|Fourth Quarter 2001|
WHO's Five-Year Global Action Program for Mental Health
Towards the end of its year-long campaign in 2001 to draw attention to mental health, the World Health Organization decided to continue its effort in a new five-year program to "provide a clear and coherent strategy for closing the gap between what is urgently needed, and what is currently available to reduce the burden of mental disorders, world wide." Those were the words of WHO Director-General Gro Harlem Brundtland, describing the new Global Action Program (mhGAP for short) at a Council for Mental Health Seminar in her native Norway on 11 December 2001. She continued that "WHO will work with governments to move mental health towards the center of health agendas."*
In developing its new program, WHO has engaged in a broad consultation exercise and identified four main strategies consistent with the functions of the organization. Benedetto Saraceno, Director of WHO's Department of Mental Health and Substance Dependence, outlined them in January as follows: "information generation and its wide dissemination; provision of technical and managerial support to countries for policy, programme and service development; research capacity building and multiplication of research initiatives, especially in developing countries; and lastly, promotion of advocacy and the protection of human rights of people with mental illness."
He added that in the next five years "WHO Headquarters, regional and country offices will focus on providing strong technical support to assist in the development and implementation of national mental health goals. It is now a question of ensuring that the accumulated knowledge and technology are rapidly put to use in the service of ALL those who need mental health care around the world.
To do this, countries need to make mental health services available to people as close as possible to where they live. They need to transfer mental health care from psychiatric hospitals to communities which means that budgets must be maintained or even increased; mental health teams must be trained; the needs of especially vulnerable groups must be met; crisis centers for the management of acute conditions must be available; and there must be broad public support for creating and sustaining this shift."
Dr. Saraceno said that such wide goals would need broad-based support. "It is clear that such a massive effort cannot be undertaken by the health sector alone and that partnerships with other sectors, services and civil groups are a must. Governments and non-governmental organizations are calling for intensive technical support from WHO and the international community."
World Health Report
The initiatives follow the release of WHO's World Health Report 2001 with the title "Mental Health: New Understanding, New Hope." The Report was launched at a series of regional events in October and November, ending with one at the Pan American Health Organization in Washington, D.C. The 178-page volume brings together a large amount of material to provide a global perspective on mental health, and gives attention to external factors ranging from the effects of social conditions to the psychological impact of major physical diseases.
Pirkko Lahti, WFMH President, says "One of the most important aspects of the report is its attention to the fact that many people living in poverty experience mental health problems. There are many reasons for this…. Poor people have less chance to obtain treatment than wealthier groups." The Report points out that even in rich countries, the poor are particularly at risk, and notes that many people with mental illness can slide into poverty because of the nature of the illness itself.
The five chapters cover a public health approach to mental health; the burden of mental and behavioral disorders; solving mental health problems through effective care; policy and service provision; and recommendations for the way forward. Within these chapters the authors summarize much recent research and set out goals for improvement, citing evidence from around the world.
Tables, figures, examples and boxed commentaries on special subects are liberally provided throughout the text.
Of particular note are new estimates of the global burden of mental and behavioural disorders. The disability-adjusted life year measure (DALY) published in 1993*** showed that for 1990, mental and neurological disorders were 10.5% of DALYs lost due to all diseases and injuries. The estimate for 2000 has risen to 12.3%, and it is predicted to reach 15.0% in 2020.
Major depression ranks fourth in the table of leading causes of the overall global burden of disease for all age groups. Projections put it in second place by 2020.
In a table of the leading causes of years lived with disability by 15-44 year-olds (estimates for 2000), four of the five leading causes are mental disorders. In first place are unipolar depressive disorders, followed by alcohol use disorders and schizophrenia in second and third place, with bipolar affective disorder fifth. WHO expects to publish its final figures for the Global Burden of Disease 2000 during 2002.
|Pilot Project in Mexico
In a significant initiative to improve mental health care, Mexico has introduced a pilot project called the Modelo Hidalgo de Atencion en Salud Mental. It is intended as the foundation for general reforms based on respect for the consumer's right to receive care delivered with attention to quality, within a system of integrated medical and psychiatric services. It also marks an effort to improve often-criticized conditions in psychiatric institutions.
