Transcript Slide 1

No Health without
Mental Health
Mental
Health:
Global and
Regional
perspective
Dr. Jorge Rodriguez
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Burden of Mental Disorders
(Global Burden of Disease, 2006)
LIC
9.10%
17.70%
MIC
27.40%
HIC
WORLD
0%
2
13.50%
5%
10%
15%
20%
25%
30%
% of Total Disease Burden
13.5 % of the Global Burden of Disease (GBD) measured in Disability Adjusted Life
Years (DALYS) is due to mental, neurological and substance use disorders
(DALYS = years lost to early death + years lost due to disability)
Latin America and the Caribbean
Percent Total DALYs, 2006
Gap in treatment:
Serious cases receiving no treatment during the last 12 months
90
85%
80
76%
70
60
50
50%
40
30
35%
20
10
0
Lower range
Upper range
Developed countries
(WHO World Mental Health Consortium)
Lower range
Upper range
Developing countries
Leading Causes of Mortality and Burden of
Disease
world, 2006
Mortality
DALYs
%
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
Ischaemic heart disease
12.2 1.
Cerebrovascular disease
9.7 2.
Lower respiratory infections
7.1 3.
COPD
5.1 4.
Diarrhoeal diseases
3.7 5.
HIV/AIDS
3.5 6.
Tuberculosis
2.5 7.
Trachea, bronchus, lung cancers 2.3 8.
Road traffic accidents
2.2 9.
Prematurity, low birth weight 2.0 10.
%
Lower respiratory infections
Diarrhoeal diseases
Depression
Ischaemic heart disease
HIV/AIDS
Cerebrovascular disease
Prematurity, low birth weight
Birth asphyxia, birth trauma
Road traffic accidents
Neonatal infections and other
6.2
4.8
4.3
4.1
3.8
3.1
2.9
2.7
2.7
2.7
2030 rankings:
The leading causes of DALYs
World
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2
3
HIV/AIDS
Depression
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
Financing: mental health from total health budget
% of Mental Health Budget dedicated to Mental
Hospitals
(Atlas 2011)
MH budget and its used by
psychiatric hospitals
9
Financing: Spending per capita
Human Resources for Mental Health Care
35.00
29.15
30.00
Rate of
perprofessionals
100000
population
per 100,000
population
25.00
Low
20.00
Low er Middle
Upper Middle
15.00
High
9.72
10.00
8.59
5.00
3.79
2.03
0.05 0.54
2.93
2.16
1.47
0.02 0.14
0.42
0.01 0.13
0.76
1.51
0.00 0.01 0.23
0.00
Psychiatrists
Psychologists
Nurses
Social Workers
Occupational Therapists
n = 177
n = 147
n = 158
n = 129
n = 119
Distribution of psychiatric beds
Number of psychiatric beds per 10,000 population
ATLAS WHO 2011
Region
Number
Africa
0.6
America
2.6
Europe
7.1
World
3.2
Proportion of psychiatrist beds in different settings
Settings
%
Mental Hospitals
45
General Hospitals
21
Other
33
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Distribución de camas psiquiátricas en
diferentes tipos de dispositivos
Regiones del Mundo / Atlas 2011
Plans, legislation and services
Problems / Region of Americas / Response of Health Sector
(ATLAS WHO 2011 / AIMS 2011)
65.6% of the countries in the Region have a national mental health plan; 74%
approved or Revised these plans in 2005 or later.
56.3% of the countries in the Region have legislation on mental health; but,
in many cases, these laws are incomplete, scattered, and do not meet
international standards.
There is a median of 2.6 psychiatric beds per 10,000 population; an
assessment of their distribution found that 45% are in psychiatric
hospitals.
The indicators for mental health human resources lag far behind those of
high-income countries and are inequitably distributed.
The psychoactive drugs are not within the reach of most of the population.
Countries have major limitations in their information systems regarding mental
health, such that we can also speak of an information gap.
The PHC team is not prepared to handle mental health problems.
