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DEBATE ON GLOBAL MENTAL HEALTH MOVEMENT - FOR
Year : 2016  |  Volume : 32  |  Issue : 3  |  Page : 257-260

Global mental health movement has helped in reducing the global burden of psychiatric disorders


Department of Psychiatry, Pushpagiri Institute of Medical Sciences, Tiruvalla, Kerala, India

Date of Web Publication3-Nov-2016

Correspondence Address:
Prof. Roy Abraham Kallivayalil
Department of Psychiatry, Pushpagiri Institute of Medical Sciences, Tiruvalla, Kerala
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0971-9962.193204

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How to cite this article:
Kallivayalil RA, Enara A. Global mental health movement has helped in reducing the global burden of psychiatric disorders. Indian J Soc Psychiatry 2016;32:257-60

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Kallivayalil RA, Enara A. Global mental health movement has helped in reducing the global burden of psychiatric disorders. Indian J Soc Psychiatry [serial online] 2016 [cited 2022 Jun 28];32:257-60. Available from: https://www.indjsp.org/text.asp?2016/32/3/257/193204


  Introduction Top


“Mental health is an integral part of health and social services provision, but has received inadequate attention by policy makers and also by society in general. Mental disorders impose an enormous disease burden and an increasing obstacle to development in countries around the world”.[1]

Global mental health movement has come here to stay. It is an imperative of this century. With an estimated 10% of the world population and about 20% children and adolescents affected by mental disorders,[1] we can ignore it only at our own peril. With mental disorders accounting for 10% of overall disease burden, contributing to poverty and other economic consequences and impeding development, it should be top most on our agenda.

Unmet mental health needs have a negative effect on poverty reduction initiatives and economic development which in turn contributes to economic loss by increasing the school and work absenteeism and dropout rates, healthcare expenditure, and unemployment.[2] We require development of better mental health infrastructure and workforce and overall integration of mental and physical health services with primary care, especially in the developing nations.

Global health is “an area for study, research and practice that places a priority on improving health and achieving equity in health for all people worldwide”.[3] Global mental health is the application of these principles to the domain of mental ill-health. This movement, led by the international psychiatric community and engaging a wide assemblage of actors, has given rise to a new field of research and practice now known as Global Mental Health.

The most striking inequity in global mental health is that concerning the disparities in provision of care and respect for human rights of people living with mental disorders between rich and poor countries.[4] The Global Mental Health movement focuses on those populations where the gaps are the largest: among people living in low- and middle-income countries (LAMIC). This Movement seeks to promote actions based on two fundamental principles: evidence on effective treatments and the human rights of people with mental disorders.[5]


  Estimates of Global Burden of Mental Illness Top


Mental disorders account for an enormous global burden of disease that is largely underestimated and underappreciated. In a given year, about 30% of the population worldwide is affected by a mental disorder and over two-thirds of those affected do not receive the care they need.[6] The projected burden of mental health disorders is expected to reach 15% of all disability adjusted life years by the year 2020, where common mental disorders (depression, anxiety, and substance-related disorders including alcohol) will disable more people than complications arising from AIDS, heart disease, traffic accidents, and wars combined. Almost one-third (28%) of disability-adjusted life-years in 2005 were attributed to neuropsychiatric disorders.[7]

Mental, neurological, and substance (MNS) use disorders were identified by The Global Burden of Disease Study 2010 and constitute significant causes of the world’s disease burden.[8] Between 1990 and 2010, absolute disability-adjusted life-years (DALYs) due to MNS disorders rose by 41%, from 182 million DALYs to 258 million DALYs (the proportion of global disease burden increased from 7.3% to 10.4%).[9] The estimates of the global burden of MNS disorders fail to acknowledge not only the massive economic and social consequences of these disorders, but also the enormous impact it has on communities and economies. The estimates still largely remain underappreciated because of the overlap between psychiatric and neurological disorders; the grouping of suicide and self-harm as a separate category; exclusion of all chronic pain syndromes with musculoskeletal disorders; exclusion of personality disorders from disease burden calculations; and inadequate consideration of the contribution of severe mental illness to mortality from associated causes.[10]

In many of the developing nations the policies to address the needs and rights of the individuals with mental illness is still lacking. This leads to lesser prioritization of mental health when it comes to health planning, resource allocation, and workforce development. Many times people in the developing nations go untreated leaving the available mental health services unused. In addition, the issue of untackled stigma adds to the under estimated burden of mental illness.