The Hidalgo Model won support after a change of administration in Mexico, when Vicente Fox became president in 2000 and signaled concern for mental health care by giving a prominent consumers' advocate, Virginia Gonzalez Torres, a post in the Health Ministry. She directs a new Office of Psychosocial Rehabilitation, Citizens Participation, and Human Rights. The model program is a joint project of the Health Ministry and the Mexican Foundation for the Rehabilitation of Persons with Mental Illness, together with the governments of different Mexican states.
The reform movement focused initially on the State of Hidalgo, where conditions at the Ocaranza institution had attracted widespread criticism. Ocaranza was closed down, and a group of services was put together to provide for prevention, mental health care in the community integrated with regular health care, hospitalization where necessary, and social reintegration.
A variety of service formats are now used, including mental health services in clinics and community centers, general hospitals, psychiatric hospitals for people in the acute stages of illness, and new, very small hospital units called "villas." The network includes various residential arrangements including halfway houses, residences for senior citizens, independent housing and group housing. Social reintegration is offered through clubs and employment opportunities at sponsored workshops and business cooperatives.
The Governor of Hidalgo attended the Pan American Health Organization's mental health conference in Washington, D.C. on 6 November 2001, to present his state government's mental health policy reforms and its commitment to press on with them. Virginia Gonzalez Torres was also there to describe the national government's support for the Hidalgo Model and her personal support for consumer involvement in its development. Her staff distributed material describing the project, in Spanish and English, to health ministry representatives from other South American countries.
One of the main objectives of her office in the Health Ministry is to promote the development of the Hidalgo Model in other Mexican states, and to request sufficient funding allocations from the federal and state authorities to make this possible.
To provide information
about the current status of mental health systems and to highlight the
great variations among countries, WHO collected basic information from
181 countries for a "Project Atlas of Mental Health Resources." This
important survey revealed that roughly four out of ten countries have no
defined mental health policy; approximately one-third have no drug and
alcohol policy; one-third have no specific budget for mental health and
half of the remainder allocate under 1% of their public health budget to
mental health. One-third of the countries reporting had no mental health
program at all. WHO finds the lack of policy related to children and
adolescents particularly significant.
UN New York
The NGO Committee on Mental Health presented a program on 13 December 2001 to mark the UN Human Rights Day and the Ten Year Anniversary of UN Resolution 46/119 - "The Protection of Persons with Mental Illness and the Improvement of Mental Health Care." The panel was organized and chaired by Nancy Wallace, WFMH Main Representative at the UN and Past Chair of the NGO Committee.
The three speakers were Tina Minkowitz, J.D., a member of the World Network of Users and Survivors of Psychiatry ("What does Disability Rights have to do with the MI Principles? A Perspective from the User/Survivor Movement"); Laura Prescott, President of Sister Witness International, Inc.("Shattering the Silence: Protecting the Rights of Institutionalized Women across the Spectrum"); and Maribel Derjani-Bayeh, Social Affairs Officer in the Programme on Disability in the UN's Department of Economic and Social Affairs ("Update on the General Assembly Resolution calling for an International Convention to Protect and Promote the Rights and Dignity of Persons with Disabilities").
Ms. Derjani-Bayeh reported on an important new development at the United Nations of special interest to NGOs concerned with disabilities. On Friday, 30 November, the UN General Assembly approved, by consensus, a Resolution put forward by the Government of Mexico calling for a comprehensive international convention to protect the rights and dignity of people with disabilities.
An Ad Hoc Committee will be established by the General Assembly to consider proposals for the convention, taking into account recommendations of the UN Commission on Human Rights and the UN Commission on Social Development. The two Commissions will play a leading role in developing the content of the convention. In 2002 the consultative process of creating the convention is expected to occupy a central place in the work of UN bodies and NGOs concerned with disabilities and human rights, including the NGO Committee for Mental Health.