MH programs and services for children and adolescent are very limited.
There are few actions in mental health promotion and prevention.
Mental health research is poor or nonexistent.
The mental health protection of the vulnerable populations is not a priority of
the services and programs.
Mobilizing a global response:
Setting the agenda
2001
2005
Helsinki
Brasilia
2007
2008
2009- 2010
2010 +
mhGAP country
implementation
Mental Health Gap Action Programme
Scaling up care
Burden/budget gap to be reduced
15%
13%
10%
Budget
Burden
5%
0%
3%
Mental health services organized rationally
High
Low
Mental
Hospitals
& Specialist
Services
Cost
Psychiatric
services in
General
Hospitals
Community
mental
health
services
Frequency
of need
Mental health services through
primary health care
Informal community care
Low
Self-care
High
•
•
•
•
Child and
Adolesce
nt Mental
Disorders
Depressio
n
Developm
ental
disorders
Behaviou
ral
disorders
mhGAP Intervention Guide
•
•
•
•
Launched on 7th of October 2010
Based on systemtic review of
evidence of effective treatments
for priority conditions
For use by non-specialized health
providers in low resource settings
Includes both pharmacological and
psychosocial interventions
Carga versus respuesta
Ante la carga muy significativa que representan
los trastornos mentales, aún la respuesta de los
programas y servicios es insuficiente.
Se evidencia: 1) persistencia, en gran medida, del
modelo hospitalario asilar; y 2) pobre desarrollo
de un modelo comunitario, descentralizado,
integrado a la red de servicios y basado en la
APS.
El modelo comunitario
1. La atención de salud mental se debe proporcionar mediante los
servicios de salud general y en entornos comunitarios. Las grandes
instituciones psiquiátricas centralizadas deben ser reemplazadas.
2. El modelo comunitario integra los servicios de SM en la atención
general de salud y en otros ámbitos externos (por ejemplo, los de
educación, vivienda, empleo, justicia y bienestar social).
3. La combinación óptima de los servicios de salud mental por niveles
de atención hace hincapié en la atención comunitaria y destaca los
nexos necesarios entre los diferentes niveles.
4. Podemos entrenar al personal de APS para atender
apropiadamente una amplia franja de problemas relacionados con
la SM. Se requiere un buen sistema de referencia, de manera que
los espcialistas puedan ser consultados cuando sea necesario.
Brasil: Centros de Atención Psicosocial (CAPS
Los CAPS constituyen recursos novedosos en la atención
de salud mental, por medio de servicios de puertas
abiertas y atención clínica y actividades diarias para
personas con trastornos mentales, se evitan las
internaciones innecesarias y el aislamiento social en los
hospitales psiquiátricos.
Los CAPS se articulan con la APS, con el sistema de
urgencia y con otras instituciones para fortalecer los
vínculos sociales de los usuarios en sus barrios. Desde
fines del año 2010, los CAPS están presentes en 1,118
ciudades del Brasil, con 1,620 unidades, dando así
cobertura a 60% de la población. Esto se compara
favorablemente con el año 2001, cuando se promulgó la
Ley de Reforma Psiquiátrica. En ese año el país contaba
con 295 servicios y una cobertura de 21% de la
población.
Brasil: # de CAPS
Cuba: red de centros comunitarios
de salud mental
P R
V C
C H
1 0
1 5
1 4
S S
C A
1 2
1 3
L T
H G
1 0
1 8
M t
2 1
1 4
H
1
2 0
IJ
C F
1 5
C m
T O T A L : 1 9 9.
