The "huge treatment gap" in the developing the world for
psychiatric, neurological, and substance use disorders can be narrowed if
governments and donors can increase funding, expand mental health services,
and integrate the latter into primary care settings, said the World Health
Organization (WHO) in announcing its Mental Health Gap Action Program (mhGAP)
in October.FIG1
The plan seeks to strengthen commitments by governments and international
organizations to put more human and financial resources into treating these
disorders and expand access to targeted interventions in low-income and
lower-middle-income countries.
"We have in hand, right now, all the evidence, solutions, and lines
of action we need to address the global burden of morbidity and premature
mortality caused by these disorders," said Margaret Chan, director
general of WHO, at a news conference in Geneva. "But have no
illusions.... Having evidence and a well-designed package of interventions are
not enough. We will not see progress in mental health without political
commitment."
Worldwide, only 2 percent of health funding is allocated to mental health,
according to the WHO. Access to affordable care is difficult or impossible for
millions of people. Many poor countries have fewer than one mental health
professional per 100,000 population. The report estimates that one-third of
people living with schizophrenia, more than half with depression, and
three-quarters of those with alcohol use disorders lack access to care for
those disorders.
The WHO plan focuses on conditions with the highest burden of illness or
economic cost or those associated with human-rights violations induced by
stigma: depression, schizophrenia and other psychotic disorder, suicide,
epilepsy, dementia, alcohol and drug abuse, and mental disorders in
children.
It describes evidence-based interventions to meet these challenges and
calls for additional help for poor countries with high levels of
disability-adjusted life years and greatest burden of mental, neurological, or
substance abuse disorders.
The program calls for policymakers, health professionals, health
economists, social scientists, and nongovernmental organizations to organize
and push for political commitment "at the highest level" to
provide funds and human resources.
"Political leaders have to be aware of the problem ... [and] must be
convinced that taking action serves their best interests," said
Chan.
The costs of increasing services would vary from country to country, the
document pointed out, but "should be feasible in absolute terms,
although challenging." Reallocation of resources within national health
budgets may be one strategy. Funds from international agencies or foundations
may be another.
"In public health we see, time and time again, how a comprehensive
program of action, backed by solid evidence, can attract political attention,
inspire partners, secure funds, and accelerate progress," said Chan."
Care for these highly prevalent, persistent, and debilitating disorders
is not a charity. It is a moral and ethical duty.... And it is entirely
feasible."
"Mental Health Gap Action Programme (mhGAP): Scaling Up Care
for Mental, Neurological, and Substance Use Disorders" is posted at<www.who.int/entity/mental_health/mhgap_final_english.pdf>.▪