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Mental Health in WHO: A Historical Perspectives Dr. Shekhar Saxena Department of Mental Health and Substance Abuse Mental Health in WHO: Mental Health in WHO: A Historical Perspectives A Historical Perspectives Dr. Shekhar Saxena Dr. Shekhar Saxena Department of Mental Health and Substance Abuse Department of Mental Health and Substance Abuse 29 th September 2010
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Page 1: Mental Health in WHO: A Historical Perspectives Dr ......Mental Health in WHO: A Historical Perspectives Dr. Shekhar Saxena Department of Mental Health and Substance Abuse Mental Health

Mental Health in WHO: A Historical Perspectives

Dr. Shekhar Saxena Department of Mental Health and Substance Abuse

Mental Health in WHO:Mental Health in WHO: A Historical PerspectivesA Historical Perspectives

Dr. Shekhar SaxenaDr. Shekhar Saxena Department of Mental Health and Substance AbuseDepartment of Mental Health and Substance Abuse

29th September 2010

Page 2: Mental Health in WHO: A Historical Perspectives Dr ......Mental Health in WHO: A Historical Perspectives Dr. Shekhar Saxena Department of Mental Health and Substance Abuse Mental Health

29th September 20102 |

Early PeriodEarly Period

Establishing the universality of mental disorders

Estimating their prevalence

Developing Assessment Instruments

Reinforcing psychiatry as a medical discipline

Page 3: Mental Health in WHO: A Historical Perspectives Dr ......Mental Health in WHO: A Historical Perspectives Dr. Shekhar Saxena Department of Mental Health and Substance Abuse Mental Health

29th September 20103 |

WHO International Pilot Study of Schizophrenia

WHO International Pilot Study of Schizophrenia

Page 4: Mental Health in WHO: A Historical Perspectives Dr ......Mental Health in WHO: A Historical Perspectives Dr. Shekhar Saxena Department of Mental Health and Substance Abuse Mental Health

29th September 20104 |

Depression in Different CulturesDepression in Different Cultures

Psychological Medicine

1980 Nov;10(4):743-9.

WHO collaborative study: assessment of depressive disorders.

Sartorius N, Jablensky A, Gulbinat W, Ernberg G.

Page 5: Mental Health in WHO: A Historical Perspectives Dr ......Mental Health in WHO: A Historical Perspectives Dr. Shekhar Saxena Department of Mental Health and Substance Abuse Mental Health

29th September 20105 |

Psychological Problems in General Health Care (PPGHC)

Psychological Problems in General Health Care (PPGHC)

Archives of General Psychiatry 1993 Oct;50(10):819-24.

An international study of psychological problems in primary care. Preliminary report from the World Health Organization Collaborative Project on 'Psychological Problems in General Health Care'.

Sartorius N, Ustün TB, Costa e Silva JA, Goldberg D, Lecrubier Y, Ormel J, Von Korff M, Wittchen HU.

Division of Mental Health, World Health Organization, Geneva, Switzerland.

Page 6: Mental Health in WHO: A Historical Perspectives Dr ......Mental Health in WHO: A Historical Perspectives Dr. Shekhar Saxena Department of Mental Health and Substance Abuse Mental Health

29th September 20106 |

Assessment InstrumentsAssessment Instruments

The World Health Organization (WHO) Composite International Diagnostic Interview (CIDI)

Schedules for Clinical Assessment in Neuropsychiatry (SCAN)

Page 7: Mental Health in WHO: A Historical Perspectives Dr ......Mental Health in WHO: A Historical Perspectives Dr. Shekhar Saxena Department of Mental Health and Substance Abuse Mental Health

29th September 20107 |

ICD-9 (1978)ICD-9 (1978)

Page 8: Mental Health in WHO: A Historical Perspectives Dr ......Mental Health in WHO: A Historical Perspectives Dr. Shekhar Saxena Department of Mental Health and Substance Abuse Mental Health

29th September 20108 |

ICD-10 (1992)ICD-10 (1992)

Page 9: Mental Health in WHO: A Historical Perspectives Dr ......Mental Health in WHO: A Historical Perspectives Dr. Shekhar Saxena Department of Mental Health and Substance Abuse Mental Health

29th September 20109 |

More Recent PeriodMore Recent Period

Establishing mental health within public health

Giving policy advice

Attention on human rights

Providing data on resources

Economic considerations

Scaling up services

Page 10: Mental Health in WHO: A Historical Perspectives Dr ......Mental Health in WHO: A Historical Perspectives Dr. Shekhar Saxena Department of Mental Health and Substance Abuse Mental Health

