Dr Margaret Chan, Director-General of the World Health Organization, Mike Glynn and Nico Moshé, Co-Chairs of the Global Campaign Against Epilepsy
PRESS RELEASE (Please scroll down to read the full text of Dr. Chan message)
New intervention guide to facilitate the management of depression, alcohol use disorders, epilepsy and other common mental disorders in the primary health-care setting
7 OCTOBER 2010 | GENEVA — Millions of people with common, but untreated, mental, neurological and substance use disorders can now benefit from new simplified diagnosis and treatment guidelines released today by WHO. The guidelines are designed to facilitate the management of depression, alcohol use disorders, epilepsy and other common mental disorders in the primary health-care setting.
The Intervention guide extends competence in diagnosis and management to non-mental health specialists including doctors, nurses and other health providers. These evidence-based guidelines are presented as flow charts to simplify the process of providing care in the primary health-care setting.
“In a key achievement, the Intervention guide transforms a world of expertise and clinical experience, contributed by hundreds of experts, into less than 100 pages of clinical wisdom and succinct practical advice,” says Dr Margaret Chan, Director-General of the World Health Organization.
Almost 95 million people with depression do not receive any treatment or care
The WHO estimates that more than 75% of people with mental, neurological and substance use disorders — including nearly 95 million people with depression and more than 25 million people with epilepsy — living in developing countries do not receive any treatment or care. Placing the ability to diagnose and treat them into the primary health care system will significantly increase the number of people who can access care.
Expensive technologies are not required to improve mental health services
“Improvement in mental health services doesn’t require sophisticated and expensive technologies. What is required is increasing the capacity of the primary health care system for delivery of an integrated package of care,” says Dr Ala Alwan, Assistant Director-General for Noncommunicable Diseases and Mental Health at WHO.
An estimated one in four people globally will experience a mental health condition in their lifetime. People with mental, neurological and substance use disorders are often stigmatized and subject to neglect and abuse. The resources available are insufficient, inequitably distributed and inefficiently used. In the majority of countries, less than 2% of health funds are spent on mental health. As a result, a large majority of people with these disorders receive no care at all.
Implementing the guidelines
WHO in collaboration with partners will provide technical support to countries to implement the guidelines and has already initiated the programme for scaling up care in six countries; Ethiopia, Jordan, Nigeria, Panama, Sierra Leone and Solomon Islands.
How the programme will help people
“The programme will lead to nurses in Ethiopia recognizing people suffering with depression in their day to day work and providing psychosocial assistance. Similarly, doctors in Jordan and medical assistants in Nigeria will be able to treat children with epilepsy,” says Dr Shekhar Saxena, Director of the Department of Mental Health and Substance Abuse at WHO. “Both these conditions are commonly encountered in primary care, but neither identified nor treated due to lack of knowledge and skills of the health care providers.”
The Intervention guide will help scale up care for mental, neurological and substance use disorders – which is the aim of WHO mental health Gap Action Programme (mhGAP). Multiple partners including Member States, UN agencies, research institutes, universities, multilateral agencies, foundations, WHO Collaborating Centres and NGOs under the (mental health Gap Action Programme (mhGAP) Forum have agreed to assist WHO in advocating for improving mental health care and services in developing countries.
WHO through its mhGAP programme, calls on governments, donors and mental health stakeholders to rapidly increase funding and basic mental health services to close the huge treatment gap.
For more information, please contact:
Dr Shekhar Saxena
Director, Mental Health and Substance Abuse Department
Telephone: +41 22 791 3625
Mobile: +41 79 308 9865
Telephone: +41 22 791 3228
Mobile: +41 79 475 5556
Dr Margaret Chan, Director-General of the World Health Organization
Closing the mental health gap
Excellencies, colleagues and partners in public health, representatives of professional associations and civil society, ladies and gentlemen,
We are grateful for the support from all of you, whether financial or in the field, as researchers, practitioners, representatives of patient groups, or advocates for patients rights.
The magnitude of the problem we are jointly addressing can be measured, in part, by some numbers. WHO estimates that, worldwide, more than 150 million people suffer from depression. Some 125 million people are affected by alcohol-use disorders.
