|Press Release WHO/67
12 November 1999
RAISING AWARENESS, FIGHTING STIGMA, IMPROVING CARE
Brundtland Unveils New WHO Global Strategies for Mental Health,
Sees Poverty as a Major Obstacle to Mental Well Being
Beijing, 12 November 1999.To ease the "burden" of mental disorders and neurological illnesses, currently affecting some 400 million people worldwide, the Director-General of the World Health Organization (WHO), Dr Gro Harlem Brundtland, launched here today WHO's new Global Strategies for Mental Health. The strategies are aimed at improving the population coverage and quality of psychiatric and neurological care throughout the world, particularly in developing countries.
WHO expects to achieve these objectives through a number of measures that will be vigorously promoted in both developing and developed countries. First of all, the Organization has to raise awareness among the general public, health professionals and public health decision-makers about the relative importance of mental and neurological disorders as major contributors to the global burden of disease.
This burden has recently been clarified using a new measure -- the "Disability-Adjusted Life Years" (DALY) jointly developed by WHO, the World Bank and Harvard University. The DALY measures the overall burden of a disease by combining, on the one hand, the years of potential life lost due to premature death from the disease and, on the other, the years of productive life lost due to the disability produced by the condition.
"For mental health, the DALY has brought a critical reality to light and showed that psychiatric disorders and neurological diseases are amongst the most important contributors to the global burden of disease," stated Dr Brundtland at a press conference in Beijing. "In 1998, these disorders were estimated to account for almost 12% of the deaths and lost productivity due to all diseases and injuries globally, with an estimated 23% in high income countries and approximately 11% in middle and low income nations. In 2020, their share is projected to increase to 15%, if urgent action is not taken," she said.
According to estimates for Global Burden of Disease 1990, five of the ten leading causes of disability worldwide, in both developed and developing countries, are mental problems. They are major depression, schizophrenia, bipolar disorders, alcohol dependence and obsessive compulsive disorders. For DALYs estimates in 1998 major depression ranks fifth on this list. By 2020, this disorder will jump to second place, if the present trend continues.
Major depression is linked closely with suicide, since most persons, who attempt suicide, are also clinically depressed. Once suicide and its attempts are taken into account, the burden associated with depression increases quite significantly.
In spite of the fact that almost 70% of WHO Member States have an updated list of essential drugs, including psychotropic ones, one third of the global population has no access to them. In Africa, only one out of two people has such access. The situation is particularly serious in rural areas, where antidepressant, anticonvulsant and antipsychotic drugs are rarely available.
WHO's Director-General emphasized that the traditional methods of prioritizing health problems, based normally on the mortality and prevalence of an illness, had important limitations. The numbers of deaths, she said, did not take into consideration the non-fatal outcomes of illness, while prevalence rates did not take into account the severity and duration of disability produced by diseases. As a result, for many years the burden of psychiatric and neurological conditions has been underestimated. This, Dr Brundtland said, had obvious consequences on budget allocation and policy planning.
By raising awareness about the importance of mental problems, the World Health Organization hopes to heighten the profile of mental health on the political, health and development agenda of governments in its 191 Member States, of international agencies, as well as of national and international nongovernmental organizations.
WHO would also fight social stigma, misconceptions and discrimination associated with neuropsychiatric conditions, as well as promote human rights of the mentally ill persons, stressed Dr Brundtland. "Very often and in many countries, individuals, who are affected by neuropsychiatric disorders, endure double suffering, namely from the conditions themselves and from the social stigma and discrimination attached to them. In this respect, every country is a developing country," said WHO's Director-General.
December 2001 will mark the 10th anniversary of the Principle for the Protection of Persons with Mental Illness and for the Improvement of Mental Health Care, adopted by the UN General Assembly in 1991. Dr Brundtland proposed to seize this occasion to launch concerted measures to foster the implementation of these principles, including, for example, the development of an International Convention on the Rights of Persons with Mental Disorders.
Another important objective of the new WHO Strategies for Mental Health is improving treatment rates for psychiatric and neurological conditions. For example, even in the established marketeconomies with well-developed health care systems, only an estimated 35% of patients who suffer from depression receive treatment.
The situation is especially worrisome in developing countries the home of around 80% of the world's population by 2020. For example, in India, treatment rates of 20% for schizophrenia and epilepsy contrast with the 80% treatment rates for the same disorders in countries with established market economies. In the countries of sub-Saharan Africa, treatment rates for depression are estimated around 5%. In disaster and war-stricken areas of the world, the situation is even worse.
These treatment rates could not be increased through awareness raising only, WHO's Director-General stressed. Shifts in emphasis from large specialized psychiatric institutions -- which are usually concentrated in urban settings and are a major source of treatment today -- towards more effective community-based mental health services covering both urban and, particularly, rural areas, are needed.
The World Health Organization, Dr Brundtland said, would also promote wider use of effective intervention and essential drugs that have proven to help control psychiatric disorders and neurological diseases. For example, a demonstration project in China has shown that simple family interventions, when combined with pharmacotherapy, can substantially increase the cost-effectiveness of treatment of persons with schizophrenia. Epilepsy can be effectively treated with phenobarbitone -- a safe and inexpensive drug, which is still in short supply in many developing countries.
The new Strategies would finally continue to monitor the mental health of the world. WHO, its Director-General said, was in the final planning stage of Mental Health Survey 2000. This survey will be carried out in 19 countries, including China (Beijing, Guangzhou and Shanghai provinces), to collect data onmental and physical disorders and disability, work loss, risk factors, as well as on the provision and use of services and medications.
Dr Brundtland also announced that WHO has developed and is launching global campaigns targeting depression/suicide prevention, schizophrenia and epilepsy. These important campaigns will involve key international and national NGOs, professional organizations, academic institutions and civil society.
Underpinning the announcement, she stressed, is the notion that "mental health" goes beyond the mere absence of mental or neurological disorders. For WHO, mental well being is an integral part of mental health. Dr Brundtland saw poverty as a major obstacle to such mental well being. "More than three billion people - that is half of the world's population - still remain poor and live on less than two US dollars per day. Of these, 1.3 billion live on less than one dollar a day. Population growth may have increased these figures to four billion and nearly two billion respectively by 2025," she pointed out.
"The world has set a target of halving the number of absolute poor by 2015. That is a very tall order We need a portion of decency on the part of the richer countries to pay a fair share to bring the excluded billion [of people] on board. Only four of the richest countries the Netherlands, Denmark, Norway and Sweden live up to their obligation of providing at least 0.7% of their GDP for development assistance. The average [contribution among the richest countries] is falling towards a record low 0.2%. This, in my view, is a shame, and all groups in civil society committed to development should hold their leaders to account," stated Gro Harlem Brundtland.
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