29th September 201010 |

6%

6%

4%

3%3%

6%7%

5%

13%

3%

10%

4%3%

12% Cardiovascular diseases

DiabetesMalignant neoplasms

Digestive diseases

Neuropsychiatric disorders

Other NCDs

Injuries

Other CD causes

Maternal conditions

MalariaChildhood diseases

Tuberculosis

Diarrhoeal diseases

Perinatal conditions

HIV/AIDS

Respiratory infections

Respiratory diseases

Nutritional deficiencies

Sense organ disorders

Diseases of the genitourinary systemMusculoskeletal diseases

Congenital abnormalities

Disease Burden (DALYs)

Source: WHR 2002

Page 11: Mental Health in WHO: A Historical Perspectives Dr ......Mental Health in WHO: A Historical Perspectives Dr. Shekhar Saxena Department of Mental Health and Substance Abuse Mental Health

29th September 201011 |

The World Health Report 2001

The World Health Report 2001

Mental Health: New Understanding,

New Hope

Page 12: Mental Health in WHO: A Historical Perspectives Dr ......Mental Health in WHO: A Historical Perspectives Dr. Shekhar Saxena Department of Mental Health and Substance Abuse Mental Health

29th September 201012 |

Comparative data on resourcesComparative data on resources

Page 13: Mental Health in WHO: A Historical Perspectives Dr ......Mental Health in WHO: A Historical Perspectives Dr. Shekhar Saxena Department of Mental Health and Substance Abuse Mental Health

29th September 201013 |

Mental health policy and service guidance package

Page 14: Mental Health in WHO: A Historical Perspectives Dr ......Mental Health in WHO: A Historical Perspectives Dr. Shekhar Saxena Department of Mental Health and Substance Abuse Mental Health

29th September 201014 |

Human Rights AbusesHuman Rights Abuses

Page 15: Mental Health in WHO: A Historical Perspectives Dr ......Mental Health in WHO: A Historical Perspectives Dr. Shekhar Saxena Department of Mental Health and Substance Abuse Mental Health

29th September 201015 |

Evidence for Prevention and PromotionEvidence for Prevention and Promotion

Page 16: Mental Health in WHO: A Historical Perspectives Dr ......Mental Health in WHO: A Historical Perspectives Dr. Shekhar Saxena Department of Mental Health and Substance Abuse Mental Health

29th September 201016 |

Levels of services (WHO, 2003)FR

EQU

ENC

YO

F NEED

CO

STS

LOWHIGH

HIGH LOW

SELF CARE

INFORMAL COMMUNITY CARE

Mental Health Services through PHC

CommunityMental Health

Services

PsychiatricServices in

GeneralHospitals

Mental Hospitals

& Specialist Services

Page 17: Mental Health in WHO: A Historical Perspectives Dr ......Mental Health in WHO: A Historical Perspectives Dr. Shekhar Saxena Department of Mental Health and Substance Abuse Mental Health

29th September 201017 |

Current versus target expenditure on specified mental health package in 12 selected countries

Current versus target expenditure on specified mental health package in 12 selected countries

$-

$50

$100

$150

$200

$250

$300T

otal

ann

ual e

xpen

ditu

re (i

n U

S$ m

illio

ns, 2

005)

Additional expenditure needed 9 80 166 116 187 77 50 39 14 176 39 142

Current expenditure on package 4 54 22 7 86 15 3 4 3 81 134 15

Albania Chile China (Hunan) Ethiopia Iran Morocco Nepal Nigeria Paraguay Thailand Ukraine Viet

Nam

Page 18: Mental Health in WHO: A Historical Perspectives Dr ......Mental Health in WHO: A Historical Perspectives Dr. Shekhar Saxena Department of Mental Health and Substance Abuse Mental Health

29th September 201018 |

Page 19: Mental Health in WHO: A Historical Perspectives Dr ......Mental Health in WHO: A Historical Perspectives Dr. Shekhar Saxena Department of Mental Health and Substance Abuse Mental Health

29th September 201019 |

Launched by WHO

Director General on

9th October 2008

Page 20: Mental Health in WHO: A Historical Perspectives Dr ......Mental Health in WHO: A Historical Perspectives Dr. Shekhar Saxena Department of Mental Health and Substance Abuse Mental Health

29th September 201020 |

To be launched on 7th October 2010To be launched on 7th October 2010

Page 21: Mental Health in WHO: A Historical Perspectives Dr ......Mental Health in WHO: A Historical Perspectives Dr. Shekhar Saxena Department of Mental Health and Substance Abuse Mental Health

29th September 201021 |

WHO DGWHO DG

Governments across the world need to see mental health as a vital component of primary health care. We need to change policy and practice. Only then can we get the essential mental health services to the tens of millions in need.

Page 22: Mental Health in WHO: A Historical Perspectives Dr ......Mental Health in WHO: A Historical Perspectives Dr. Shekhar Saxena Department of Mental Health and Substance Abuse Mental Health

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