As many as 40 million people suffer from epilepsy, and 24 million from Alzheimers disease and other dementias. Every year, nearly one million people take their own lives.
WHO further estimates that mental, neurological, and substance use disorders account for 14% of the global burden of disease. Three quarters of this burden occurs in low- and middle-income countries.
But numbers alone do not measure the suffering, the isolation, the lost productivity, the brake on developing human potential, and the brake on development in general for countries.
The impact is all the more significant because so many people develop these disorders at a young age and receive no effective help, whatsoever, throughout their lives.
Today, we are moving a big step closer to addressing a central problem: the gap between the number of people with mental disorders who need, and deserve, treatment, and those who actually receive it.
In some parts of the developing world, this gap approaches 80%. How can a burden of this magnitude be ignored, when we already have the know-how? Why is the mental health gap so large?
As we all know, closing the gap faces many, sometimes interacting, barriers. Ignorance is one: public ignorance about these disorders, and political ignorance about the many ways they hold back development for countries.
People with mental disorders are stigmatized within communities and marginalized on national and international development agendas. Resources are insufficient, and they are inefficiently used, sometimes wasted on interventions that do no good, may cause harm, and have no evidence base.
Perhaps most important, efforts to close the mental health gap have been impeded by a widespread assumption that improvements in mental health require sophisticated and expensive technologies, delivered in highly specialized settings by highly specialized staff.
In other words, we face a misperception that mental health care is a luxury item on the health agenda that care is beyond reach in resource-constrained settings where higher mortality diseases win the lions share of domestic and external financial support.
We now have good reason to challenge this thinking.
With publication of the mhGAP Intervention guide, we now have a simple technical tool for detecting, diagnosing, and managing the most common, and burdensome, mental, neurological, and substance use disorders, in any resource setting.
The emphasis is firmly placed on interventions that can be undertaken by busy doctors, nurses, and medical assistants working, with limited resources, at first- and second-level facilities.
Mental health problems, whether depression, epilepsy, dementia, or alcohol dependence, are real disorders. They cause death and disability. They cause suffering. They have symptoms. And they can be managed, in any resource setting.
This is the message we can now communicate with confidence.
No matter how weak the health system or how constrained the resources, something can always be done.
In a key achievement, the Intervention guide transforms a world of expertise and clinical experience, contributed by hundreds of experts, into less than 100 pages of clinical wisdom and succinct practical advice.
The guide, in effect, extends competence in diagnosis and management to the non-specialist, while respecting their busy schedules.
Medicines are effective for many of these disorders. The guide provides information on when to use, and also when not to use, specific medicines. In a balanced approach, it also covers many simple and effective psychosocial interventions, like educating the patient and family, giving advice on sleep, and linking with community sources of social support. This is feasible care, and this is first-rate care.
Development of the Guide benefitted from the work of more than 150 expert contributors and reviewers, and 20 international organizations and professional associations.
I congratulate all of you on this achievement. It has the power to change the landscape of mental health care.
Ladies and gentlemen,
Publication of the Intervention guide is the third in a logical series of steps.
First, document the mental health gap. Measure it. Make people sit up and take notice.
Second, explain what this unmet need means. Tell the story. Document the impact.
And third, show how to fill the gap. Make it feasible.
We have a simple, authoritative technical tool that extends competence to the non-specialist. But this is only the beginning.
The next critical step is to document implementation and impact with evidence gathered in countries.
WHO has initiated a programme for scaling up care for these disorders in six countries: Ethiopia, Jordan, Nigeria, Panama, Sierra Leone, and the Solomon Islands.
You will be hearing about some of these country experiences later today. You will be considering whether success can be replicated, on a much larger scale.
You will be considering the potential integration of mental health interventions into existing primary health care services. You will be looking at barriers as well as enabling factors.
Above all, you will be providing help. Help for the many millions of people debilitated by these disorders, and help to doctors, nurses, and medical assistants who want to take care of the full health needs of their patients but, up to now, lacked the knowledge and skills.
I wish you a most productive meeting.