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RAISING AWARENESS, FIGHTING STIGMA, IMPROVING CARE
Brundtland Unveils New WHO Global
Strategies for Mental Health,
Sees
Poverty as a Major Obstacle to Mental Well Being
To ease the "burden" of mental
disorders and neurological illnesses, currently affecting some 400
million people worldwide, the Director-General of the World Health
Organization (WHO), Dr. Gro Harlem Brundtland, launched here today
WHO's new Global Strategies for Mental Health. The strategies are
aimed at improving the population coverage and quality of psychiatric
and neurological care throughout the world, particularly in developing
countries.
WHO expects to achieve these objectives
through a number of measures that will be vigorously promoted in both
developing and developed countries. First of all, the Organization has
to raise awareness among the general public, health professionals and
public health decision makers about the relative importance of mental
and neurological disorders as major contributors to the global burden
of disease.
This burden has recently been
clarified using a new measure -- the "Disability-Adjusted Life Years"
(DALY) – jointly developed by WHO, the World Bank and Harvard
University. The DALY measures the overall burden of a disease by
combining, on the one hand, the years of potential life lost
due to premature death from the disease and, on the other, the years
of productive life lost due to the disability produced by the
condition.
"For mental health, the DALY has
brought a critical reality to light and showed that psychiatric
disorders and neurological diseases are amongst the most important
contributors to the global burden of disease," stated Dr Brundtland at
a press conference in Beijing. "In 1998, these disorders were
estimated to account for almost 12% of the deaths and lost
productivity due to all diseases and injuries globally, with an
estimated 23% in high income countries and approximately 11% in middle
and low income nations. In 2020, their share is projected to increase
to 15%, if urgent action is not taken," she said.
According to estimates
for Global Burden of Disease 1990, five of the ten leading causes of
disability worldwide, in both developed and developing countries, are
mental problems. They are major depression, schizophrenia, bipolar
disorders, alcohol dependence and obsessive compulsive disorders. For
DALYs estimates in 1998 major depression ranks fifth on this list. By
2020, this disorder will jump to second place, if the present trend
continues.
Major depression is linked closely with
suicide, since most persons, who attempt suicide, are also clinically
depressed. Once suicide and its attempts are taken into account, the
burden associated with depression increases quite significantly.
In spite of the fact that almost
70% of WHO Member States have an updated list of essential drugs,
including psychotropic ones, one third of the global population has no
access to them. In Africa, only one out of two people has such access.
The situation is particularly serious in rural areas, where
antidepressant, anticonvulsant and antipsychotic drugs are rarely
available.
WHO's Director-General
emphasized that the traditional methods of prioritizing health
problems, based normally on the mortality and prevalence of an
illness, had important limitations. The numbers of deaths, she said,
did not take into consideration the non-fatal outcomes of illness,
while prevalence rates did not take into account the severity and
duration of disability produced by diseases. As a result, for many
years the burden of psychiatric and neurological conditions has been
underestimated. This, Dr Brundtland said, had obvious consequences on
budget allocation and policy planning.
By raising awareness about the
importance of mental problems, the World Health Organization hopes to
heighten the profile of mental health on the political, health and
development agenda of governments in its 191 Member States, of
international agencies, as well as of national and international
nongovernmental organizations.
WHO would also fight social
stigma, misconceptions and discrimination associated with
neuropsychiatric conditions, as well as promote human rights of the
mentally ill persons, stressed Dr Brundtland. "Very often and in many
countries, individuals, who are affected by neuropsychiatric
disorders, endure double suffering, namely from the conditions
themselves and from the social stigma and discrimination attached to
them. In this respect, every country is a developing country," said
WHO's Director-General.
December 2001 will mark the 10th
anniversary of the Principle for the Protection of Persons with
Mental Illness and for the Improvement of Mental Health Care,
adopted by the UN General Assembly in 1991. Dr Brundtland proposed to
seize this occasion to launch concerted measures to foster the
implementation of these principles, including, for example, the
development of an International Convention on the Rights of Persons
with Mental Disorders.
Another important
objective of the new WHO Strategies for Mental Health is improving
treatment rates for psychiatric and neurological conditions. For
example, even in the established market
economies with well-developed health care systems, only an estimated
35% of patients who suffer from depression receive treatment.
The situation is especially
worrisome in developing countries – the home of around 80% of the
world's population by 2020. For example, in India, treatment rates of
20% for schizophrenia and epilepsy contrast with the 80%
treatment rates for the same disorders in countries with established
market economies. In the countries of sub-Saharan Africa, treatment
rates for depression are estimated around 5%. In disaster and
war-stricken areas of the world, the situation is even worse.
These treatment rates could not
be increased through awareness raising only, WHO's Director-General
stressed. Shifts in emphasis from large specialized psychiatric
institutions -- which are usually concentrated in urban settings and
are a major source of treatment today -- towards more effective
community-based mental health services covering both urban and,
particularly, rural areas, are needed.
The World Health Organization,
Dr Brundtland said, would also promote wider use of effective
intervention and essential drugs that have proven to help control
psychiatric disorders and neurological diseases. For example,
a demonstration project in China has shown that simple family
interventions, when combined with pharmacotherapy, can substantially
increase the cost-effectiveness of treatment of persons with
schizophrenia. Epilepsy can be effectively treated with phenobarbitone
-- a safe and inexpensive drug, which is still in short supply in many
developing countries.
The new
Strategies would finally continue to monitor the mental health of the
world. WHO, its Director-General said, was in the final planning stage
of Mental Health Survey 2000. This survey will be carried out in 19
countries, including China (Beijing, Guangzhou and Shanghai
provinces), to collect data on
mental and physical disorders
and disability, work loss, risk factors, as well as on the provision
and use of services and medications.
Dr Brundtland also announced
that WHO has developed and is launching global campaigns
targeting depression/suicide prevention, schizophrenia and
epilepsy. These important campaigns will involve key international
and national NGOs, professional organizations, academic institutions
and civil society.
Underpinning the announcement,
she stressed, is the notion that "mental health" goes beyond the mere
absence of mental or neurological disorders. For WHO, mental well
being is an integral part of mental health. Dr Brundtland saw poverty
as a major obstacle to such mental well being. "More than three
billion people - that is half of the world's population - still remain
poor and live on less than two US dollars per day. Of these, 1.3
billion live on less than one dollar a day. Population growth may have
increased these figures to four billion and nearly two billion
respectively by 2025," she pointed out.
"The world has set a
target of halving the number of absolute poor by 2015. That is a very
tall order… We need a portion of decency on the part of the richer
countries to pay a fair share to bring the excluded billion [of
people] on board. Only four of the richest countries – the
Netherlands, Denmark, Norway and Sweden – live up to their obligation
of providing at least 0.7% of their GDP for development assistance.
The average [contribution among the richest countries] is falling
towards a record low 0.2%. This, in my view, is a shame, and all
groups in civil society committed to development should hold their
leaders to account," stated Gro Harlem Brundtland.
www.who.int
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