Global Mental Health: Implications for resource limited settings

Samuel MalingDepartment of Psychiatry

Mbarara University

Introduction

World Map: Land Area

World Map: population

Nurses Working

Physicians working

Poverty

About 14% of the Global burden of disease has been attributed to neuropsychiatric disorders

Developing countries tend to place much emphasis on communicable diseases

Mental illness are the most neglected of the neglected diseases

“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.”

Global mental health is the application of these

principles to the domain of mental ill health.

Global inequity

Low- and middle-income countries are home to more than 80% of the global population but command less than 20% of the share of the mental health resources.

Resource Limited settings

Where materials, personnel, facilities, funds, and anything else that can be used for providing mental health care and services is scarce or not available

1. Policy2. Infrastructure within countries3. Mental health services4. Community resources 5. Human resources

Inequity within a limited resource setting

Health expenditure towards mental health

96%

4%

All other health expendituresMental health expenditure

Mental health expenditure towards mental hospital

55%45%

Expenditure for menatl health hospital

All other mental health expenditures

Human resources for mental health in each income group of countries per 100 000 population

Human resources for mental health in Uganda (Per 100,000 population)

Psych

iatrists

Other d

octors

Nurses

Psych

ologists

Social W

orkers OTPC O

0.080.04

0.78

0.01 0.01 0.01

0.2

THE REPUBLIC OF UGANDA MINISTRY OF HEALTH

NATIONAL MENTAL HEALTH POLICY 2008

JULY 2008

Global evidence for clinical treatments

Less than 1% of Clinical trials are from low-income countries and 10% of trials are from low-income and middle-income countries.

MDGs or ‘GMHDGs’?

Core indicators

Ensure that national and regional health plans pay sufficient attention to mental health

1: Presence of official policy, programmes, or plans for mental health, either including or accompanied by a policy on child and adolescent mental health

Invest more in mental health care

2: Specified budget for mental health as a proportion of total health budget

Increase trained staff to provide mental health care

3: Mental health and related professionals per 100 000 population

Make basic pharmacological treatments available in primary care

4: Proportion of PHC clinics in which a physician or an equivalent health worker is available, and at least one psychotropic medicine of each therapeutic category (antipsychotic, antidepressant, mood stabiliser, anxiolytic, and antiepileptic) is available in the facility or in a nearby pharmacy all year long

Increase the treatment coverage for people with schizophrenia

5: People treated each year for schizophrenia as a proportion of the total estimated annual prevalence of schizophrenia

Secondary indicators

Balance expenditure in hospital and community services

6: Proportion of total mental health expenditure spent on community-based services, including primary and general health-care services

Provide de adequate basic training in mental health

7: Proportion of the aggregate total training time in basic medical and nursing training degree courses devoted to mental health

Distribute staff equitably between urban and rural areas

8: Proportion of psychiatrists nationally who work in mental health facilities that are based in or near the largest cities

Ensure least restrictive practice

9: Involuntary admissions as a proportion of all annual admissions

Protect the human rights of people with mental disorder

10: Presence of a national body that monitors and protects the human rights of people with mental disorders, and issues reports at least every year

Reduce the suicide rate

11: Deaths by suicide and self-inflicted injury rate

1970’sMental health units in large Regional Referral

Hospitals (out-patient and in-patient services offered)