Ms. Wallace is convening a new Working Group on Human Rights and Mental Health that will focus on this new UN initiative.
UN World Assembly on Ageing
|Retirement of Josee Van Remoortel
Josee Van Remoortel, the first Executive Director of Mental Health Europe (formerly known as the European Regional Council of WFMH), retired at the end of October. She has served in this position as a volunteer since 1993, having previously been Chair of the ERC-WFMH from 1989 to 1993. She was a founding member of the ERC and is a life member of WFMH, which she joined in 1975.
After qualifying with a Master's degree in Community Nursing and Social Work, she held a position in the community mental health service attached to the Department of Psychiatry at the State University of Gent, Belgium, for several years. She then served as Deputy Director of the Belgian National Association for Mental Health and as Director of the Flemish Association for Mental Health. At Mental Health Europe she became involved in many activities of the European Union and served on the boards of numerous organizations.
Mental Health Europe arranged a concert and reception in Brussels on 27 October in Josee's honor, to recognize her exceptional service in the cause of mental health promotion and her leadership in trying to improve the situation of socially disadvantaged people with mental health problems.
In appreciation of Josee Van Remoortel's work, Mental Health Europe has created a special fund to benefit low-income members, to allow them to participate fully in MHE activities. Contributions can be made to the MHE account 442-8026622-96, swift code: KRED BE 99, Banque: KBC Potuit, Antwerpsesteenweb 465, directed to the "Josee Van Remoortel Farewell Fund."
New MHE Director
Mental Health Europe has now made a transition to a paid Executive Director. Pascale Van den Heede started in the post part-time on 1 April, and took over full time on 1 November. She has a degree in Pharmaceutical Sciences from the University of Gent, Belgium, and postgraduate qualifications in Women's Studies and in Human Ecology. Her work experience is in marketing and communications.
|News from the Regions
MHE has issued a six-page brochure called "Social Inclusion - A Challenge for the European Union!" The brochure contains specific, concise guidelines for policy-makers and service providers to improve the social inclusion of people with mental health problems. The attention of policy-makers is directed to employment, education and training, welfare benefits, family life issues, human rights and housing. Matters for consideration by service providers include access to treatment, housing issues, confidentiality of personal data, and the need for public education. This should include employers, the media, and even health and social workers. The brochure is available from:
Mental Health Europe
At the end of a long period of information gathering, MHE has also produced a directory of projects concerned with "Mental Health Promotion of Adolescents and Young People." This catalogues a wide range of initiatives in European Union countries to promote positive mental health and prevent mental illness among adolescents and young people up to the age of 25. To obtain the directory contact the project co-ordinator, Kirsten Zenzinger, at the MHE address above or email@example.com
Conference in Israel
ISAS International Seminars
The Philippine Mental Health Association opened its 51st National Mental Health Week, and its observance of World Mental Health Day, on 8-9 October 2001 with a national conference on "Mental Health and Work." The meeting took place in Bacalod City on the island of Negros. In addition to general workplace concerns the topics included child labor, life after work, and the workplace as a center of wellness. Special World Mental Health Day celebrations involving a number of private schools in Bacalod City were also arranged for 10 October. WFMH Regional Vice President for Southeast Asia, Regina de Jesus, was the guest speaker for the day's program.
En la Región Andina, especialmente en Colombia, se ha logrado desarrollar actividades de Salud Mental, particularmente en los temas que afectan a los enfermos psiquiátricos. La población general de ese país vive un stress permanente por motivos conocidos, los problemas de los secuestros, la lucha contra el narcotráfico y las guerrillas están afectando más y más a la población. La Asociación Colombiana de Salud Mental realiza esfuerzos para desarrollar planes de prevención y atención al stress.
