Global health community must act on mental health

Sep 4 2007

The global public health community must take action to scale up services for mental disorders, especially in low- and middle-income (LAMI) countries, according to a team of public health experts writing in the Lancet.

The Lancet Global Mental Health Series, which has been developed by an international group of mental health and public health experts, calls for a scaling up of a basic, evidence-based package of services for core mental disorders, and the strengthening of the protection of the human rights of people with mental health disorders and their families. The authors estimate that this could be achieved for as little as US$2 per year per person in low-income countries, and US$3-4 in middle-income countries.

Mental health disorders are estimated to contribute up to 9% of the global burden of disease in low income and 17% in middle income countries. The authors argue that mental health is also key to the achievement of several Millennium Development Goals, including those on promoting gender equality, empowering women, reducing child undernutrition and improving maternal health and combating HIV/AIDS. Despite this the vast majority of people with mental disorders do not receive treatments which are effective and affordable. Many suffer discrimination and abuse of their basic human rights.

In a series of six articles, the authors document the evidence base for global mental health, with a focus on LAMI countries, and conclude with a strident call to action to the global health community to scale up services for mental health services in these countries.

The first paper examines how mental health disorders increase the risk for and are a consequence of major communicable and non-communicable diseases, and are a contributory factor to both unintentional and intentional injury. Subsequent papers go on to describe the scarcity, inequity and inefficiency of mental health resources, to examine the evidence on the effectiveness of treatments for specific mental disorders and the barriers to mental health reform. The authors look at the current status of mental health systems around the world, with a focus on LAMI countries, and point to particular inequities and deficiencies in Africa and South East Asia.

The final paper is a call for action to the global health community, to governments, to donors and multilateral agencies, and to professional bodies and consumer groups across a range of mental health stakeholders.

Professor Vikram Patel of the London School of Hygiene & Tropical Medicine is one of the series editors, and is speaking at the Series launch event which is being held today at the Science Media Centre in London. He comments: 'More than fifty experts have contributed to this Series, which would not have been possible without the extraordinary commitment of each and every one of them. The vast intellectual capital and expertise they have brought to the process are fully evident in the comprehensive data and evidence that we have compiled in order to put pressure on policy makers to scale up mental health services in their countries.

'We have shown that for as little as US$2 per year per person in low-income countries, and between US$3 and 4 in middle-income countries, and with a bit of political will and solidarity on the part of the global public health community, we could provide a level of service provision for mental disorders which would have a massive impact on the health of millions of people. We know what works, and we know what needs to be done, and this Series describes how this should be done. We just need to translate this knowledge into action, and the time to act is now'.

The London School of Hygiene & Tropical Medicine is the institution which has contributed the greatest number of experts to the Call to Action. LSHTM staff are Sir Andrew Haines, Director of LSHTM, Betty Kirkwood, Professor of Epidemiology and International Health, Vikram Patel, Professor of International Mental Health, Mary de Silva, Lecturer, and Sophia Plagerson (a PhD Student).