The document summarizes challenges faced by WHO's Mental Health Programme, including a large treatment gap for mental disorders like schizophrenia and mood disorders. It notes that most resources are concentrated in mental hospitals, and promotes establishing community-based mental health services and making psychotropic medications more available and affordable as part of scaling up care. The WHO has initiatives like mhGAP and QualityRights to help countries develop policies and train health workers to improve quality and access to rights-based mental healthcare.

1. WHO's Mental Health
Programme:
Continuing Challenges
Department of Mental Health and
Substance Abuse
World Health Organization
Geneva
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2. Disease Burden (DALYs)
Maternal conditions Perinatal conditions
Nutritional deficiencies
Respiratory infections
Malaria Other NCDs
Childhood diseases Malignant neoplasms
Diabetes
Diarrhoeal diseases
HIV/AIDS
Neuropsychiatric disorders
Tuberculosis
Other CD causes Sense organ disorders
Cardiovascular diseases
Injuries
Congenital abnormalities Respiratory diseases
Digestive diseases
Musculoskeletal diseases Diseases of the genitourinary system
Source: WHR 2002
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3. Leading Causes of Mortality and Burden of Disease
world, 2004
Mortality DALYs
% %
1. Ischaemic heart disease 12.2 1. Lower respiratory infections 6.2
2. Cerebrovascular disease 9.7 2. Diarrhoeal diseases 4.8
3. Lower respiratory infections 7.1 3. Depression 4.3
4. COPD 5.1 4. Ischaemic heart disease 4.1
5. Diarrhoeal diseases 3.7 5. HIV/AIDS 3.8
6. HIV/AIDS 3.5 6. Cerebrovascular disease 3.1
7. Tuberculosis 2.5 7. Prematurity, low birth weight 2.9
8. Trachea, bronchus, lung cancers 2.3 8. Birth asphyxia, birth trauma 2.7
9. Road traffic accidents 2.2 9. Road traffic accidents 2.7
10. Prematurity, low birth weight 2.0 10. Neonatal infections and other 2.7
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4. Leading causes of disease burden for women aged
15–44 years, high-income countries, and low-
and middle-income countries, 2004
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5. 2030 rankings:
The leading causes of DALYs lost
World 1 HIV/AIDS
2 Depression
3 Ischaemic heart dis.
High-income countries 1 Depression
2 Ischaemic heart disease
3 Alzheimer
Middle-income countries 1 HIV/AIDS
2 Depression
3 Cerebrovascular
Low-income countries 1 HIV/AIDS
2 Perinatal
3 Depression
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6. Scarcity
Human Resources
(N=157 to 183 countries)
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7. Burden versus Budget
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8. Gap in treatment:
Serious cases receiving no treatment during the last 12 months
90
80 85%
70 76%
60
50
50%
40
30 35%
20
10
0
Lower range Upper range Lower range Upper range
Developed countries Developing countries
(WHO World Mental Health Consortium, JAMA, June 2nd 2004)
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9. THE BURDEN OF MENTAL DISORDERS: Treatment
gap for Schizophrenia and Mood Disorders
Treatment Treatment
Gap Gap
69% 98%
COVERAGE
COVERAGE
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10. INEFFICIENT USE OF RESOURCES:
High concentration of resources in mental hospitals
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11.  Provide treatment in  Establish national policies,
primary care programmes and legislation
 Make psychotropic drugs  Develop human resources
available
 Link with other sectors
 Give care in the community
 Monitor community mental
 Educate the public health
 Involve communities,  Support more research
families and consumers
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12. Impact of WHR-2001
Awareness +++
Understanding ++
Action +
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13. Additional yearly investment on the package that will be needed per
capita population to get from current to target coverage levels
(2006-2015)
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14. mhGAP
mental health Gap Action Programme
Scaling up care for mental, neurological and substance use disorders
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15. Mental Health Services (WHO, 2003)
HIGH LOW
Specialist
Services
FREQUENCY
OF NEED
COST Psychiatric Community
Services in Mental
General Health
Hospitals Services
Mental Health Services
through PHC
INFORMAL COMMUNITY CARE
LOW
HIGH
SELF CARE
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16. mhGAP: Scaling Up Care
 Objectives
– To achieve significantly higher coverage with
key interventions for priority MNS conditions in
resource-poor countries
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17. 17 |

18. 18 |

19. 19 |

20. 20 |

21. 21 |

22. 22 |

23. WHO QualityRights
Improving quality and human rights in
facilities and promoting a civil society movement
 Assessment of facilities
 Development of a change plan
 Capacity building on human rights issues
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24. How can WHO Collaborative Centres help?
 Advocacy
 Demonstrating that community based models work
 Developing guidelines and manuals
 Publishing scientific evidence on effectiveness and
cost
 Training professionals from other countries
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