In India, mental health is part of the general health services and carries no separate budget. The prevalence of mental morbidity in rural and urban areas of the country is comparable to global rates. Although India is well placed as far as trained manpower in general health services is concerned, the mental health trained personnel are quite limited, and these are mostly based in urban areas.[11] Despite the ongoing and existing efforts, a lot still needs to be done toward all aspects of mental health care in India (like mental health training, research, provision of clinical services, and tackling of stigma) to promote mental health in all sections of the society.


  Global Mental Health Movement Top


The Global Mental Health Movement is a coalition of individuals and institutions committed to collective actions that aim to close the treatment gap for people living with mental disorders worldwide.[5] It is based on two fundamental principles: evidence on effective treatments and the human rights of people with mental disorders. It was launched on October 10, 2008, after The Lancet published a series of five articles on Global Mental Health that documented the current evidence for global mental health, with a focus on low- and middle-income countries and those populations where the mental health gaps are the largest. The concept and foundation for such a movement emerges from the wealth of evidence, synthesized in a series of landmark publications, notably the World Mental Health Report, the 2001 World Health Report, and the Lancet series on global mental health. The Global Mental Health Movement aims to bring together institutions and individuals from diverse background, and who share the common goal of reducing the mental health gap all over the world.

Global Mental Health Movement is increasingly recognized and integrated into the international health, humanitarian, and developmental sectors including the emerging Sustainable Developmental Goals Post 2015 Agenda. This movement has its roots in the mental health disciplines, public health and human rights and it prioritizes the vulnerable population who are marginalized, stigmatized, and no access to quality mental health.


  Impact Top


The impact of the Global Mental Health Movement is largely credited to psychiatrists and policy makers all over the world who are grounded on the principles of evidence for effective treatments and the protection of human rights of the people with mental disorders. Global Mental Health Movement has rejuvenated the importance of Person Centered Medicine and how humanitarian concerns have to be bought up front especially in low- and middle-income countries. The support of the WPA (World Psychiatric Association), WASP (World Association of Social Psychiatry), and eminent psychiatrists all over the world has made this movement reach where it is today.

Global Mental Health Movement has given visibility to some exemplary experiences of mental health care in various regions of the world. It promotes the development of a consensus in the mental health field and delivers some basic messages consistently worldwide. It has also made the policy makers rethink the strategies on the issues related to burden of neurological, mental- and substance-related problems, suicides, stigma, and how effectively one can increase the availability and utilization of mental health services all over the world by possible integration into the primary care.

The impact of the Global Mental Health Movement can be organized as four broad themes: the effect on global advocacy; the effect on global-health programs; the effect on policies and resources; and the effect on professional societies. The field of Global Mental Health has very quickly engendered a new institutional and research landscape, having recently established a number of its own research centers and training programs. Under the banner of this field, there has also been an explosion of international research programs and interventions which have received significant financial backing from a range of international donors, development agencies, and governments.[12] The agenda setting of the Global Mental Health Movement included researchers from low- and middle-income countries. Western psychiatric nosologies such as the Diagnostic and Statistical Manual (DSM) and International Classification of Diseases (ICD) were not the driving force behind the agenda, but the basis was the World Health Organization’s (WHO) mental health intervention guide mhGAP[13] which aims at scaling up services for a small selection of MNS use disorders in low- and middle-income countries. Mental Health Action Gap Action Program provides health planners, policy makers, and donors with clear and coherent activities and programs for scaling up care for MNS use disorders. The objectives of the program are to reinforce the commitment of all stakeholders to increase the allocation of financial and human resources for care of MNS use disorders and to achieve higher coverage with key interventions, especially in countries with low and low-middle incomes that have large proportions of the global burden attributable to these disorders.

