mental care experts to develop a common agenda and for the WHO to develop mental care strategies that are more cost-effective than existing stigmatizing or simply ineffective responses to mental conditions. What is to be done in countries were certain services are missing? Dr. Saraceno prescribed opportunism, citing as an example the use of HIV clinics in South Africa to mainstream previously unavailable health services.

Dr. Ariel Eytan, from the Department of Psychiatry of the University Hospitals of Geneva, drew our attention to the impact of war and crisis on mental health. It has been found that intentional human made disasters (such as war and terrorism) are responsible for greater mental distress and disorders than natural or non-intentional human made disasters. Several epidemiological studies indicate that the two most common disorders in post-war settings are depression and post traumatic stress disorder (PTSD) with high co-morbidity rates. However, he urged us to be wary of committing Kleiman's 'Category Fallacy', which consists in applying a disease-classification developed for a particular culture to another culture without justifying its validity.

Ms. Yvonne Kayiteshonga, from the Rwandan Ministry of Health, described how the Mental Health National Program is trying to integrate mental care through cultural adaptation (for example creating a concept in the native tongue to refer to the collective trauma of the genocide survivors) and to decentralize medical care by channeling it through seven operational Ministry of Health services and reinforcing the care and support providing capacity of national referral structures.

Prof. R. Srinivasa Murthy, Former Professor of Psychiatry, India,presented a positive picture of how it is possible to scale up mental care in developing countries using community support. He reported that there have been initiatives emphasizing family involvement in mental care in India as early as the 1950s. This is only one way in which India seeks to address the problem of scarce resources: the new approach also exhibits a paradigm shift towards decentralized facilities, general emphasis on non-specialist community members, integrating mental care with other services to fight the stigma associated with it, and to root the service in local culture to make it less impersonal.

Among the innovative initiatives to extend mental care we find a programme to bring elderly people in Bombay together to encourage mutual support between them, and the emergence of mutual-support groups among family members of mental patients in partnership with professionals.