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WHO's Mental Health Programme:

Continuing Challenges Department of Mental Health and

Substance Abuse

World Health Organization

Geneva

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Cardiovascular diseases

Diabetes Malignant neoplasms

Digestive diseases

Neuropsychiatric disorders

Other NCDs

Injuries

Other CD causes

Maternal conditions

Malaria Childhood diseases

Tuberculosis

Diarrhoeal diseases

Perinatal conditions

HIV/AIDS

Respiratory infections

Respiratory diseases

Nutritional deficiencies

Sense organ disorders

Diseases of the genitourinary system Musculoskeletal diseases

Congenital abnormalities

Disease Burden (DALYs)

Source: WHR 2002

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Leading Causes of Mortality and Burden of Disease world, 2004

%

1.  Ischaemic heart disease 12.2

2.  Cerebrovascular disease 9.7

3.  Lower respiratory infections 7.1

4.  COPD 5.1

5.  Diarrhoeal diseases 3.7

6.  HIV/AIDS 3.5

7.  Tuberculosis 2.5

8.  Trachea, bronchus, lung cancers 2.3

9.  Road traffic accidents 2.2

10.  Prematurity, low birth weight 2.0

%

1.  Lower respiratory infections 6.2

2.  Diarrhoeal diseases 4.8

3.  Depression 4.3

4.  Ischaemic heart disease 4.1

5.  HIV/AIDS 3.8

6.  Cerebrovascular disease 3.1

7.  Prematurity, low birth weight 2.9

8.  Birth asphyxia, birth trauma 2.7

9.  Road traffic accidents 2.7

10.  Neonatal infections and other 2.7

Mortality DALYs

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Leading causes of disease burden for women aged 15–44 years, high-income countries, and low-

and middle-income countries, 2004

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World 1 HIV/AIDS 2 Depression 3 Ischaemic heart dis.

High-income countries 1 Depression 2 Ischaemic heart disease 3 Alzheimer

Middle-income countries 1 HIV/AIDS 2 Depression 3 Cerebrovascular

Low-income countries 1 HIV/AIDS 2 Perinatal 3 Depression

2030 rankings: The leading causes of DALYs lost

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Scarcity Human Resources

(N=157 to 183 countries)

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Burden versus Budget

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(WHO World Mental Health Consortium, JAMA, June 2nd 2004)

Gap in treatment: Serious cases receiving no treatment during the last 12 months

0 10 20 30 40 50 60 70 80 90

Developed countries Developing countries

Lower range Upper range Lower range Upper range

35%

50%

76%

85%

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THE BURDEN OF MENTAL DISORDERS: Treatment gap for Schizophrenia and Mood Disorders

Treatment

Gap

69%

Treatment

Gap

98%

COVERAGE COVERAGE

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INEFFICIENT USE OF RESOURCES: High concentration of resources in mental hospitals

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  Provide treatment in primary care

  Make psychotropic drugs available

  Give care in the community

  Educate the public

  Involve communities, families and consumers

  Establish national policies, programmes and legislation

  Develop human resources

  Link with other sectors

  Monitor community mental health

  Support more research

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Impact of WHR-2001

Awareness +++

Understanding ++

Action +

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Additional yearly investment on the package that will be needed per capita population to get from current to target coverage levels

(2006-2015)

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mental health Gap Action Programme Scaling up care for mental, neurological and substance use disorders

mhGAP

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Mental Health Services (WHO, 2003)

FREQUENCY OF NEED

COST

LOW HIGH

HIGH LOW

SELF CARE

INFORMAL COMMUNITY CARE

Mental Health Services through PHC

Community Mental Health

Services

Psychiatric Services in

General Hospitals

Specialist Services

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mhGAP: Scaling Up Care

 Objectives

– To achieve significantly higher coverage with

key interventions for priority MNS conditions in

resource-poor countries

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WHO QualityRights Improving quality and human rights in

facilities and promoting a civil society movement

  Assessment of facilities

 Development of a change plan

 Capacity building on human rights issues

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How can WHO Collaborative Centres help?

 Advocacy

 Demonstrating that community based models work

 Developing guidelines and manuals

 Publishing scientific evidence on effectiveness and cost

 Training professionals from other countries