Scaling up mental health care: a framework for action

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Scaling up mental health care: a framework for action

Agenda item 4(b)62nd session of the WHO Regional Committee for the

Eastern MediterraneanKuwait, 58 October 2015

Scaling up mental health care: a framework for action2

Background and context


Source: Lancet. 2012; 380:222460.

Cause Proportion of total disease burden (%)

Disability (%) Premature death (%)

Cardiovascular and

circulatory disorders

11.9 2.8 15.9

Neonatal disorders 8.1 1.2 11.2

Cancer 7.6 0.6 10.7

Mental and substance use disorders

7.4 22.9 0.5

HIV/AIDS/tuberculosis 5.3 1.4 7.0

Unintentional injuries 4.8 3.4 5.5

Leading causes of global burden of disease 2010


Treatment gap• A range of interventions, spanning medicines, psychological treatments

and social interventions, are available to address this disease burden

• The estimated cost of providing a package of evidence-based and cost-effective interventions for prioritized mental disorders is:

» US$ 12 per capita per year in low- and lower-middle income countries

» US$ 35 in upper-middle income countries

• However, coverage is inadequate. Treatment gaps of 35–50% in developed countries and 76–85% in less developed countries have been documented for serious disorders.


Comprehensive mental health action plan 20132020Vision

A world in which mental health is valued, promoted and protected, mental disorders are effectively prevented and persons affected by these disorders are able to exercise the full

range of human rights and to access high quality, culturally appropriate health and social care in a timely way to promote recovery, all in order to attain the highest possible level of health

and participate fully in society and at work free from stigma and discrimination

GoalTo promote mental well-being, prevent mental disorders, provide care, enhance recovery, promote human rights and reduce the mortality, morbidity and disability for persons with mental disorders

Objectives and targets

1. To strengthen effective leadership and governance for

mental healthTargets 1.1 and 1.2

2. To provide comprehensive, integrated and

responsive mental health and social care

services in community-based settings

Target 2

3. To implement strategies for mental

health promotion and prevention in mental

healthTargets 3.1 and 3.2

4. To strengthen information systems,

evidence and research for mental

healthTargets 4

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Capacities and resources

Mental health governance:Policies and legislation

55% of countries have updated their mental health policies or plans in the past 5 years, but only 32% of countries have mental health policies that are fully compliant with international human rights instruments

73% of countries have mental health legislation, but only 27% have mental health legislation that is fully compliant with international human rights instruments

No country is fully implementing its existing policy while about 45% of countries are partially implementing the relevant legislation


Health services • The median number of mental health beds per 100 000 population

is 6.1 across the Region (1.7 to 6.4 and 11.3 in Group 3, 2 and 1 countries). This compares with over 50 in high-income countries in the rest of the world

• 64% of psychiatric beds are located in mental hospitals and 36% are located in community settings

• The median number of mental health workers is 14.6 personnel per 100 000 population in the Region; half that reported in the rest of the world, and there is extreme variation with greater density of mental health workers in Group 1 countries.


Promotion and prevention• 41% of countries have at least two functioning mental health

promotion and prevention programmes, a similar percentage to the rest of the world

• 60% of Group 2 countries have more than one functioning national mental health prevention or promotion programme, which is twice the rate in Group 1 and Group 3 countries

• Only 14% of countries (all in Group 2) have developed national suicide prevention strategies.


Surveillance, monitoring and research


• Although 52% of countries regularly compile mental health specific data, half the countries have not published a specific mental health information report in the past 2 years

• Less than 25% of countries were able to report on the number of suicide deaths

• Compared with the global average, the Region produces one sixth of the expected number of mental health publications per million population

Population Publications0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

EM Region Rest of World

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Regional framework


Mental health interventions: “Best buys”Health care Promotion and prevention Emergencies

• Integration of early recognition and management of depression, anxiety, psychosis disorders, epilepsy in the basic health delivery package

• Legislative and regulatory measures that restrict access to the means for self-harm/suicide

• Embedding mental health and psychosocial support in national emergency preparedness response and recovery plans

• Downsizing of long stay mental institutions and relocation to community-based care

• Mass public awareness campaigns promoting mental health literacy and reducing stigma and discrimination

• Provision of psychological interventions through community workers in complex emergencies

• Continuing care for severe mental disorders (such as psychosis) through non-specialist service delivery

• Universal and targeted social and emotional learning programmes using a whole school approach

• Recognition and management of mental health problems that are relevant to emergencies

• Provision of care for complex and severe mental disorders in psychiatric units in general hospital settings

• Parenting skills programmes


Regional framework for scaling up action on mental health

Governance Health care Promotion and prevention Surveillance, monitoring and research

• Establish/update a multisectoral national policy and action plan for mental health

• Establish mental health services in general hospitals for outpatient and short-stay inpatient care

• Provide cost-effective, feasible and affordable preventive interventions through community and population-based platforms

Integrate the core indicators within the national health information systems

• Embed mental health and psychosocial support in national emergency plans

• Integrate delivery of cost-effective, feasible and affordable evidence-based interventions for mental conditions in primary health care and other priority health programmes

• Train emergency responders to provide psychological first aid

Enhance national capacity to undertake prioritized research

• Review legislation related to mental health in line with international human rights instruments

• Provide people with mental health conditions and their families with access to self-help and community-based interventions

• Integrate priority mental conditions in the basic health delivery package

• Downsize the existing long-stay mental hospitals

Domains and strategic interventions

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Conclusions


Key actions• Accord higher priority to mental health in the health and

social sector policies and plans to minimize stigma and discrimination faced by persons suffering from mental disorders

• Enhance the resources allocated for mental health to bridge the treatment gap

• Scale up evidence-based interventions to protect the rights of persons with mental disorders and their care providers


Thank you

Scaling up mental health care: a framework for action

Health & Medicine

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