cccurrent ch allenges in global mental health - ifpma · pdf fileleading causes of diseas ......
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C CC CCurrent ChCurrent ChGlobal MenGlobal Men
Dr ShekhaDr ShekhaDirector, DepartmHealth and Subs
World Health O
Gene
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iiallenges in allenges in ntal Healthntal Health
r Saxenar Saxenament of Mental stance Abuse
Organizationg
va
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Disease BurdDisease Burd
Maternal conditions
Respiratory infections
4%
3%3%
6%MalariaChildhood diseases
Diarrhoeal diseases
6%
4%
HIV/AIDS
6%Other CD causes
Tuberculosis
12%
InjuriesC it l b liti
Musculoskeletal diseases
Congenital abnormalities
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den (DALYs)den (DALYs)
7% Oth NCD
Perinatal conditionsNutritional deficiencies
7%
5%Diabetes
Malignant neoplasmsOther NCDs
13%Neuropsychiatric disorders
3%
disordersSense organ disorders
10%
4%3%
Cardiovascular diseases
R i t diDigestive diseases
Respiratory diseases
Diseases of the genitourinary system
Source: WHR 2002
Leading causes of diseas15–44 years, high-inco
Leading causes of diseas15–44 years, high-incoy , g
and middle-incomy , g
and middle-incom
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e burden for women aged me countries, and low-e burden for women aged me countries, and low-,
me countries, 2004,
me countries, 2004
2030 ranThe leading cause
World 1 HIV
The leading cause
2 Dep3 Isch
High-income countries 1 Dep2 I h2 Isch3 Alzh
Middle-income countries 1 HIV2 Dep2 Dep3 Cer
Low-income countries 1 HIV2 Per3 Dep
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kings:es of DALYs lost
V/AIDS
es of DALYs lost
pressionhaemic heart dis.
pressionh i h t dihaemic heart diseaseheimer
V/AIDSpressionpressionrebrovascular
V/AIDSinatal pression
The nuThe nuThe nuThe nu150 illi ith d 150 million with depres
25 million with schizop
38 million with epilepsy
90 million with alcohol
Nearly 1 million commity
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umbersumbersumbersumbersission
hrenia
y
or drug use disorder
t suicide every yeary y
Economic burden oEconomic burden o(Source: WEF, 2011 – The Glob(Source: WEF, 2011 – The Glob
New estimates by the World Economic Forum for the global economic impact of mental, neurological and substance use disorders, using d ff ( d bl ) h3 different (and non‐comparable) approaches:– Cost of illness
(health care + lost productivity)– Value of lost output
(reduced economic growth)– Value of statistical lifeValue of statistical life
(monetary cost of lost lives)
Whichever way you look at it, the amounts are enormous
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of mental disordersof mental disordersbal Economic burden of NCDs)bal Economic burden of NCDs)
2010 20302010 2030
Cost of ill
US$ 2.5 t illi
US$ 6 t illiillness trillion trillion
Value of future lost output N/A
US$ 16.3 trillion
(cumulative)p N/A
Value of lost lives
US$ 8.5 trillion
US$ 16.1 trillionlost lives trillion trillion
Economic burden oEconomic burden o(Source: WEF, 2011 – The Glob(Source: WEF, 2011 – The Glob
45
50
‐2030) Mental, neurological and
substance use disorders
30
35
40
trillion, 2011‐
4 major NCDs (CVD, diabetes,cancer, respiratory disorders)
20
25
30
output (U
S$ t
10
15
20
e econom
ic o
0
5
10
Foregone
0Low income Lower‐middle
incomeU
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of mental disordersof mental disordersbal Economic burden of NCDs)bal Economic burden of NCDs)
,)
Upper‐middleincome
High income World
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KEY MESKEY MESKEY MESKEY MES
1 R t t t d1. Resources to treat and premain insufficient
2. Resources for mental hedi t ib t ddistributed
3 R f t l h3. Resources for mental heutilized
4. Institutional care for mel l d i ldslowly decreasing world
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SSAGESSSAGESSSAGES SSAGES
t t l di dprevent mental disorders
ealth are inequitably
lth i ffi i tlealth are inefficiently
ntal disorders may be d iddwide
INSUFFIINSUFFIBudBud
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CIENCYCIENCYdgetdget
INEQINEQINEQINEQ
Al t h lf f th ld' l ti lAlmost half of the world's population lthere is one psychiatrist or less to s
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QUITYQUITYQUITYQUITY
li i t hlive in a country where, on average, serve 200,000 people or more.