En el Cono Sur de Sud América se han producido varias reuniones regionales sobre Salud Mental y Trabajo. La última, realizada en diciembre en Montevideo, tuvo representantes de Argentina y Uruguay. Ya existen propuestas para un plan de trabajo para el año 2002 que incluyen una extensión a otros países. Se preve el fomento de la investigación y también la cuantificación de los costos por causas atribuibles a la pérdida de la Salud Mental.
La Federación y la ILO están impulsando la sensibilización de los sindicatos, empleadores y los gobiernos. Necesitamos acumular información sobre la situación de la Salud Mental y el Trabajo en los países de la región. Por ello, agradecemos de antemano envíen a la Vice-Presidencia Regional la información disponible, en especial estudios y datos de lo que está aconteciendo en los restantes países.
En diciembre del 2001 se ha realizado una nueva reunión sobre Mass Media y Salud Mental. Esta fue coorganizada por varias Fundaciones de Argentina y Uruguay y convocada por la Sección correspondiente de la Asociación Mundial de Psiquiatría (WPA) y nuestra Federación. Fue un verdadero encuentro interdisciplinario, en el cual participaron profesionales de amplia diversidad, representantes de Facultades, de la Universidad de Buenos Aires (Argentina) y de Uruguay. Es destacable que en ella participaron activamente empresarios de los medios de comunicación y periodistas.
Prof. Dr. Paulo Alterwain
A group of WFMH leaders met at the Asai Hospital in Chiba, Japan, on
4-5 November to discuss the development of regional activities. Honorary
President Tsung-yi Lin attended, together with WFMH Regional
Vice-President Kazuyoshi Yamamoto, former Board members Kunihiko Asai
and Shimpei Inoue, and Board member-at-large Chueh Chang. The group
intends to organize a WFMH Asia-Pacific symposium on mental health and
human rights in conjunction with the World Psychiatric Association's
conference in Yokohama in August 2002. They also discussed progress
towards the establishment of a Regional Council, which they hope can be
inaugurated at the WFMH World Congress in Melbourne in February 2003.
Regional Vice-President Kazuyoshi Yamamoto attended the 52nd Session
of the WHO Regional Committee for the Western Pacific in Brunei
Darussalam on 10-14 September 2002, and read a statement on behalf of
|The Impact of September 11 on Refugees Applying for
By Solvig Ekblad, co-chair of WFMH's International Committee on Refugees and Other Migrants (ICROM)
Eighty days after the terrorist attacks in the United States, I was walking at "Ground Zero" in New York. Christmas decorations were hanging in the streets at the edge of the site, but I was aware of the sticky smell of fire which not only induced stress but was also unhealthy to inhale. For all those directly and indirectly effected by the terror attacks, recovery from long-term psychological scars will take time. This was one of the main topics at the 17th Annual International Society for Traumatic Stress Studies Meeting in New Orleans in December, which mainly focused on trauma produced by terrorism and mass disaster. However, I have been thinking recently that the mental health impact of detention among asylum seekers must not be neglected, especially as our alertness against terrorism now encourages suspiciousness and hostility toward foreigners. That is the topic of my column, and I will draw on experiences as a visiting researcher in Australia earlier this year, at the department of my Committee co-chair, Professor Derrick Silove.
In supporting the war against terrorism, we should not forget that one of the most certain outcomes is a large flow of refugees seeking asylum. We should all remember the lessons of history, and the purpose of the Refugee Convention, a landmark international instrument committing ratifying countries to providing humane protection to persons fleeing persecution worldwide . But "instead of providing special care for the most traumatised individuals fleeing persecution, Western countries may be subjecting them to the very conditions that are likely to hinder psychosocial recovery" (Silove, Steel, Mollica, 2001, p.1437). Contemporary refugee policies in Western countries have been thrown into stark relief by the effects of the terror attacks in the US.
Detention of asylum seekers
After the 11 September terror attacks, there was bipartisan political support in Australia for an international war against terrorism. At the same time, those fleeing from terrorist States are treated as criminals when they reach Australia. Recent asylum seekers are mainly confined in detention centres in remote areas and in economically poor island countries to the north of Australia, a policy which has been criticized by UN and other international agencies.
