global mental health

Friday, August 10, 2012
In today’s health column, we bring you a presentation done by Momodou Gassama, Health Promotion Officer, WHO country  office on the state of mental health globally. He did this presentation during a two-day workshop for nurses on mental health held at the SerreKunda General Hospital, Kanifing.

Please read on:
First ,he said  mental health is not just the absence of mental disorder. It is defined 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 positive dimension of mental health is stressed in WHO’s definition of health as contained in its constitution: “Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.”
—    Mental, neurological, and substance use disorders are common in all regions of the world, affecting every community and age group across all income countries.  An estimated 450 million people suffer from mental and neurological disorders and psychosocial problems. While 14% of the global burden of disease is attributed to these disorders, most of the people affected - 75% in many low-income countries - do not have access to the treatment they need.

Ten facts on mental health
Fact 1: About half of mental disorders begin before the age of 14. Around 20% of the world’s children and adolescents are estimated to have mental disorders or problems, with similar types of disorders being reported across cultures. Yet, regions of the world with the highest percentage of population under the age of 19 have the poorest level of mental health resources.

Fact 2: Depression is characterized by sustained sadness and loss of interest along with psychological, behavioral and physical symptoms. It is ranked as the leading cause of disability worldwide.

Fact 3: On average about 800 000 people commit suicide every year, 86% of them in low- and middle-income countries. More than half of the people who kill themselves are aged between 15 and 44. The highest suicide rates are found among men in eastern European countries. Mental disorders are one of the most prominent and treatable causes of suicide.

Fact 4: War and other major disaster have a large impact on the mental health and psychosocial well-being. Rates of mental disorder tend to double after emergencies.

Fact 5: Mental disorders are among the risk factors for communicable and non-communicable diseases. They can also contribute to unintentional and intentional injury.

Fact 6: Stigma about mental disorders and discrimination against patients and families prevent people from seeking mental health care. In South Africa, a public survey showed that most people thought mental illnesses were related to either stress or a lack of willpower rather than to medical disorders. Contrary to expectations, levels of stigma were higher in urban areas and among people with higher levels of education.

Fact 7: Human rights violations of psychiatric patients are routinely reported in most countries. These include physical restraint, seclusion and denial of basic needs and privacy. Few countries have a legal framework that adequately protects the rights of people with mental disorders.

Fact 8: There is huge inequity in the distribution of skilled human resources for mental health across the world. Shortages of psychiatrists, psychiatric nurses, psychologists and social workers are among the main barriers to providing treatment and care in low- and middle-income countries. Low-income countries have 0.05 psychiatrists and 0.42 nurses per 100 000 people. The rate of psychiatrists in high income countries is 170 times greater and for nurses is 70 times greater.

Fact 9: In order to increase the availability of mental health services, there are five key barriers that need to be overcome: the absence of mental health from the public health agenda and the implications for funding; the current organization of mental health services; lack of integration within primary care; inadequate human resources for mental health; and lack of public mental health leadership.

Fact 10: Governments, donors and groups representing mental health workers, patients and their families need to work together to increase mental health services, especially in low- and middle-income countries. The financial resources needed are relatively modest: US$ 2 per person per year in low-income countries and US$ 3-4 in lower middle-income countries.

A brief look at World Mental Health Day 2012

—    World Mental Health Day: 10 October 2012
—    The theme of this year: Depression, a global crisis.
—    Depression is common, affecting about
              121 million people worldwide.
—    Depression is among the leading causes of
              disability worldwide.
—    Depression can be reliably diagnosed and
              treated in primary care.
—    Fewer than 25 % of those affected have access to
              effective treatments.

What is depression
—    Depression is a common mental disorder that presents with depressed mood, loss of interest or pleasure, feelings of guilt or low self-worth, disturbed sleep or appetite, low energy, and poor concentration. These problems can become chronic or recurrent and lead to substantial impairments in an individual’s ability to take care of his or her everyday responsibilities. At its worst, depression can lead to suicide, a tragic fatality associated with the loss of about 850 000 lives every year.

    The hard facts

—    A balance of community-based and hospital-based services has been shown to be the most effective form of comprehensive mental health care. Yet such a balance has only been achieved in a few high-income countries, where financial resources have been matched by the political will to increase community care. If community-based mental health care is defined broadly, as “any type of care, supervision and rehabilitation of patients with mental illness outside the hospital by health and social workers based in the community”, then only about half the countries in Africa, the eastern Mediterranean, and southeast Asia provide such care
—    Human resources for mental health (psychiatrists, psychologists, nurses, and social workers) per 100 000 population is gross inadequate:
—    Low-income countries have a median of 0·05 psychiatrists and 0·16 psychiatric nurses per 100 000 population. High-income countries have a ratio of psychiatric health-workers to population that is about 200 times higher

    Inadequate financial resources for mental health:

—    Almost a third of countries (31%) do not have a specified public budget for mental health. Of the 101 countries that have a designated mental health budget, 21 (with more than 1 billion people), spend less than 1% of their total health budget on mental health
—    Worldwide, the most common method of financing mental health care is taxation (60%), followed by social insurance (19%), out-of-pocket payments (16%), external grants (3%), and voluntary insurance (2%). But more than a third of low-income countries rely on out-of-pocket payments as a primary source of finance for mental health care, compared with only 3% of high-income countries.

    Huge inequities in access to mental health care:

—    Not only are resources for mental health scarce, but they are also distributed inequitably: between countries, between regions, and within local communities. Need and access tend to vary inversely—those with highest need have least access to care. The rate of mental disorders and the need for care are highest in poor people, those who are least educated, women, young people, and rural communities
—    Stigma and discrimination against the mentally
              ill persist:
—    Though under-provision of resources remains the most important barrier to effective mental health care, even in the highest-income countries, most people with mental disorders receive no effective care; for example, in the USA, two-thirds of people with mental disorders received no treatment (and paradoxically half who did receive treatment did not meet diagnostic criteria for a mental disorder)
—    Stigma and discrimination are important factors in the reluctance of many people worldwide to seek help, or even to accept that their difficulties relate to mental illness:
—    Ethiopia, for example, 75% of relatives of people with diagnoses of schizophrenia or mood disorders said that they had experienced stigma because of the presence of mental illness in the family, and 37% wanted to conceal the fact that a relative was ill
—    A survey in South Africa reported a general public perception that mental illnesses were related to either stress or insufficient willpower, rather than medical causes. People therefore believed that such problems could be dealt with by discussion, rather than consultation with health professionals
—    In China, a large-scale survey reported that more than half the family members of people with schizophrenia said that the effect of stigma on them and their family was such that they had decided to conceal the mental illness in their family.
Many people with mental disorders experience outright abuses of their human rights, and sometimes even within treatment facilities. This type of inequity is much less common in the treatment of other medical conditions
—    Mental disorders are estimated to cost nearly a third of the projected US$47 trillion dollars by all non-communicable diseases by 2030.
—    “The burden on people living with mental disorders is incalculable”

Lancet 2012

Author: lamin njie
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