The Mental Health Gap Action Program provides criteria to identify the countries that have a high burden of MNS disorders and a high resource gap.[14] Priority disorders are identified on the basis that they represent a high burden (in terms of mortality, morbidity, and disability), cause large economic costs, or are associated with violations of human rights. These priority disorders are depression, schizophrenia and other psychotic disorders, suicide, epilepsy, dementia, disorders due to use of alcohol, disorders due to use of illicit drugs, and mental disorders in children and adolescents.[14] The Mental Health Gap Action Programme package consists of interventions for prevention and management for each of these priority disorders.

A WPA publications taskforce was appointed in 2008 to promote the dissemination of research from LAMIC. The taskforce began work together with journal editors to strengthen their chances of being indexed in international databases. Among the first journals participating in the project was the Indian Journal of Psychiatry, which is now an inspiration and source of support for other journals.[15] The taskforce continued its efforts with workshops at major WPA meetings to include new editors as well as those who can describe their successful stories.[16]

There have been a number of exciting developments for the implementation science in global mental health in the year 2015. Large research projects evaluating the scale-up of mental health services are providing new insights; researchers are partnering with implementers to strengthen evaluation of real-world programs; key learning is being harnessed and disseminated beyond the academic community; and research funders are turning their attention toward delivery at larger/wider scale.[17] The first results of the PRIME project (PRograme for Improving Mental health carE), a UK AID-funded consortium developing and evaluating district-level mental health care plans in India, Ethiopia, Nepal, South Africa, and Uganda, outline the development and content of the plans and the methods to evaluate their implementation and impact.[18] This knowledge will be invaluable not only for the PRIME countries, but also for other low- and middle-income countries seeking to scale up mental health plans in similar contexts.[19]

Global Mental Health Movement has made momentous progress in reducing global burden of mental illness in a very short time. Many challenges remain in front of this movement for meeting all the goals it set out for. Implementation science as a field is young, and we need to learn from advancements in service delivery in other areas of global health, such as HIV/AIDS and maternal and child health. Methodological advances are needed, particularly in how to monitor and evaluate the process of implementation to understand and therefore overcome the implementation of bottlenecks. If we are serious about understanding how to deliver mental health programs at scale, then we need to develop better mental health information systems to enable monitoring and evaluation at scale.[17]


  Future of Global Mental Health Movement Top


The field is now poised for rapid growth as donors pledge new or strengthened commitments to global mental health (such as The Department of International Development and the Wellcome Trust); the launch of new academic initiatives such as the Centre for Global Mental Health in London; the growth in capacity building initiatives in global mental health, such as the Masters in International Mental Health Policy, Services and Research by the University of Lisbon; and the launch of a new Grand Challenge in Global Mental Health led by the National Institute for Mental Health and the Global Alliance for Chronic Diseases. Much, of course, remains to be done. Above all, the field must continue to advocate to donors that mental health is not a luxury item on the health agenda of less resourced countries.[4] There is no health without mental health, and mental health is highly relevant to the management of existing health priorities as defined by the Millennium Development Goals.

Considering the significant burden contributed by MNS use diseases to the Global Burden of Diseases, the increasing impact of mental disorders, increasing human right violations, stigma and discrimination, and the inequalities in the provision for right to care in the low- and middle-income countries, mental health needs to be integrated to the Sustainable Development Goals.[20]

Global Mental Health Movement has not achieved everything but it has certainly helped to bring back focus on mental health, which was neglected for so long. Especially in the low- and middle-income countries, it provides a ray of hope for people with mental disorders. It has also given an impetus for policy makers, governments, NGOs, administrators, and psychiatric associations to work together to usher in new era in mental health.

Financial support and sponsorship

Nil

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
World Bank [internet]. Out of the Shadows: Making Mental Health a Global Priority April 13-14, 2016. Available from http://www.worldbank.org/en/events/2016/03/09/out-of-the-shadows-making-mental-health-a-global-priority. [cited 2016 Jun 13].  Back to cited text no. 1
    
2.
Ngui EM, Khasakhala L, Ndetei D, Roberts LW. Mental disorders, health inequalities and ethics: a global perspective. Int Review Psychiat 2010;22:235-44.  Back to cited text no. 2
    
