Transcript Guidelines - Mental Health and Psychosocial Support Network

Invest in Mental Health
Mental Health Gap Action Programme
Scaling up care for mental, neurological
and substance use disorders
World Mental Health Day, 2011
presentation for health providers
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World Mental Health Day, 2011
Outline
 The problem
 The resources
 The solution (mhGAP)
 Objectives
 Strategic directions
 Framework for action
 How to find resources and reallocate
 The tool for intervention: mhGAP-IG
 How to start and proceed at the
country level
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World Mental Health Day, 2011
Mental disorders are common
 Lifetime prevalence rates of mental disorders in adults
are 12.2- 48.6 worldwide.
 High burden
– 13% 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)
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Large treatment gap
 A large multi-country survey supported by WHO showed that 35.5–50.3 % of serious
cases in developed countries and 76.3 –85.4 % in less-developed countries had received
no treatment in the previous year
 It means that almost 4 out of 5 people in need of treatment for serious mental
disorders in developing countries do not receive any treatment.
 In many countries there is absolutely no mental health care.
 Mental health systems in LAMICs provide care to only a small proportion of all who need
care, with a median treated prevalence of 0.67% of the population per year. The
corresponding rate for children is even lower - 0.16% (2)
 Seven out of 10 people with schizophrenia are not receiving treatment in LAMICs. (2)
(2) Mental health systems in selected low and middle-income countries: A WHO-AIMS cross national analysis" publication (2009)
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Mental disorders and other conditions
 Mental disorders are closely related to other priority
conditions including HIV/AIDS, maternal and child
health and noncommunicable diseases
 Up to 63% of HIV-positive people in LAMICs have also
have depression
 People with co-morbid depression are three times less
likely to comply with recommended treatment plans
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Poverty & Mental Health: A Vicious Cycle
 80% of the global burden of
disease due to mental health
disorders is found in LAMIC(1)
 Mental disorders are
associated with unemployment
rates between 70-90%(1)
 Depression is 1.5 to 2 times
more prevalent among lowincome groups of a
population(2)
1.
World Health Organization (2010). Mental health and
development: targeting people with mental health conditions as
a vulnerable group. Geneva, World Health Organization.
2.
World Health Organization (2003). Investing in Mental Health.
Geneva, World Health Organization.
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World Mental Health Day, 2011
Poverty
Unemployment
Low Income
Less Education
Mental
Disorders
The resources
 The median per capital spending on mental health in Low and Middle
Income countries (LMIC) is 0.30 US $.This is far below the estimated 3-4 US
$ needed for a cost effective package for the treatment of common mental
disorders (2)
 33% have no separate budget for mental health care. (3)
 The median percentage of the health budget devoted to mental health in
LMIC is 2% (2)
 35% of the countries do not have the minimum number of essential
medications (three) to treat these disorders (1)
(1) Mental Health Atlas 2001 and 2005
(2) Mental health systems in selected low and middle-income countries: A WHO-AIMS cross
national analysis publication (2009)
(3) mhGAP: Mental Health Gap Action Programme: Scaling up care for mental, neurological and
substance use disorders
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The resources (continued)
 40% of countries do not have training facilities for primary health care
personnel in mental health (1)
 The median number of mental health professionals per 100,000 population in
LAMICs is only 6 (2)
 Most of world’s population does not have access to minimum number of
psychiatrists and other professionals required for mental health care (1)
 68.6% of the beds for mental health care are in separated mental hospitals (1)
 The move from institutional to community care is slow and uneven, as
inpatient care is still the predominant form of care delivered. In LAMICs there
is less than one outpatient contact/visit (0.7) per one day spent in inpatient
care (2)
(1) Mental Health Atlas 2001 and 2005
(2) Mental health systems in selected low and middle-income countries: A WHO-AIMS cross national analysis" publication (2009)
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World Mental Health Day, 2011
There are cost-effective interventions
 Current mental health spending in low– and
middle-income countries is $ 0.30 per capita
o An investment of US $3-4 per capita can result in
350-700 healthy years of life gained(2)
o Depression treatment in primary care is as cost-effective
as antiretroviral treatment for HIV/AIDS(1)
