C CC CCurrent ChCurrent ChGlobal MenGlobal Men

Dr ShekhaDr ShekhaDirector, DepartmHealth and Subs

World Health O

Gene

1 |

iiallenges in allenges in ntal Healthntal Health

r Saxenar Saxenament of Mental stance Abuse

Organizationg

va

2 |

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

3 |

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

4 |

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

5 |

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

6 |

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

7 |

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

8 |

of mental disordersof mental disordersbal Economic burden of NCDs)bal Economic burden of NCDs)

,)

Upper‐middleincome

High income World

9 |

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

10 |

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

11 |

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

12 |

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.

13 |

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

14 |

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

15 |

hts Abuseshts Abuseshts Abuseshts Abuses

The Lancet Series on 20

The Lancet Series on 202020

16 |

Global Mental Health07Global Mental Health070707

The Lancet series on 20

The Lancet series on 202020

17 |

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

18 |

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

19 |

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

20 |

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

21 |

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

22 |

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

23 |

ework for Action

Octob

24 |

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

25 |

on of mhGAPon of mhGAPon of mhGAPon of mhGAP

nama, Belize, Benin,

da, Lao, Pacific islands,

technical materialtechnical material

Knowing more aKnowing more a

26 |

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

27 |

ntal health: b d ?ntal health: b d ?be done now?be done now?nto mental healthnto mental healthsources

ready have

osocial care

es