WHO is appealing to countries to increase their support for mental health services. The appeal is part of a series of six reviews on global mental health which is published in the journal The Lancet. WHO has worked closely with the journal to generate the evidence and formulate the call for action.
Mental disorders are common but as many as half of all people with severe mental disorders and a vast majority of those with mild or moderate disorders worldwide do not receive any treatment. Even when treatment is available, it is often delivered in institutional settings which in many countries are associated with stigma and human rights violations.
The reasons for this bleak situation are clear: mental health services are being starved of both human and financial resources.
WHO's Mental Health Atlas database shows that a majority of countries in Africa and South-East Asia spend less than 1 per cent of their health budget on mental health.
Low-income countries have an average of 0.05 psychiatrists and 0.16 psychiatric nurses per 100000 population (about 200 times less than in high-income countries); these extremely low rates make it impossible for satisfactory services to be delivered in these countries.
Call to public health planners
WHO is supporting a call for action to increase the coverage of mental health services for mental disorders in low-and middle-income countries. The call is targeted at public health planners and urges them to assign a higher priority to mental health.
"This topic should matter to everyone, because people living with mental disorders in low- and middle-income countries are systematically locked out of the benefits of development that are open to others. When not addressed, mental disorders deprive people of opportunities to escape from poverty and deny them a voice to claim their rights," said Dr Catherine Le Gales-Camus, WHO Assistant DirectorGeneral for Noncommunicable Diseases and Mental Health.
Neglect and discrimination
"The current situation means that people with mental illnesses are at best ignored and at worst actively discriminated against in many countries. We can only improve the services available to people with mental disorders if there is a major and rapid increase in investment in this area," said Dr Benedetto Saraceno, WHO Director of Mental Health and Substance Abuse.
Estimates show that the
amount of money required to deliver a core package of mental health care is approximately USD 2 per person per year in low-income countries and USD 3-4 in lower-middle income countries. This package, based on treatment of mental disorders in primary health care and in community-based facilities would increase the treatment coverage to 80 per cent for severe mental disorders and 25-33 per cent for less severe ones.
These targets are currently the best attainable level for most low- and middle-income countries given the current poor infrastructure and scarcity of human resources for mental health care.
The call for action further reinforces WHO's global action programme on assisting low- and middle-income countries in providing mental health care.
What is mental health? Mental health is not just the absence of mental disorder. It is defined as a state of wellbeing in which every individual realises 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.
In most countries, particularly low- and middle-income countries, mental health services are severely short of resources - both human and financial. Of the health care resources available, most are currently spent on the specialised treatment and care of the mentally ill, and to a lesser extent on an integrated mental health system.
Instead of providing care in large psychiatric hospitals, countries should integrate mental health into primary health care, provide mental health care in general hospitals and develop communitybased mental health services. Even less funding is available for mental health promotion, an umbrella term that covers a variety of strategies, all aimed at having a positive effect on mental health. The encouragement of individual resources and skills, and improvements in the socio-economic environment are among the strategies used.
Mental health promotion requires multi-sectoral action, involving a number of government sectors and nongovernmental or communitybased organisations. The focus should be on promoting mental health throughout the lifespan to ensure a healthy start in life for children and to prevent mental disorders in adulthood and old age.