1

2

mhGAP MENTAL HEALTH GAP ACTION PROGRAMME

SCALING UP CARE FOR MENTAL, NEUROLOGICAL, AND SUBSTANCE USE DISORDERS

VISIONEffective and humane care for all with mental, neurological, and substance use disorders.

GOALClosing the GAP between what is urgently needed and what iscurrently available to reduce the burden of mental,neurological, and substance use disorders worldwide by:

• Reinforcing the commitment of stakeholders to increase the allocation of financial and human resources; and

• Achieving higher coverage of key interventions especially in countries with low and lower middle incomes.

3

THE PROGRAMME

• Tackle priority conditions: depression, schizophrenia and other psychotic disorders, suicide, epilepsy, dementia, disorders due to use of alcohol and illicit drugs and mental disorders in children.

• Develop and implement an essential mental health package to improve service delivery and reduce inequity.

• Target countries for intensified support i.e. low- and lower middle-income countries with the maximum burden and a large resource gap.

• Identify and roll out a strategy to scale up care.

4

FACTS

• Mental, neurological, and substance use disorders are common in all regions of the world, affecting every community and age group across all income categories.

• 14% of the global burden of disease is attributable to mental, neurological, and substance use disorders.

• Depression is the fourth leading cause of disease burden globally and is projected to be the second leading cause in 2030.

• Epilepsy affects about 50 million people worldwide – 80% of whom live in low-income countries.

• Worldwide, suicide is the third leading cause of death in young people.

5

FACTS

• Harmful use of alcohol is the fifth leading risk factor for premature death and disability in the world.

• More than 75% of patients with mental, neurological, and substance use disorders in many low-income countries do not have access to treatment.

• The associated stigma and violations of human rights hasten the decline into poverty and hinder care and rehabilitation.

• Most countries allocate a small fraction of the resources that are needed to be able to adequately respond to mental, neurological, and substance use disorders. One in three countries does not have a specific budget for mental health.

6

TREATMENT IS FEASIBLE

• Non-specialist health providers can deliver mental health interventions.

• In low-income countries, scaling up a package of essential interventions for three mental disorders –schizophrenia, bipolar disorder and depression- and for one risk factor – hazardous alcohol use- requires an additional investment as low as $0.20 per person per year.

7

PROVIDING EFFECTIVE AND AFFORDABLE TREATMENTS THROUGH PRIMARY CARE

• Depression can be treated effectively in all countries with low-cost antidepressants and psychological interventions.

• It is effective and feasible to treat people with epilepsy using inexpensive antiepileptic medicines at primary care level.

• Community-based models of care together with first-generation antipsychotic drugs for schizophrenia are effective, locally feasible, and affordable.

• Brief interventions delivered by primary care workers are effective in reducing hazardous alcohol use.

• Community-based rehabilitation provides low-cost, integrative care of children and adults with chronic mental disabilities.

• Mental health interventions and psychosocial support need to be available during and after emergencies.

8

SCALING UP STRATEGY FOR COUNTRY ACTION

ASSESSMENT OF NEEDSAND RESOURCES

POLITICAL COMMITMENT

SUPPORTIVE POLICYENVIRONMENT

SCALING UPSTRATEGY

DEVELOP THE INTERVENTION

PACKAGE

STRENGTHENHUMAN

RESOURCES

ESTABLISH A PLAN FOR MONITORING AND EVALUATION

MOBILIZE FINANCIAL

RESOURCES

DELIVERING THE INTERVENTION

PACKAGE

REDUCTION OF TREATMENT GAP

9

WHAT RESULTS ARE EXPECTED?

• A comprehensive and result-oriented programme for mental health implemented in targeted countries.

• Greater investment in care for mental, neurological, and substance use disorders. Increase in the proportion of expenditure on community-based services.

• Increase in the proportion of primary health facilities that have trained health professionals for diagnosis and treatment of mental, neurological, and substance use disorders.

• Enhanced implementation of human rights standards in care facilities for mental, neurological, and substance use disorders.

• Greater coverage of services of MNS disorders with essential interventions.

10

THE WAY FORWARD

• The essence of mhGAP is to build innovative partnerships and alliances; to reinforce commitments with existing partners; and to attract and energize new partners.

• Scaling up MH is a process that engages many contributors of government ministries, health professionals, nongovernmental organizations and donors in the international community but also civil society, communities10 and families.

• The goal of WHO is to ensure that mental health is integrated into health care systems across the globe.

THE TIME TO ACT IS NOW!

11

Mental Health Budget

Percentage of Health Budget Spent on Mental

Health

Percent of Mental Health Expenditures Spent on MH

Hospitals

Costa Rica 2.9% 67%Honduras 1.6% 88%Guatemala 1.4% 90%Dominican Republic 0.4% 50%Nicaragua 0.8% 91%El Salvador 1.1% 92%Panama 2.9% 44%Guyana 1.0% 61%Belize 2.0% 26%

12

Disorder Average prevalencePrevious year

(x100 adult population)

Treatment gap(%)

Non-affective Psychosis 1,0 37,4

Major Depression 4,9 58,9

Dysthimia 1,7 58,8

Bipolar Disorder 0,8 64,0

Generalized Anxiety Disorder

3,4 63,1

Panic Disorder 1,0 52,9

Obsessive Compulsive Disorder

1,4 59,9

Alcohol Abuse or Dependency

5,7 71,4

13

Region Median Number per 100.000 population

Africa 0.04

America 2.00

Europe 9.80

World 1.20

14

THE SECRETARY - GENERALMESSAGE ON WORLD MENTAL HEALTH DAY10 October 2008

More broadly, we must do more to integrate mental health awareness into all aspects of health and social policy, health-system planning, and primary and secondary general health care. Mental health is important for personal well-being, family relationships and an individual’s ability to contribute to society. On this World Mental Health Day, let us recognize that there can be no health without mental health.

15

GraciasMerciObrigadaThanks

Working for Working for

the right of the right of

health in the health in the

Americas!Americas!

Gracias

Thanks!