(1) Saraceno B., van Ommeren M., Batniji R., Cohen A., Gureje O., Mahoney J. Barriers to improvement of mental health services in lowincome and middle-income countries. Lancet. 2007;370:1164–1174.
(2) World Health Organization (2006). Dollars, Dalys and Decisions: Economic Aspects of the Mental Health System. Geneva, World Health Organization
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Summary: Need to reorient our efforts
 General awareness about mental health has improved.
Awareness generates more demand for country specific
action.
 Disease burden or coverage with key interventions has not
been improving as expected.
 There is a real need for studying, mobilizing and reorganizing
potential resources to deal with the problem.
 Shortage of resources can partly be compensated for through
integration of the programmes into primary care.
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Finding new resources and reallocation
 Identify new resources for mental health, e.g. increasing
tax on alcohol and tobacco may increase resources for
health.
 Reallocate investment from large hospitals to primary
health care and community mental health care.
 Do not forget children and adolescents
 Foster inter-sectoral collaboration. Adopt and promote
mental health policies, laws and services that support
comprehensive education, employment, housing and
social services for people with mental disorders.
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World Mental Health Day, 2011
Mobilizing a global response:
Setting the agenda
2001
2005
Helsinki
Brasilia
2007
2008
2009- 2010
mhGAP country
2010 +
implementation
Day, 2011
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mental health Gap Action Programme (mhGAP)
Today, with the launch of the Mental Health
Gap Action Programme, we have reached a
critical juncture. The long-standing failure
to take action and make progress against
these disorders is no longer acceptable.
There are no excuses anymore.
Dr Margaret Chan, WHO Director General
mhGAP Launch, 9 October 2008
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World Mental Health Day, 2011
mhGAP: objectives
 Reinforce the commitment of governments, international
organizations and other stakeholders to increase financial
and human resources
 Accelerate activities to achieve significantly higher
coverage with key interventions in the resource-poor
countries
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mhGAP Vision
Effective and humane care for all with
mental, neurological and substance use
disorders
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Main strategic directions
 Advocating at all levels, adopting a participatory approach ,establishing
partnerships and intersectoral collaboration
 Identification of barriers for implementation of scaling up , realistic
prioritization of needs and planning accordingly
 Integration into primary care and strengthening the health systems
 Considering various entry points based on country's health needs and
services (e.g. HIV or maternal health programme)
 Proactive resource mobilization and appropriate reallocation of resources
 Constant improvement through monitoring, evaluation and application of
lessons learned
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World Mental Health Day, 2011
Priority conditions,
Can be adapted at the country level
 Depression
 Psychosis and Bipolar disorder
 Self harm/ Suicide
 Epilepsy
 Dementia
 Alcohol use and alcohol use disorders
 Drug use and drug use disorders
 Child and adolescent mental disorders:
- depression
- developmental disorders
- behavioural disorders
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
Child and
Adolescent
Mental
Disorders

Depression

Development
al disorders

Behavioural
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
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How to start and proceed at country level
(framework for action)?
 Establish national level stakeholders committee for
scaling up services
 Conduct situation analysis, identify priorities and
barrier to scaling up
WHO-AIMS: a useful tool for situation analysis
 Adapt the intervention guide accordingly
 Identify a geographic area for demonstration
project
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How to start and proceed at country level ?
(framework for action, continued)
 Plan and Implement the demonstration project
 Involve health managers and receive the required agreements
 Identify resources and consider reallocation of resources
 Provide logistics and essential medicines
 Develop capacity, manage task shifting and train health
providers at different levels
 Regularly monitor, evaluate the programme, reapply the lessons
learned and expand the programme to a larger scale
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And Always…
Respect the dignity and
promote the rights of
people with mental
disorders.
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Thank you
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World Mental Health Day, 2011