G R
6
1 8
1 2
S C
G T
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2010
Mental Health
Draft Mental Health Action Plan
2013-2020
An Overview
Resolution on Mental Health
(2012)
"Global burden of mental disorders and the need for a comprehensive,
coordinated response from health and social sectors at the country level"
World Health Assembly WHA 65.4 (25 May 2012)
WHA 65.4 requests the Director-General: To strengthen advocacy, and
develop a comprehensive mental health action plan…
Process for developing the action plan
Background paper on vulnerabilities and risks- June 2012
Working paper on the mental health action plan- July 2012
Regional technical consultations on Working paper/Zero draft action plan
April – SEARO
July - EMRO
August - AFRO
September - EURO
October- PAHO
Web consultation with all stakeholders – 27th August to 19th October 2012
Discussion in Regional Committees
Face to face consultation with all stakeholders in Geneva on World Mental
Health Day on 10th October 2012
Informal Consultation with Member States (Geneva) 2nd November 2012
Submission – 12th November 2012
Draft Mental Health Action Plan
Structure and Contents
Introduction
Global situation
Determinants and consequences of mental disorder
Health system resources and responses
Vision and Cross cutting principles
Goal and Time frame
Objectives
Actions for member states and secretariat (by objective)
Actions by international and national partners
Appendix 1: links to other global and regional action plans and strategies
Appendix 2: conceptual overview of global mental health action plan
Appendix 3: options for the implementation of the global mental health action
plan (by objective)
Vision
A world in which mental health is valued,
mental disorders are effectively prevented
and in which persons affected by these
disorders are able to access evidence-based
health and social care and exercise the full
range of human rights to attain the highest
possible level of health and functioning free
from stigma and discrimination.
Cross-cutting principles
Universal access and equity
Human rights
Evidence-based practice
Life course approach
Multisectoral approach
Empowerment of persons with mental
disorders
Goal
The overall goal of the Global Mental
Health Action Plan is to promote mental
well-being, prevent mental disorders, and
reduce the mortality and disability for
persons with mental disorders.
Objectives
1. To strengthen effective leadership and
governance for mental health
2. To provide comprehensive, integrated and
responsive mental health and social care services
in community-based settings
3. To implement strategies for mental health
promotion and protection, including actions to
prevent mental disorders and suicides
4. To strengthen information systems, evidence and
research for mental health
Actions
Example: Resource planning
Member states
Allocate a budget that is commensurate with
identified human and other resources needed
to implement agreed mental health plans and
actions.
WHO
Offer technical assistance to countries in
resource planning, tracking and budgeting for
mental health.
Actions
Example: Human resource development:
Member states
Build and sustain human resource capacity to
deliver mental health and social care services,
especially in non-specialized care settings.
WHO
Support countries in the formulation of a human
resource strategy for mental health, including
the specification of gaps and needs, training
requirements and core competencies.
Actions
Example: Suicide prevention
Member states
Develop suicide prevention programmes,
with special attention to young people.
WHO
Provide technical support to countries in
strengthening their suicide prevention
programmes with special attention to young
people.
Actions
Example: Information systems
Member states
Identify, collate, routinely report and use core mental
health indicators (including on completed and
attempted suicides).
WHO
Provide guidance and technical assistance on
surveillance/information systems to capture
information on core mental health indicators, and
augment the WHO global health observatory by
establishing baseline data for and monitoring of the
global mental health situation (including progress on
reaching the targets laid out in this action plan).
Targets
Examples
80% of countries will have updated their mental health policies and
laws (within the last 10 years) by year 2016.
The number of beds used for long-term stays in mental hospitals will
decrease by 20% by year 2020, with a corresponding increase in the
availability of places for community-based residential care and
supported housing
Rates of suicide in countries will be reduced by year 2020
80% of countries will be collecting and reporting at least a core set of
mental health indicators annually by year 2020
United Nations Secretary-General
Message on World Mental Health Day
10 October 2012
"Some 350 million people of all ages, incomes
and nationalities suffer from depression. Millions
more - family, friends, co-workers - are exposed
to the indirect effects of this under-appreciated
global health crisis."
"On World Mental Health Day, let us pledge to talk
more openly about depression. This is the first
critical step to removing one of the barriers to
treatment and helping to reduce the disability and
distress caused by this global crisis."
Gracias
Thanks!
Gracias
Merci
Obrigada
Thanks
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