INEFFICINEFFICINEFFICINEFFIC
Globally, 62% of psychiatric beds are located in mental hospitals.are located in mental hospitals.
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CIENCYCIENCYCIENCY CIENCY
Gap in treSerious cases receiving no treatSerious cases receiving no treat
80
90
70
80
50
60
50%
30
40
35%
50%
10
20
0
Lower range Upper range
(WHO World Mental Health Consortium, JAMA, June 2nd 2004)
Developed countries
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eatment:tment during the last 12 monthstment during the last 12 months
85%
76%
85%
Lower range Upper range
Developing countries
Human RigHuman RigHuman RigHuman Rig
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hts Abuseshts Abuseshts Abuseshts Abuses
The Lancet Series on 20
The Lancet Series on 202020
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Global Mental Health07Global Mental Health070707
The Lancet series on 20
The Lancet series on 202020
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Global Mental Health11Global Mental Health111111
Grand Challenges in G(
Grand Challenges in G((Nature, J(Nature, J
Top five challenges:Top five challenges:
– Integrate screening and core se
– Reduce the cost and improve th
– Provide effective and affordable
– Improve children's access to car
– Strengthen mental health comp– Strengthen mental health comp
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Global Mental Healthl )
Global Mental Healthl )July 2011)July 2011)
rvice packages in PHC
he supply of medications
e community based care
re
ponent in training of health personnelponent in training of health personnel
Mental Health Gap ActiWHO's Flagship PrograWHO s Flagship Progra
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ion Programme (mhGAP)amme for Mental Healthamme for Mental Health
Mental HealthMental HealthProgrammeProgramme
To achieve significan
with key interventions
neurological and sub
in resource-poor settp
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h Gap Action h Gap Action e (mhGAP)e (mhGAP)
ntly higher coverage
s for priority mental,
stance use conditions
ingsg
Mental health servMental health serv
Me
High
MeHosp& SpeServ
Psychiatricservices in
Cost
Mental health
GeneralHospitals
primary he
Informal com
Low Self‐c
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vices organized rationallyvices organized rationally
ental
Low
ental pitals ecialist vices
Communitymental h l h
Frequency of need
services through
healthservices
gealth care
mmunity care
Highcare
mhGAP priorit
Priority condy Depressio Psychose S i id Suicide p Child men Epilepsyp p y Dementia Disorders Disorders Disorders
Criteria: High burd Large eco EffectiveEffective
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ty conditions
itions:ones
tireventionntal disorders
as due to use of alcohols due to illicit drug uses due to illicit drug use
den (mortality, morbidity, disability)onomic costintervention availableintervention available
mhGAP Frame
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ework for Action
Octob
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ber 2010
ImplementatioImplementatioImplementatioImplementatio
W ll th i Well on their way-– Ethiopia, Jordan, Nigeria, Pan
Preparing for Preparing for-– Brazil, India, Thailand, Ugand
Many others are using the t Many others are using the t
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on of mhGAPon of mhGAPon of mhGAPon of mhGAP
nama, Belize, Benin,
da, Lao, Pacific islands,
technical materialtechnical material
Knowing more aKnowing more a
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bout mhGAPbout mhGAP
Global menWh t h ld b
Global menWh t h ld bWhat should bWhat should b
Increase resources flowing in Increase resources flowing in– From public as well as private s
Use the knowledge that we alr
T i Train manpower – Specialist and non-specialist
Scale up services – Delivering medicines and psychog p y
Decrease human rights abuse
Monitor the situation
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ntal health: b d ?ntal health: b d ?be done now?be done now?nto mental healthnto mental healthsources
ready have
osocial care
es