A visit to the Villawood Detention Centre
During my hour of conversation with Aamer Sultan I was deeply impressed by his courage and the way he retained his world view in spite of losing his liberty for an indeterminate period of time. To me the physical environment at Villawood was intimidating, even during a short visit. The compound where we had the conversation was surrounded by multiple layers of high fencing topped and grounded by razor wire. All visitors had to pass through strict security checkpoints and I felt we (the visitors) were treated as cattle. Nevertheless my colleague was allowed to bring a manuscript to discuss with his co-author, Dr. Sultan. The detained people around us sat with visitors, but with boredom, aimlessness and apathy in their eyes. Birds were the only ones with freedom, flying in and out of the compound.
I heard from Dr Sultan that most of the asylum seekers detained at Villawood came from developing countries ruled by oppressive regimes with poor human rights records. Many have been victims of state-organized violence, including torture and other forms of inhuman or degrading treatment and/or have family members who are suffering from such abuses. These people are at high risk of the different kinds of post-traumatic psychological reactions we know about from the literature. Children living in Villawood are at special risk of being influenced by a secondary effect mediated via their parents, whose ability to provide a normal caring and nurturing environment is more or less non-existent. These children are vulnerable to neglect and physical abuse.
In the international arena, the United Nations meeting on children in New York in May could provide an opportunity to raise urgent issues about the impact of asylum detention centers on children's mental health and well-being, under the provisions of the Convention on the Rights of the Child.
Steel, Z., Silove, D.M. (2001).
Sultan, A., O'Sullivan, K. (2001).
United Nations High Commissioner for Refugees (UNCHR)(2000).
Partnership or Pretence
At the start of 2002 a new edition of "Partnership or Pretence" has appeared in Australia, with several new chapters reflecting developments in the consumer scene there. This book by WFMH Board member Janet Meagher, AM, a leading consumers' representative in Australia, was first published in 1995. She says it "is not a heavy intellectual tome but is a useful brief handbook for those who need to regain their place in the world." To judge by the reception of earlier editions, it provides a viewpoint that is widely appreciated. The first edition sold out, and a second edition was produced in 1996. [That year, Ms. Meagher was awarded an Australian honor, the AM, for service as an advocate for people with mental illness and psychiatric disability.] The book was later translated into Japanese, sold out in that language within a year, and may be reprinted in Japan the near future. A translation into Spanish is almost complete, and one into Chinese is now under consideration.
The book's thoughtful observations were the result of research undertaken by Ms. Meagher when she held a Churchill Fellowship in 1994 to investigate consumer empowerment and self-advocacy programs in Great Britain, the USA and Canada. At that time there was a need in Australia for an informative handbook which could assist consumers setting out on a path to empowerment, and would also be helpful to policy makers and health workers interested in providing assistance. The book did not underestimate the pitfalls and difficulties likely to be encountered along the way.
To obtain a copy of "Partnership or Pretence" send a check or bank
draft in Australian currency, for $25 (Australian) to:
Postage is included in the cost. The book is printed, bound and published by consumers at Buckprint Graphics.
Women's Mental Health in Pakistan
Unaiza Niaz, M.D. has produced a monograph , "Women's Mental Health,"
for the Pakistan Psychiatric Society which integrates a standard
clinical overview of women's mental health with insights about the
situation of women in Pakistan. The monograph is intended for
psychiatrists, obstetricians, other physicians, medical students and
other mental health professionals. The medical survey is supplemented
with sections by guest writers on additional topics. A chapter on
"Threats and Challenges to Pakistani Women" finds that observance of
purdah is less of a threat to women's advancement than lack of
education. The author argues that placing blame on religious practices
has distracted attention from the government's failure to include women
in education planning and to consider the needs of women's health care
in both urban and rural areas. For information about this book, contact:
The WFMH Newsletter is published by the Secretary General
of the World Federation for Mental Health for its members four times