Fourth Quarter 2001 Newsletter

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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

Left to right: Richard Hunter, WFMH Deputy Secretary General;
George A. O. Alleyne, M.D., Director, PAHO;
Benedetto Saraceno, M.D., Director, Division of Mental Health and Substance Dependence, WHO;
and Jose Miguel Caldas de Almeida, Coordinator, Mental Health Program, PAHO

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.

Itzhak Levav, M.D., (left) former Regional Adviser in Mental Health
at PAHO, with the current head of the mental health program,
Jose Miguel Caldas de Almeida.

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.

Fourth Quarter 2001 Newsletter