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Global mental health: policy, progress, and prospects
Editorial
On Nov 28, an investigation by Community Care and the BBC announced that seven people in the UK with mental illness, for whom beds in mental health facilities had not been found, had died by suicide since March, 2012. The following day, it was reported that a woman aged 16 years with mental health problems had been held in police cells in Devon, UK, for 2 days, again for a lack of care beds. These appalling, and all too predictable, failures reflect growing pressure on National Health Service facilities and an absence of adequate specific provision for mental health care. That such problems are reported widely is welcome, however, even with an impending general election in which health care will be a major issue. The growing recognition of the challenging situation of people with mental illness in Britain, and other countries, can propel the organisation and provision of appropriate psychiatric services in the future, contingent on sufficient funding and judicious prioritisation among other health needs. In many developing countries, gaps in care for people with mental illness are very substantial. Two Lancet Series on global mental health, in 2007 and 2011, have sought to scrutinise and highlight the need for clinical evidence and expertise, and especially resources, for mental health services in low-income and middle-income countries. On Nov 26, Mental Health for Sustainable Development was launched—a report by the UK’s All-Party Parliamentary Group on Global Health and Mental Health, which are supported by The Lancet and other organisations. Intended to raise the priority of mental health care in development plans, the report makes four recommendations: that the UK’s Department for International Development incorporates global mental health plans and metrics in its work; that non-governmental organisations and other development organisations introduce mental health planning and programmes; that partnerships in psychiatric training and research should be established by the relevant professional bodies together with lowincome and middle-income countries; and that an explicit mental health target should be included in the health goal of the nascent Sustainable Development Goals (SDGs). In alignment with WHO’s Comprehensive Mental Health Action Plan 2013–20, Mental Health for Sustainable Development aims to promote a threefold change in policy: bringing about an improvement in living and working environments to reduce the incidence of mental www.thelancet.com Vol 384 December 6, 2014
disorders; provision of psychiatric care appropriate to individual countries and cultures; and recognition of the rights of people with mental health issues. The statistics indicate that mental illness is responsible for about 13% of the global burden of ill health, and almost a quarter of years lived with disability, yet receives no more than 2% of health funding in most developing countries. The report includes examples of promising mental health projects in developing countries—it seems that priorities are gradually being realigned in global health, with mental health taking its appropriate place alongside other non-communicable diseases in the communal health priorities for the future. Also published in November was Global mental health from a policy perspective: a context analysis, a new report by Jessica Mackenzie of the Overseas Development Institute. Drawing on work of the Mental Health Innovation Network, supported by Grand Challenges Canada, the report seeks to analyse methods by which global mental health stakeholders could achieve greater influence on policy. Stigma and low tractability, indicating that addressing problems in delivering care for people with mental illness might be perceived as difficult to achieve and unappealing to attempt, are seen to be reasons underlying low investment in mental health provision. But the report agrees that the prominence of mental health in high-income countries has grown substantially in the past 20 years, and that this cultural change should leave mental health advocates well placed to exploit opportunities to influence policy and resource allocation. Mental health is a fundamental prerequisite for overall health, and ample evidence shows that countries around the world need to improve the priority and organisation of, and resources devoted to, mental health care. Yet the global mental health movement will not lack challenges in the future. Acute health threats such as Ebola could divert resources from long-term projects, for example; the oft-discussed precedent of successful concerted action against HIV/AIDS could prove counter-productive (development of an intervention comparable to highly active antiretroviral therapy for people with mental illness, for instance, seems unlikely); and mental health could become buried in the complex negotiations about SDGs. Crucially, will advocacy achieve a central role for mental health in the move towards universal health coverage in developing countries? The Lancet
Robin Hammond/Panos
Global mental health: policy, progress, and prospects
For the Community Care report see http://www.communitycare. co.uk/2014/11/28/deathslinked-mental-health-bedscrisis-cuts-leave-little-slacksystem/ For The Lancet’s 2011 Global Mental Health Series see http:// www.thelancet.com/series/ global-mental-health-2011 For Mental Health for Sustainable Development see http://www.appg-globalhealth. org.uk/reports/4556656050 dl/u/4009611296/4616404388/ APPGs_Mental-Health_Report_ Web.pdf&rct=j&frm=1&q=&esrc= s&sa=U&ei=vtJ9VJe2NK6p7AbkhI HIDA&ved=0CD8QFjAH&usg=AF QjCNEwrT8Dc7x8a_ JxTlVPfAsp8jdUwA For Global mental health from a policy perspective: a context analysis see http://mhinnovation. net/resources/odi-global-mentalhealth-policy-perspectivecontext-analysis-report#. VHtUzrsqVMs
