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GLOBAL MENTAL HEALTH

Overview of Mental Health Worldwide

Pamela Smith, MDFall 2014

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OVERVIEW1) General Facts Regarding Mental

Health Worldwide

2) Mental health resources available worldwide (WHO/Mental Health Atlas 2011 Analysis)

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DEFINITIONMENTAL HEALTH:

A “state of well-being in which every individual realizes his or her own

potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a

contribution to her or his community” (WHO)

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DEFINITIONGlobal Mental Health:

Refers to the international perspective on varied aspects of mental health; area of study, research and practice that places

a priority on improving mental health and achieving equity in mental health for all people worldwide (Koplan et al,

2009). 

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GENERAL FACTSFact 1:

Mental and substance use disorders are significantly prevalent & the leading cause

of disability worldwide 450 million people worldwide have some type of

mental illness

Neuropsychiatric disorders contribute to approximately 13% of the global burden of disease

About 23% of all years lost because of disability is caused by mental and substance use disorders.

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GENERAL FACTSFact 2:

Stigma and discrimination against patients and families prevent people from seeking mental

health care Misunderstanding and stigma surrounding mental ill

health are widespread. Despite the existence of effective treatments for

mental disorders, there is a belief that they are untreatable or that people with mental disorders are difficult, not intelligent, or incapable of making decisions.

This stigma can lead to abuse, rejection and isolation and exclude people from health care or support. Within the health system, people are often treated in institutions which resemble human warehouses rather than places of healing.

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GENERAL FACTSFact 3:

Around 20% of the world's children and adolescents have mental disorders or

problems About half of mental disorders begin before the age

of 14. Similar types of disorders are being reported across

cultures. Neuropsychiatric disorders are among the leading

causes of worldwide disability in young people. Yet, regions of the world with the highest percentage of population under the age of 19 have the poorest level of mental health resources.

Most low- and middle-income countries have only one child psychiatrist for every 1 to 4 million people.

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GENERAL FACTSFact 4:

About 800 000 people commit suicide every year Over 800 000 people die due to suicide every year

and suicide is the second leading cause of death in 15-29-year-olds.

There are indications that for each adult who died of suicide there may have been more than 20 others attempting suicide.

75% of suicides occur in low- and middle-income countries.

Mental disorders and harmful use of alcohol contribute to many suicides around the world.

Early identification and effective management are key to ensuring that people receive the care they need.

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GENERAL FACTSFact 5:

Mental disorders are important risk factors for other diseases, as well as unintentional and intentional

injury Mental disorders increase the risk of

getting ill from other diseases such as HIV, cardiovascular disease, diabetes, and vice-versa.

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GENERAL FACTSFact 6:

War and disasters have a large impact on mental health and

psychosocial well-being Rates of mental disorder tend to double

after emergencies.

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MENTAL HEALTH RESOURCES WORLDWIDE

World Health Organization (WHO) 2011 Report (Mental Health Atlas 2011):

Assessment of mental health resources for 184 of 196 (WHO) member states (representing 95% of WHO member states and 98% of the world’s population)

1st report published in 2001; 2nd in 2005 Contributors include WHO representatives

& staff in country offices, MOH officials in member states, MH professionals worldwide expert in area of global MH

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MENTAL HEALTH RESOURCES WORLDWIDEGeographic Regions (pg 76): Africa (AFR) Americas (AMR) Eastern Mediterranean (EMR) Europe (EUR) South/South-East Asia (SEAR) Western Pacific (WPR)

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MENTAL HEALTH RESOURCES WORLDWIDEIncome Levels (pg 76) High (gross national per capita income

of US$ 12, 276 or more) Upper-Middle (US$ 12,275 – $3,976) Lower-Middle (US$ 3975 - $1006) Low (US$ 1005 or less)

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MENTAL HEALTH RESOURCES WORLDWIDEIndicators of Global Mental Health

Resources (WHO, 2011)1) Governance2) Financing3) Mental health care delivery of services4) Human resources5) Medicines for mental & behavioral

disorders6) Information systems.  

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MENTAL HEALTH RESOURCES WORLDWIDE1) Governance a) mental health policy b) mental health plan c) mental health legislation

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MENTAL HEALTH RESOURCES WORLDWIDE1) Governance

Mental Health Policy: The official statement of a government

conveying an organized set of values, principles, objectives and areas for action

to improve the mental health of a population.

 60% of countries report having a mental health policy

Mental health policies tend to exist in high income countries (77.1%) compared to low income countries (48.7%).

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MENTAL HEALTH RESOURCES WORLDWIDE1) Governance

Mental Health Plan:  scheme realizing the objectives of

mental health policy 71% of countries reported having a

mental health plan. Wealthier countries had a tendency to

have plans compared to countries with low income.

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MENTAL HEALTH RESOURCES WORLDWIDE1) Governance

Mental Health Legislation:Legal statutes to ensure good practice standards

(i.e laws governing access to & quality of care, consent to treatment, admission/treatment w/i

hospitals, etc..) Laws aid in legally reinforcing MH policies &

plans 59% of countries report having mental health

legislation Higher (i.e. high and upper-middle) income

countries tended to have legislation present compared to lower (i.e. lower-middle and low) income countries.

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MENTAL HEALTH RESOURCES WORLDWIDE2) Financing

Median mental health expenditures per capita are US$ 1.63 with large variation among income groups, ranging from US$ 0.20 in low income countries to US$ 44.84 in high income countries.

Sixty-seven percent (67%) of financial resources worldwide are directed toward mental hospitals /institutions (as opposed to community-based facilities)

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MENTAL HEALTH RESOURCES WORLDWIDE3) Mental Care Delivery of Services a) Primary health care (PHC) cliniciansb) Mental health facilities (outpatient, day

treatment, general hospital psychiatric ward, community residential, and mental hospital facilities)

c) Other aspects of service (length of mental hospital stay, follow up care, psychosocial interventions, and distribution of beds across facilities).

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MENTAL HEALTH RESOURCES WORLDWIDE Higher income countries typically have

more facilities and higher admission / utilization rates.

A significant majority (77%) of individuals admitted to mental hospitals remain there less than one year. However, this also implies that almost a quarter of people admitted to mental hospitals remain there longer than a year after admission.

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MENTAL HEALTH RESOURCES WORLDWIDE4) Human Resources Worldwide, nurses represent the most

prevalent health professional group working in the mental health sector (5.8 per 100,000 population).

Greater rates of human resources are observed in higher income countries.

User and family associations are present in 64% and 62% of countries, respectively.

Both user & family associations are more prevalent in higher income countries

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MENTAL HEALTH RESOURCES WORLDWIDE5) Medicines for mental & behavioral

disorders Worldwide, the median expenditure per

person per year on medicines for mental and behavioral disorders - approx $7 ($6.81) USD.

The actual expenditure is likely to be lower, however, as fewer than 30% of countries involved in the survey reported data, with those responding being disproportionately from high income countries

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MENTAL HEALTH RESOURCES WORLDWIDE6) Information systems Majority of countries collect mental

health care data for individuals receiving treatment from mental hospitals, general medical hospitals, day treatment & outpatient clinics.

Less data tends to be collected from primary care and community residential facilities.

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MENTAL HEALTH RESOURCES WORLDWIDESUMMARY Growing burden of neuropsychiatric disease Mental health resources remain insufficient The burden of disease is much greater in

low income countries compared to high income countries.

EMR & EUR consistently ranked high; AFR low regarding elements of MH resources

Number of beds in mental hospitals is reduced in the majority of countries (may indicate a shift from institutional care to community-based care).