| Colleagues, It gives me
great pleasure to welcome you to WHO on this very special occasion.
Today and tomorrow we are opening the doors of WHO to listen. When I took office last
July there was one thing of which I was certain: WHO needed to devote considerable
attention to the mounting challenges from mental health disorders.
As a physician, a politician and a Prime Minister, I had followed the evolution of new
knowledge and evidence over the years, noting how mental health gradually – and often
silently – was growing to become a substantial cause of the global burden of disease
– in rich and poor countries alike.
In contrast to the dramatic improvements in physical health in most countries over the
course of the current century - in particular, unprecedented improvements in mortality
rates - the mental component of health has in many places not improved.
At the same time I noticed – in my own country as well as in the international
debate -that there was considerable uncertainty in the way health authorities recommended
to deal with the issue. Mental health covers a broad range of medical and social
dimensions. In many countries the area is marked by social taboos and in the professional
debate there are strong and often conflicting schools of thought, not making it any easier
for primary health care workers – or for political decision-makers.
It was clear to me that WHO has a critical role to play in shaping the global focus on
the mental health challenge and to develop further evidence and knowledge about best
practices.
We have a pretty clear picture of the burden of disease coming from mental health
disorders. Increasingly sophisticated methods to measure health and its burden, in
particular the DALY (Disability Adjusted Life Year), have helped to provide a more
balanced conception of needs and priorities.
What the DALY does is to quantify not only the number of deaths but also the impact of
premature death and disability on a population. It combines them into a single unit of
measurement of the overall burden of disease. Using the DALY as the basis for measurement,
mental health problems have been found to be one of the most significant contributors to
the global burden of disease.
In the World Health Report that we put out two weeks from now we bring updated figures.
Worldwide, mental disorders accounted for approximately 12% of all disability adjusted
life years lost in 1998. Their contribution is higher in high-income countries (23%) than
in low and middle income countries (11%).
Major depression was ranked fifth in the 10 leading causes of global disease burden and
this condition is as relevant in developing countries. After major depression, the most
important causes of neuropsychiatric burden are alcohol dependence, bipolar affective
disorders and schizophrenia. In high-income countries, Alzheimer's and other
dementias are the third leading cause of neuropsychiatric burden.
Major depression is closely linked with suicide, since most individuals who commit
suicide are also clinically depressed. The burden attributable to major depression is 40%
more than the direct burden, once suicide is taken into account.
Five of the ten leading causes of disability worldwide (major depression,
schizophrenia, bipolar disorders, alcohol use and obsessive compulsive disorders) are
mental problems. They are as relevant in developing countries as they are in high income
countries.
And the more we know about the present, the more we learn about the future. All
predictions are that the future will bring an exponential increase in mental problems. The
most important reasons include the ageing of the population, exacerbating social problems
and unrest, including the rising number of persons affected by violent conflicts, civil
wars and disasters and the growing number of displaced persons.
There can be no doubt: Mental health has to be given renewed and increased attention
from WHO. That means a strengthened organizational emphasis and that we are doing. Our
contribution has to look beyond what WHO funds can buy – it is a question of how we
as the lead agency in health can help mobilize resources, attention and new knowledge and
better advise governments on how to adapt and develop their policies.
We have completed our reorganization and you will learn more about our new structure
during the day. As we target our strategies we have wanted to call on you – a
distinguished group of experts - with the simple purpose of listening, understanding and
seeking together with you the best way to pursue.
This is – to my knowledge - the first attempt of WHO to bring together a group of
outstanding specialists to examine mental health issues in a comprehensive way and from an
innovative perspective.
Meetings on mental health have indeed been organised in the past. The programme
'Nations for Mental Health' had expert consultations in '96 and in '97
and a Global WHO Mental Health Programme Coordinating Group meeting was convened every two
years, each time in a different region, the last one in 1994 in Beijing. That meeting was
an attempt to provide the WHO with a general perspective on mental health.
However, the focus of these meetings was to review and update existing workplans
and strategies for WHO's mental health programme.
My intention is for this meeting to be more comprehensive and ambitious. Before
reviewing the existing WHO workplan, we need to examine what is the best evidence for the
mental health burden – what is the best evidence for assessment, treatment,
prevention and health promotion. Then – at the end of these two days – we will
be better placed to develop a forward looking workplan for mental health and the best way
for the WHO to contribute to an effective mental health response.