3.
Koplan JP, Bond TC, Merson MH, Reddy KS, Rodriguez MH, Sewankambo NK. Towards a common definition of global health. The Lancet 2009 6:1993-5.  Back to cited text no. 3
    
4.
Patel V, Prince M. Global Mental Health: a new global health field comes of age. J Am Med Assoc 2010;303:1976-7.  Back to cited text no. 4
    
5.
Patel V, Collins PY, Copeland J, et al. Kakuma R, Katontoka S, Lamichhane J. The Movement for Global Mental Health. Bri J Psychiat 2011;198:88-90.  Back to cited text no. 5
    
6.
Lancet Global Mental Health Group.Chisholm D, Flisher AJ, Lund C, Patel V, Saxena S. Scale up services for mental disorders: a call for action. The Lancet 2007;370:1241-52.  Back to cited text no. 6
    
7.
Harvard School of Public Health, World Health Organization and the World Bank. The Global Burden of Disease and Injury Series, in: Murray CJL, Lopez A. editors, The global burden of disease: a comprehensive assessment of mortality and disability from diseases. injuries and risk factors in 1990 and projected to 2020. Harvard Harvard University Press; World Health Organization 1996   Back to cited text no. 7
    
8.
Whiteford HA, Degenhardt L, Rehm J, Baxter AJ, Ferrari AJ, Erskine HE. et al. Global burden of disease attributable to mental and substance use disorders: findings from the Global Burden of Disease Study 2010. The Lancet 2013;382:1575-86.  Back to cited text no. 8
    
9.
Patel V, Chisholm D, Parikh R, Charlson FJ, Degenhardt L. Dua T. et al. Addressing the burden of mental, neurological, and substance use disorders: key messages from Disease Control Priorities. The Lancet 2016;387:3rd edition 1672-85.  Back to cited text no. 9
    
10.
Vigo D, Thornicroft G, Atun R. Estimating the true global burden of mental illness. Lancet Psychiatr 2016;3:171-8.  Back to cited text no. 10
    
11.
Khandelwal SK, Jhingan HP, Ramesh S, Gupta RK, Srivastava VK. India mental health country profile. Int Rev Psychiat 2004;16:126-41.  Back to cited text no. 11
    
12.
O’Donnell KS, Global mental health: a resource primer for exploring the domain. Int Perspect Psychol Res Pract Consult. 2012;1:191-05.  Back to cited text no. 12
    
13.
World Health Organization WHO Mental Health Gap Action Programme (mhGAP) [Internet]. WHO. Available from: http://www.who.int/mental_health/mhgap/en/. [cited 2016 May 2].  Back to cited text no. 13
    
14.
Patel V, Garrison P, de Jesus Mari J, Minas H, Prince M, Saxena S. et al. The Lancet’s Series on Global Mental Health: 1 year on. The Lancet 2008;372:1354-7.  Back to cited text no. 14
    
15.
Herrman H. Partnerships for promoting dissemination of mental health research globally. Ind J Psychiat 2010;52:(Suppl 1)S43-6.  Back to cited text no. 15
    
16.
Herrman H, Kieling C, Mari J de J, Working with the World Psychiatric Association to promote dissemination of mental health research worldwide. Revista Brasileira de Psiquiatria 2010;32:4-5.  Back to cited text no. 16
    
17.
De Silva MJ, Ryan G. Global mental health in 2015: 95% implementation. Lancet Psychiat 2016;3:15-7.  Back to cited text no. 17
    
18.
Lund C, Tomlinson M, De Silva M, Fekadu A, Shidhaye R, Jordans M. PRIME: A Programme to Reduce the Treatment Gap for Mental Disorders in Five Low- and Middle-Income Countries. PLoS Med [Internet]. 2012 Dec Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3531506/. [cited 2016 May 2].  Back to cited text no. 18
    
19.
Lund C, Tomlinson M, Patel V. Integration of mental health into primary care in low- and middle-income countries: the PRIME mental healthcare plans. Br J Psychiat 2016;208:s1-3.  Back to cited text no. 19
    
20.
Votruba N, Eaton J, Prince M, Thornicroft G. The importance of global mental health for the Sustainable Development Goals. J Mental Health 2014;23:283-6.  Back to cited text no. 20
    



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