1999
On Nov 28, an investigation by Community Care and the BBC announced that seven people in the UK with mental illness, for whom beds in mental health facilities had not been found, had died by suicide since March, 2012. The following day, it was reported that a woman aged 16 years with mental health problems had been held in police cells in Devon, UK, for 2 days, again for a lack of care beds. These appalling, and all too predictable, failures reflect growing pressure on National Health Service facilities and an absence of adequate specific provision for mental health care. That such problems are reported widely is welcome, however, even with an impending general election in which health care will be a major issue. The growing recognition of the challenging situation of people with mental illness in Britain, and other countries, can propel the organisation and provision of appropriate psychiatric services in the future, contingent on sufficient funding and judicious prioritisation among other health needs. In many developing countries, gaps in care for people with mental illness are very substantial. Two Lancet Series on global mental health, in 2007 and 2011, have sought to scrutinise and highlight the need for clinical evidence and expertise, and especially resources, for mental health services in low-income and middle-income countries. On Nov 26, Mental Health for Sustainable Development was launched—a report by the UK’s All-Party Parliamentary Group on Global Health and Mental Health, which are supported by The Lancet and other organisations. Intended to raise the priority of mental health care in development plans, the report makes four recommendations: that the UK’s Department for International Development incorporates global mental health plans and metrics in its work; that non-governmental organisations and other development organisations introduce mental health planning and programmes; that partnerships in psychiatric training and research should be established by the relevant professional bodies together with lowincome and middle-income countries; and that an explicit mental health target should be included in the health goal of the nascent Sustainable Development Goals (SDGs). In alignment with WHO’s Comprehensive Mental Health Action Plan 2013–20, Mental Health for Sustainable Development aims to promote a threefold change in policy: bringing about an improvement in living and working environments to reduce the incidence of mental www.thelancet.com Vol 384 December 6, 2014
disorders; provision of psychiatric care appropriate to individual countries and cultures; and recognition of the rights of people with mental health issues. The statistics indicate that mental illness is responsible for about 13% of the global burden of ill health, and almost a quarter of years lived with disability, yet receives no more than 2% of health funding in most developing countries. The report includes examples of promising mental health projects in developing countries—it seems that priorities are gradually being realigned in global health, with mental health taking its appropriate place alongside other non-communicable diseases in the communal health priorities for the future. Also published in November was Global mental health from a policy perspective: a context analysis, a new report by Jessica Mackenzie of the Overseas Development Institute. Drawing on work of the Mental Health Innovation Network, supported by Grand Challenges Canada, the report seeks to analyse methods by which global mental health stakeholders could achieve greater influence on policy. Stigma and low tractability, indicating that addressing problems in delivering care for people with mental illness might be perceived as difficult to achieve and unappealing to attempt, are seen to be reasons underlying low investment in mental health provision. But the report agrees that the prominence of mental health in high-income countries has grown substantially in the past 20 years, and that this cultural change should leave mental health advocates well placed to exploit opportunities to influence policy and resource allocation. Mental health is a fundamental prerequisite for overall health, and ample evidence shows that countries around the world need to improve the priority and organisation of, and resources devoted to, mental health care. Yet the global mental health movement will not lack challenges in the future. Acute health threats such as Ebola could divert resources from long-term projects, for example; the oft-discussed precedent of successful concerted action against HIV/AIDS could prove counter-productive (development of an intervention comparable to highly active antiretroviral therapy for people with mental illness, for instance, seems unlikely); and mental health could become buried in the complex negotiations about SDGs. Crucially, will advocacy achieve a central role for mental health in the move towards universal health coverage in developing countries? The Lancet
Robin Hammond/Panos
Global mental health: policy, progress, and prospects
For the Community Care report see http://www.communitycare. co.uk/2014/11/28/deathslinked-mental-health-bedscrisis-cuts-leave-little-slacksystem/ For The Lancet’s 2011 Global Mental Health Series see http:// www.thelancet.com/series/ global-mental-health-2011 For Mental Health for Sustainable Development see http://www.appg-globalhealth. org.uk/reports/4556656050 dl/u/4009611296/4616404388/ APPGs_Mental-Health_Report_ Web.pdf&rct=j&frm=1&q=&esrc= s&sa=U&ei=vtJ9VJe2NK6p7AbkhI HIDA&ved=0CD8QFjAH&usg=AF QjCNEwrT8Dc7x8a_ JxTlVPfAsp8jdUwA For Global mental health from a policy perspective: a context analysis see http://mhinnovation. net/resources/odi-global-mentalhealth-policy-perspectivecontext-analysis-report#. VHtUzrsqVMs
1999