Beyond the striking figures related to those suffering from defined mental disorders,
there exist a number of groups of people who, because of extremely difficult circumstances
or conditions, are at special risk of being affected by the burden of mental problems.
These include persons in extreme poverty (such as slum-dwellers); children and adolescents
experiencing disrupted nurturing; abused women; abandoned elderly people; persons
traumatized by violence such as forced migrants and refugees. The Kosovo tragedy tells all
about it.
We are, today, in a position to make better use of a wealth of knowledge and
technologies that allows us more effectively to manage, treat and prevent a wide range of
mental health and neurological problems. It is time to review priorities and commitments
and to recognize the substantial benefits that will accrue through investing in mental
health.
WHO intends to respond to this challenge.
First of all, WHO has an essential role in assisting countries in the strengthening of
the overall mental health system, assisting them in generating policies and improving the
provision of services and treatment. We also need to strengthen the technical capacity of
individuals working in the area of mental health to utilise effectively state-of-the-art
information on mental health intervention.
In order to make cost-effective treatments available to the population, we must
consider access to care, which no doubt needs to increase substantially. Almost 140
countries have now an updated list of essential drugs, including psychotropic drugs. But
at the same time we know that one third of the global population has no access to these
essential drugs. In Africa, 50% of the population is unable to access the required drugs;
the situation is particularly pertinent in rural areas where antidepressants,
anticonvulsants and antipsychotic drugs are rarely available.
In relation to the issue of access we need to make overall treatment for mental
problems - not only drugs - available to the population. Mental health needs to be
integrated into general health, especially into primary health care.
Secondly, we should promote operational research at country level to understand better
the cost-effectiveness of implemented strategies. Cost-effectiveness should not be limited
to treatment, rehabilitation and prevention strategies but should encompass the use of
advocacy strategies and awareness-raising activities. Important work in the Social
Sciences has led to the development of innovative models to maximise the impact of
advocacy and awareness raising, and we should embrace these models in order to better
plan, implement and evaluate.
However, a strategy based on health systems alone is not sufficient. In WHO as a whole,
both at Headquarters and in the Regions, the objective is to place health sector
development more squarely at the heart of the Organization's work. Health is one of
the most politically and institutionally difficult sectors in any country and involves all
the public and private institutions that have a stake in people's health.
We are working to become a more effective and reliable supporter of countries as they
restructure and reform their health sectors. Sector wide approaches offer a way of
supporting health development to strengthen national ownership and help to build national
systems.
Expanding our work in this area will require a strategy of reaching out to our many
partners – in the scientific community, with professional and nongovernmental
organisations, and with the broader family of development agencies, within and beyond the
United Nations System.
Many WHO Collaborating Centers have contributed substantially to a number of
achievements in mental health. Some notable examples include the Pilot Study on
Schizophrenia, the development of the chapter on mental and behavioural disorders in the
International Classification of Diseases, and the conception and design of the initiative
Nations for Mental Health.
We are currently reviewing the policy and the working mechanisms of our WHO
Collaborating Centers in order to improve further our collaboration and to maximise input
which is consistent with the goals of the WHO. Excellent collaborations have also been
established with many professional organizations and NGOs, - the World Psychiatric
Association, the World Federation of Mental Health, Alzheimer's Disease
International, the World Federation of Neurology, the International League against
Epilepsy and the International Association for Suicide Prevention - just to name a few.
The UN system is a huge family of agencies with different mandates many of which could
encompass mental health. With the International Labour Office we have established close
links in the field of vocational rehabilitation and mental health in the workplace; with
the UNHCR we have common projects concerning the mental health of refugees, and with
ECOSOC we have collaborated on issues related to the human rights of people with mental
disorders, an activity now broadened to include the UN human rights agency.
A closer working relationship with these organizations can contribute to mainstreaming
of mental health within the UN system; thereby increasing the impact of mental health
activities at country level.
Finally, even within the WHO, partnerships should be strengthened. There are many
departments and clusters, dealing directly or indirectly with mental health issues. Only
if we work towards a 'one WHO', can we have a unique, strong and effective WHO
mental health policy.
Distinguished experts,
I thank you for agreeing to attend this meeting, to share with us your valuable
knowledge and experience and to help WHO set the agenda for its response to an
increasingly important public health issue.
I invite you to engage actively during these two days of brainstorming and to share
with us your insight and knowledge.
Thank you. |
