Address at the launch of the WHO mental health gap action programme
Dr Margaret Chan
Director-General of the World Health Organization
Your excellencies, distinguished guests, ladies and gentlemen,
First and foremost, let me say how pleased I am to see so many of our key partners present today. You represent federations, associations, collaborating centres, nongovernmental organizations, and civil society. You are the power base.
We are here today to launch an action plan that addresses the abysmal lack of care, especially in low- and middle-income countries, for people suffering from mental, neurological, and substance use disorders. Success depends absolutely on the leadership and engagement of our partners.
Let me also thank the many countries around the world, including those represented in this room, who have shown the way forward. From your experiences, as we have just heard, we know that health systems can do a better job of responding to these disorders – in any resource setting.
The way forward is clearly illuminated and well-paved. It is illuminated by a plan of action that is rational, realistic, and workable. It is paved with evidence, can-do experience, and solid technical and practical advice for countries.
Efforts to implement the action plan have abundant technical support. Together with our partners, WHO has issued an assessment instrument for gathering essential information about mental health services, a guidance package for service reform, and a collection of resources for the design of relevant legislation.
Last week, WHO and Wonca jointly issued a report showing why integration of mental health into primary care is the most rational – and the most humane – approach. The report also explains how this can be done.
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.
We know the arguments and assumptions that stand in the way, and we can counter each with evidence and recommended action. We know the magnitude of the disease burden, which is enormous, and we know where this burden is concentrated. Today, almost three quarters of the global burden of neuropsychiatric disorders occurs in low- and middle-income countries.
We can measure the costs to individuals, families, societies, and economies. And the costs of these disorders, which tend to have an early onset and are chronically disabling, are enormous.
Taking action makes good economic sense. These disorders interfere, in substantial ways, with the ability of children to learn and the ability of adults to function in families, at work, and in society at large.
Taking action is also a pro-poor strategy. Research tells us that these disorders are overwhelmingly concentrated in lower income groups. This is not difficult to understand. Poverty and its associated stresses, such as unemployment, violence, social exclusion and deprivation, and constant insecurity, are closely linked to the onset of mental disorders.
The solution is not to virtually imprison affected people in costly and largely ineffective psychiatric hospitals, where human rights abuses are often rampant. Evidence tells us that service delivery in a primary care setting is far more cost-effective, equitable, efficient, and humane.
Unfortunately, people suffering from mental disorders face considerable stigma and discrimination. Their human rights are often violated in communities as well as in mental hospitals. This is another duty: to give these people a voice as active partners in calling for adequate and appropriate care. I am pleased to note that the UN Special Rapporteur on the Right to the Enjoyment of the Highest Attainable Standard of Health, Mr Grover, is with us today.
The disorders included in the action plan are not hopeless cases. Effective and affordable interventions exist for each and every one. Moreover, these are interventions that can be taken to scale. In fact, the whole package of actions and interventions was designed with a broad impact in mind.
Care for these highly prevalent, persistent, and debilitating disorders is not a charity. It is a moral and ethical duty. It is a pro-poor strategy. It makes good economic sense. And it is entirely feasible.
Ladies and gentlemen,
When we look at the health and socioeconomic burden caused by these disorders, and compare it with the vast number of people who receive no care whatsoever, we have to conclude that mental, neurological and substance use disorders are among the most neglected problems in public health.
The action plan tells us that this situation can change, and it tells us how to do so. We have in hand, right now, all the evidence, solutions, and lines of action we need to address the global burden of morbidity and premature mortality caused by these disorders.
But have no illusions. Nothing in public health ever happens all by itself. Having evidence and a well-designed package of interventions is not enough. We will not see progress in mental health without political commitment. Political leaders have to be aware of the problem. They must be concerned about the problem. And they must be convinced that taking action serves their best interests.
The delivery of mental health services in primary care is cost-effective and efficient. But it still needs resources, both human and financial. The vast majority of countries allocate less than 2% of their health budgets to mental health. This amount in no way matches the burden of these disorders, and needs to increase.
Although the requirements for technology and equipment are not high, we must have personnel in adequate numbers with adequate training, motivation, and supervision. Implementation of the action plan also requires a sufficient and reliable supply of essential medicines.
These are not insurmountable problems. In public health, we see, time and time again, how a comprehensive programme of action, backed by solid evidence, can attract political attention, inspire partners, secure funds, and accelerate progress. We have seen this most recently with malaria, which is now experiencing its billion-dollar moment.
The Mental Health Gap Action Programme gives WHO and its partners an opportunity to speak out against the neglect of these disorders with a unified and convincing voice. As I said, there is work to be done, and the voice of outcry may need to be rather shrill. But there are no excuses left. Together, we must make the case.
The way forward is bright and solidly paved. It is our job to inspire the action.