[e-drug] Effective treatments for mental illness

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E-drug: Effective treatments for mental illness
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BMJ 2001;323:769 (6 October 2001)

Effective treatments for mental illness not being used, WHO says 
Phyllida Brown, Exeter 

The World Health Organization this week urged governments
worldwide to tackle the heavy and growing burden of mental illness
and neurological disease. Effective and affordable treatments exist
for many conditions, but they are not being used, said the WHO in
its latest annual report on global health assessment, World Health
Report 2001. 

One in four people will experience mental illness at some point in
their lives, but neglect, stigma, and a "dismal" lack of resources
prevent most of them from getting any help, said the report. "The
magnitude of the burden is not matched by the size and
effectiveness of the response." 

Currently, psychiatric and neurological disorders account for nearly
a third of the world's disability, measured in years lived with a
disability. The burden is currently greatest in the industrialised
countries, mainly because their populations are older, but as life
expectancy in developing nations rises, these countries too are
expected to see mental health problems become more prevalent. By
2020, depressive disorders are expected to be the second biggest
cause of disease burden worldwide. 

Yet many countries lack even the most basic treatment and care,
said the WHO. The agency this week also released the first results
of an initiative begun last year, Project Atlas, to map mental
healthcare resources worldwide. 

In sub-Saharan Africa, there is only one psychiatrist for every two
million people and only 12000 psychiatric nurses for the entire
regional population of 626 million. More than a quarter of countries
have no separate budget for mental health in their overall health
budget. Of those who do and who provided a breakdown to the
WHO, about a third spend less than 1% of the health budget on
mental disorders, and most of the rest spend less than 5%. 

The WHO recommends that governments should integrate
treatment for mental disorders into primary care, if necessary
providing basic training for general practitioners, primary nurses,
and, where appropriate, traditional healers. 

Governments' lists of essential drugs should include
antidepressants, antipsychotics, antiepileptics, and tranquillisers,
many of which are affordable even in low income countries. Large
care institutions should be replaced with properly resourced
community care; the report suggests some options for financing
these changes. 

The report also calls on governments to launch public education
campaigns to increase understanding of mental illness. They should
also develop proper policies on mental health and update their
legislation on the rights of mentally ill persons. 

Benedetto Saraceno, the WHO's director of mental health and
substance dependence, said last week that he was "optimistic" that
health ministers were now grasping the urgency of the problem. 

World Health Report 2001: New Understanding, New Hope is
accessible at www.who.int/whr 


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