Lancet Launches Campaign to Strengthen Global Mental Health Services

Marlene Busko

September 12, 2007 — The Lancet begins its campaign to strengthen mental healthcare with the September 8 publication of the first 2 articles of a 6-part series on global mental health. The first article focuses on the way mental health affects physical health, and the second article looks at scarcity of resources and inequality and inefficiencies in mental healthcare delivery.
Editor: "We Urge Partners to Join in to Strengthen Mental Health"
In the next 2 years leading up to a global summit on mental health in 2009, the journal plans to direct attention to the neglect and stigmatization of mental illness, to provide a call to action, and to track and monitor progress, Richard Horton, MD, editor of the Lancet, explains in a Comment.
"Despite the great attention Western countries pay to the mind and human consciousness in philosophy and the arts, disturbances of mental health remain not only neglected but also deeply stigmatized across our societies," he writes.
He elaborates that institutions such as the World Health Organization and the World Bank, foundations such as the Gates Foundation, and research funding bodies such as the US National Institutes of Health share a duty to make mental health a strategic and financial priority, but, for the most part, these institutions have done far too little, and many low-income countries are "crying out for help."
He concludes his comment with a call to action: "We urge partners to join in the broad new social movement we are launching to strengthen mental health."
Mental Illness Increases Risk of Physical Illnesses
In the first article in the series, "No health without mental health," Prof. Martin Prince, from King's College London, in the United Kingdom, and colleagues explain that an estimated 14% of the global burden of disease is due to neuropsychiatric disorders, mostly depression, alcohol- and substance-use disorders, and psychoses. However the contribution of mental disorders to physical illness is inadequately appreciated, so the actual global burden of mental disorders is probably higher than this, they observe.
The group reviews the evidence for links between mental health and cardiovascular disease, diabetes, HIV/AIDS, tuberculosis, malaria, maternal and child health, and accidents and injuries.
They report that more research is needed, particularly on the potential for mental health interventions to improve physical health outcomes, and they point out that relatively little of this type of research has been carried out in low- and middle-income countries.
They urge for greater attention to mental health during the planning and delivery of healthcare. "Mental health awareness needs to be integrated into all elements of health and social policy, health-system planning, and delivery of primary and secondary care," they write.
Scarcity, Inequities, and Inefficiencies
In the second article in the series, "Resources for mental health," Shekhar Saxena, MD, from the World Health Organization, in Geneva, Switzerland, and colleagues report that not only are resources for mental health scarce, this is compounded by inequities and inefficiencies in the delivery of mental healthcare.
As a result, people who need care get none. "The treatment gap — the proportion of those who need but do not receive care — is too high for some mental disorders," they write, explaining that as many as 1 in 3 people with schizophrenia and 1 in 2 with other mental disorders do not receive any treatment. The WHO has reported that the treatment gap for serious disorders is 35% to 50% for developed countries and 76% to 85% for low- and middle-income countries.
Shortages of healthcare professionals have been shown to be the main limiting factor in delivering mental healthcare in most low- and middle-income countries, the group writes.
Inequities in care delivery are widespread, the group continues. Mental disorders and need for care is highest for women, young people, poor people, those with the least education, and those living in rural areas — the same people with low access to care, they note. Stigma further constrains the use of scarce resources.
The authors report that inefficiencies in the use of resources include the fact that whereas community-based care has been shown to be more cost-effective, most mental health systems still allocate most of their budgets to mental hospitals.
"Scarcity of available resources, inequities in their distribution, and inefficiencies in their use pose the 3 main obstacles to better mental health, especially in low-income and middle-income countries," the group summarizes, adding that innovative, concerted, and sustained efforts are needed to remove these obstacles and achieve better mental health.
Lancet. 2007;370:806 Abstract, 859-877 Abstract, 878-889. Abstract