Mental Health and the Global Agenda — NEJM
Mental Health and the Global Agenda
N Engl J Med 2013; 369:66-73July 4, 2013DOI: 10.1056/NEJMra1110827
Comments open through July 10, 2013
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- When the World Health Organization (WHO) European Ministerial Conference on Mental Health endorsed the statement “No health without mental health” in 2005,1 it spoke to the intrinsic — and indispensable — role of mental health care in health care writ large. Yet mental health has long been treated in ways that reflect the opposite of that sentiment. This historical divide — in practice and in policy — between physical health and mental health has in turn perpetuated large gaps in resources across economic, social, and scientific domains. The upshot is a global tragedy: a legacy of the neglect and marginalization of mental health.2 The scale of the global impact of mental illness is substantial, with mental illness constituting an estimated 7.4% of the world's measurable burden of disease.3 The lack of access to mental health services of good quality is profound in populations with limited resources, for whom numerous social hazards exacerbate vulnerability to poor health. The human toll of mental disorders is further compounded by collateral adverse effects on health and social well-being, including exposure to stigma and human rights abuses, forestallment of educational and social opportunities, and entry into a pernicious cycle of social disenfranchisement and poverty.4,5 Advances in efforts to alleviate the human and social costs of mental disorders have been both too slow and too few.
Impact and Response to Mental Illness
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NLM Director’s Comments Transcript
Impact and Response to Mental Illness: 08/12/2013
Regards to all our listeners!
I'm Rob Logan, Ph.D. senior staff National Library of Medicine for Donald Lindberg, M.D, the Director of the U.S. National Library of Medicine.
Here is what's new this week in MedlinePlus.
Collaborative care is a new, viable strategy to treat mental illness around the world, suggests a stimulating review article recently published in the New England Journal of Medicine. The article’s authors explain the need to find new approaches to mental health care is urgent since recent evidence suggests the global economic impact of mental illness now exceeds other diseases.
The authors note current evidence suggests the global fiscal burden of mental illness exceeds: diabetes, cardiovascular illness, chronic respiratory disease, and cancer. Compared to 11 other diseases, the authors add the fiscal impact of mental and behavioral disorders was one of only three health areas where the global economic burden (partially based on the number of years persons lived with disabilities) increased between 1990-2010. The article’s two authors explain the distribution of the growing economic impact of mental and behavioral disorders has been consistent among and between nations.
The authors report the extent of mental illness’ fiscal impact was identified from recently developed (and globally accepted) population health and economic impact metrics, such as disability adjusted life years, years of life lost from premature death, and years lived with disabilities. These measures recently demonstrated for the first time that (and we quote): ‘the scale of the global impact of mental illness is substantial, with mental illness constituting an estimated 7.4 percent of the world’s measurable burden of disease’ (end of quote).
The authors add recent evidence (and we quote): ‘renders an increasingly clear and troubling picture of the enormous global burden imposed by mental disorders’ (end of quote).
Moreover, the authors (who from Harvard Medical School and Massachusetts General Hospital) add more than 75 percent of persons with serious mental illnesses, who live in less-developed nations, do not receive treatment. The authors explain global access to mental health care is exacerbated by a shortage of clinicians with specialized training and an accompanying, small mental health workforce in many nations.
The authors suggest a shift to more collaborative care could assist more patients and accelerate the development of a mental health workforce in many countries. The authors explain a collaborative care model (and we quote): “reconfigures the role of the mental health specialist to emphasize training, supervision, and tertiary care while transferring the bulk of direct service delivery to community health workers or primary care professionals who would receive specific training and supervision in mental health’ (end of quote).
While the authors write collaborative care approaches (and we quote): ‘hold undeniable promise for broadening access to effective treatments’ (end of quote), they acknowledge it is yet to be determined how quickly a collaborative model accelerates improved patient access — and reduces the time to develop a mental health workforce in developing and other nations.
The authors explain a recurring barrier to progress (and we quote): ‘continues to be the enormously negative, destructive and almost universal stigma that is attached to mental illness, to patients with a mental illness, and their families, and to mental health care givers’ (end of quote). The authors conclude mental health may have arrived on the global health agenda, but it needs to be a higher priority to meet international public health needs.
Meanwhile, MedlinePlus.gov’s mental health health topic page provides comprehensive information about diagnosis/symptoms and alternative therapy. Within the ‘diagnosis/symptoms’ section is a helpful website (from the Mayo Foundation for Medical Education and Research) that helps you assess what behaviors are normal and abnormal. The American Psychiatric Association also provides a mental health check up website within the ‘diagnosis/symptoms’ section.
Several websites within the ‘specific conditions’ section of MedlinePlus.gov’s mental health health topic page help you become more resilient, control anger, and let go of grudges and bitterness. For example, a website within the ‘specific conditions’ section (from the American Academy of Family Physicians) provides tips to help you cope with stress.
MedlinePlus.gov’s mental health health topic page also contains research summaries, which are available in the ‘research’ section. Links to the latest pertinent journal research articles are available in the ‘journal articles’ section. Information about related clinical trials in your area is available in the ‘clinical trials’ section. You can sign up to receive updates about mental health as they become available on MedlinePlus.gov.
To find MedlinePlus.gov’s mental health health topic page, type ‘mental health’ in the search box on MedlinePlus.gov’s home page. Then, click on ‘mental health (National Library of Medicine).’ MedlinePlus.gov additionally features health topic pages on mental health disorders, child and teen mental health, as well as international health.
Otherwise, the extent of the global economic impact of mental health (explained with the review article) caught us by surprise. Mental health clearly is a major public health challenge – and perhaps some strategies, such as collaborative care, will accelerate the pace of a global response.
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Impact and Response to Mental Illness
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