World health report

Message from the Director-General

Mental illness is not a personal failure. It doesn't happen only to other people. We all remember a time not too long ago when we couldn't openly speak about cancer. That was a family secret. Today, many of us still do not want to talk about AIDS. These barriers are gradually being broken down.

The theme of World Health Day 2001 was "Stop exclusion ­ Dare to care". Its message was that there is no justification for excluding people with a mental illness or brain disorder from our communities ­ there is room for everyone. Yet many of us still shy away from, or feign ignorance of such individuals ­ as if we do not dare to understand and care. The theme of this report is "New understanding, new hope". It shows how science and sensibility are combining to break down real and perceived barriers to care and cure in mental health. For there is a new understanding that offers real hope to the mentally ill. Understanding how genetic, biological, social and environmental factors come together to cause mental and brain illness. Understanding how inseparable mental and physical health really are, and how their influence on each other is complex and profound. And this is just the beginning. I believe that talking about health without mental health is a little like tuning an instrument and leaving a few discordant notes.

WHO is making a simple statement: mental health ­ neglected for far too long ­ is crucial to the overall well-being of individuals, societies and countries and must be universally regarded in a new light.

Our call has been joined by the United Nations General Assembly, which this year marks the 10th anniversary of the rights of the mentally ill to protection and care. I believe The World Health Report 2001 gives renewed emphasis to the UN principles laid down a decade ago. The first of these principles is that there shall be no discrimination on the grounds of mental illness. Another is that as far as possible, every patient shall have the right to be treated and cared for in his or her own community. And a third is that every patient shall have the right to be treated in the least restrictive environment, with the least restrictive or intrusive treatment.

Throughout the year, our Member States have taken our struggle forward by focusing on various aspects of mental health whether it be medical, social or political. This year WHO is also supporting the development and launching of global campaigns on depression management and suicide prevention, schizophrenia and epilepsy. The World Health Assembly 2001 discussed mental health in all its dimensions. For us at the World Health Organization and in the extended community of health professionals, this heightened and sustained focus is an opportunity and a challenge.

A lot remains to be done. We do not know how many people are not getting the help they need ­ help that is available, help that can be obtained at no great cost. Initial estimates suggest that about 450 million people alive today suffer from mental or neurological disorders or from psychosocial problems such as those related to alcohol and drug abuse. Many of them suffer silently. Many of them suffer alone. Beyond the suffering and beyond the absence of care lie the frontiers of stigma, shame, exclusion, and more often than we care to know, death.

Major depression is now the leading cause of disability globally and ranks fourth in the ten leading causes of the global burden of disease. If projections are correct, within the next 20 years, depression will have the dubious distinction of becoming the second cause of the global disease burden. Globally, 70 million people suffer from alcohol dependence. About 50 million have epilepsy; another 24 million have schizophrenia. A million people commit suicide every year. Between ten and 20 million people attempt it.

Rare is the family that will be free from an encounter with mental disorders.

One person in every four will be affected by a mental disorder at some stage of life. The risk of some disorders, including Alzheimer's disease, increases with age. The conclusions are obvious for the world's ageing population. The social and economic burden of mental illness is enormous.

Today we know that most illnesses, mental and physical, are influenced by a combination of biological, psychological and social factors. Our understanding of the relationship between mental and physical health is rapidly increasing. We know that mental disorders are the outcome of many factors and have a physical basis in the brain. We know they can affect everyone, everywhere. And we know that more often than not, they can be treated effectively.

This report deals with depressive disorders, schizophrenia, mental retardation, disorders of childhood and adolescence, drug and alcohol dependence, Alzheimer's disease and epilepsy. All of these are common and usually cause severe disability. Epilepsy is not a mental problem, but we have included it because it faces the same kind of stigma, ignorance and fear associated with mental illnesses.

Our report is a comprehensive review of what we know about the current and future burden of all these disorders and their principal contributing factors. It deals with the effectiveness of prevention and the availability of, and barriers to, treatment. We deal in detail with service provision and service planning. And, finally, the report outlines policies needed to ensure that stigma and discrimination are broken down, and that effective prevention and treatment are put in place and adequately funded.

In more ways than one, we make this simple point: we have the means and the scientific knowledge to help people with mental and brain disorders. Governments have been remiss, as has been the public health community. By accident or by design, we are all responsible for this situation. As the world's leading public health agency, WHO has one, and only one option ­ to ensure that ours will be the last generation that allows shame and stigma to rule over science and reason.