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Chapter 1: A public health approach to mental health :
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An integrated public health approach
The essential links between biological, psychological and social factors in the development and progression of mental and behavioural disorders are the grounds for a message of hope for the millions who suffer from these disabling problems. While there is much yet to be learned, the emerging scientific evidence is clear: we have at our disposal the knowledge and power to significantly reduce the burden of mental and behavioural disorders worldwide.
This message is a call to action to reduce the burden of the estimated 450 million people with mental and behavioural disorders. Given the sheer magnitude of the problem, its multifaceted etiology, widespread stigma and discrimination, and the significant treatment gap that exists around the world, a public health approach is the most appropriate method of response.
Stigma can be defined as a mark of shame, disgrace or disapproval which results in an individual being rejected, discriminated against, and excluded from participating in a number of different areas of society.
The United States Surgeon General's Report on Mental Health (DHHS 1999) described the impact of stigma as follows: "Stigma erodes confidence that mental disorders are valid, treatable health conditions. It leads people to avoid socializing, employing or working with, or renting to or living near persons who have a mental disorder." Further, "stigma deters the public from wanting to pay for care and, thus, reduces consumers' access to resources and opportunities for treatment and social services. A consequent inability or failure to obtain treatment reinforces destructive patterns of low self-esteem, isolation, and hopelessness. Stigma tragically deprives people of their dignity and interferes with their full participation in society."
From a public health perspective, there is much to be accomplished in reducing the burden of mental disorders:
- formulating policies designed to improve the mental health of populations;
- assuring universal access to appropriate and cost-effective services, including mental health promotion and prevention services;
- ensuring adequate care and protection of human rights for institutionalized patients with most severe mental disorders;
- assessment and monitoring of the mental health of communities, including vulnerable populations such as children, women and the elderly;
- promoting healthy lifestyles and reducing risk factors for mental and behavioural disorders, such as unstable family environments, abuse and civil unrest;
- supporting stable family life, social cohesion and human development;
- enhancing research into the causes of mental and behavioural disorders, the development of effective treatments, and the monitoring and evaluation of mental health systems.
The remainder of this report is devoted to these crucial issues. Through the presentation of scientific information on mental and behavioural disorders, WHO hopes that stigma and discrimination will be reduced, that mental health will be recognized as an urgent public health issue, and that steps will be taken by governments across the world to improve mental health.
Chapter 2 provides the latest epidemiological information on the magnitude, burden, and economic consequences of mental and behavioural disorders worldwide.
Chapter 3 presents information on effective treatments for people with mental and behavioural disorders. It outlines general principles of care and specific strategies for treating disorders.
Chapter 4 offers strategies for policy-makers to overcome common barriers and improve mental health in their communities.
Chapter 5 highlights the priority activities to be undertaken, depending on the level of resources available.
Chapter 1: A public health approach to mental health :
1,2,3,4
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