Mental Health at a glance Why address mental health? What can be done to improve Mental and neurological disorders are prevalent. According mental health? to the WHO World Health Report (WHR) 2001, Depending on the condition, effective treatments exist and neuropsychiatric disorders account for 12% of the Global patients can lead productive lives. It has been demonstrated Burden of Disease, second only to infectious disorders that community mental health programs can be effective (23%), and are a bigger burden than AIDS, TB and malaria even in poor populations. combined (10%). In the WDR 1993, four of the top ten causes of disability were due to mental and neurological Public health interventions such as immunization and disorders. Depression was ranked fourth in 1993, and is prevention of nutritional disorders will help prevent projected to be second in 2020 and number one for developmental disorders. School health services, adolescent women. health services and maternal health services all contribute to the prevention of mental disorders and the promotion of Mental disorders are disabling and costly. They affect the mental health. A life cycle approach shows how to employment and productivity of the person with the integrate mental health into other health services. disorder, and also of the family/caregiver. Mental disorders lead to high health service utilization, and high rates of Where to start utilization of other formally delivered services including social services, housing, education and in some cases, the Policy/Program development: Establish or strengthen the criminal justice system. mental health delivery system within the framework of PHC, community based rehabilitation and school based Mental disorders can have catastrophic costs for health care. individuals/families which can tip them into poverty. Poor IEC: Increase awareness of what mental health and people are more likely to have symptoms of mental distress mental disorders are, their causes and prevention, and (Narayan, 2000). the availability of effective interventions. There are many myths about the causes of mental illness. Training: Increase the numbers of health workers and However, it is now known that mental illnesses are caused other relevant personnel (teachers, social workers, by an interaction of social, genetic, traumatic and infectious community based rehabilitation workers, psychologists) factors (WHR 2001). who can recognize and manage or refer patients with mental health problems. Mental health is linked to physical health (Davis 1996), Quality: Develop and implement standards and economic productivity, and employment (Ettner 1994, guidelines for the management of common mental health 2000), and to other development issues. Violence against problems. women, alcoholism and HIV/AIDS are some of the areas Establish or strengthen a support supervisory system. where social pathologies interact with health problems. The high burden of infectious disorders in children below five Establish or strengthen the referral system. years of age and the high burden of peri-natal and Develop and implement a mental health Management maternal mortality are often reflected in high rates of Information System. neurological disorders such as epilepsy, cerebral palsy, hydrocephalus and mental retardation. October 2003 Beneficiaries/ Objectives Key Activities Target Groups Indicators Create demand for mental health services Increase awareness of what · IEC activities such as: The whole population Process mental health and mental radio programs Number of programs organized/held disorders are, causes and posters Number of posters/pamphlets produced and distributed prevention, and availability of pamphlets Output effective interventions newspaper articles Increase in attendance at health units · Education sessions in communities including in schools and workplaces Improve access to mental health services Increase the numbers of health Develop training curricula for continuing Primary health workers Process workers, social workers, education (CME) of nursing personnel, (nurses or primary Training manual for CME available community based rehabilitation teachers, social workers, NGO personnel physicians depending on Number of health workers, social workers, community workers and teachers who can Develop curricula and carry out workshops to the country) based rehabilitation workers and teachers trained recognize and manage or refer Number of training workshops held train primary health workers, NGO personnel, Social workers Availability of core/basic training curricula (for teachers, patients with mental health social workers & teachers how to recognize problems and manage/refer common mental disorders NGO workers social workers, community based rehabilitation workers) with mental health component Integrate a mental health component in the Teachers Output core/basic training curricula of nursing Change in referral patterns of health workers, social personnel and teachers, NGO personnel and Community Rehabilitation Officers workers, community based rehabilitation workers and social workers teachers Change in prescription patterns of primary health workers Establish or strengthen a Develop guidelines for support supervision Health workers, social Process support supervisory system Develop the support supervision structure workers, teachers, Number of support supervision visits by the different Mobilize resources to facilitate the process of rehabilitation workers cadres of personnel, teachers, social workers, community support supervision providing mental health based rehabilitation workers care Output Improvement in the prescription patterns of lower level health workers Establish or strengthen the Develop guidelines for referral system Health workers Process referral system Ensure that referral structure is in place Social workers, teachers, Number of referrals made at each level and between the Mobilize resources to facilitate the process of rehabilitation workers different care systems, health, education, social protection, referral eg funding to transfer a patient from legal services one level to another. Patients Output Reduction in number of inappropriate self referrals made to regional and national referral hospitals Increase in the numbers of referrals from and to the communities and the other sectors Improve the quality of mental health care Develop and implement Develop standards and guidelines Patients with mental health Process standards and guidelines for Disseminate the standards to relevant policy problems Standards and guidelines available social workers, management of common makers and all providers of services Health workers, teachers, teachers, rehabilitation personnel as well as health workers mental health problems Train all providers of services, teachers, social social workers, Number of dissemination/training workshops held for workers, psychologists, health workers, to use rehabilitation workers, policy makers in relevant sectors, education, health and the guidelines psychologists providing social protection and for all levels of governance Evaluate and document successful interventions mental health care Output Empower service users/consumers of services Increased attendance at health units Improvement in mental health skills of health workers, teachers, social workers and rehabilitation workers Improve routine mental health data collection Develop and implement a Develop form/system for collecting routine Policy makers at each of the Process mental health Management mental health data levels where planning has Data form available at all levels of care system such as Information System Disseminate the data form to all levels of care to take place community based data collection, school based, social where information is to be collected protection, and health Establish system for collecting, compiling, Number of reports produced at each level analyzing, and disseminating the data at each Collation and analysis of all data from different sources of the levels of planning and in each of the at each level of planning and programming relevant sectors Output Improved planning and implementation of mental health services at all levels and within all relevant sectors, education, social protection, legal and health Examples of Potential Best Buys in Different Situations Possible Scenario Priority Solutions Who to Involve Eastern Europe Conflict/Post Conflict Conflict/Post Conflict Post Conflict Assess needs Ministries of Health, Social Welfare, Education Alcoholism (5 of 10 countries in Establish community based psycho-social support Relevant NGOs the world with highest per capita Alcoholism Agencies eg UNICEF, UNHCR, WFP spirit consumption) Conduct and compile alcohol country profile/brief Alcoholism Suicide (8 of 10 countries with Develop alcohol policy that includes control of supply, Ministry of Health,Ministry of Education highest rates in the world) preventing abuse and mitigating effects of abuse AAs or other NGOs Suicide Suicide Improve accessibility of mental health services in schools, Ministry of Health and Education workplaces and communities NGOs providing mental health care, support to survivors, relatives Develop materials and train primary health workers, teachers, of victims social workers, rehabilitation workers in the recognition and prevention of suicide Sub Saharan Africa HIV/AIDS HIV/AIDS HIV/AIDS Develop module for health workers, social workers, Ministry of Health, Education, Social Affairs Wars/Conflict (29 of 46 rehabilitation workers, and NGOs of PLWH/A so they can Agencies eg WHO, UNICEF Countries) provide psychological support to patients and their relatives NGOs, eg People Living with HIV/AIDS Provide psycho-social support to children and adults affected by HIV/AIDS Establish community based psycho-social support Wars/Conflicts see Conflict section for Eastern Europe above Depression Develop culture and context relevant guidelines for Ministry of Health, Education, Social Affairs (High DALY burden) management of depression (primary to tertiary level) IEC on the symptoms of depression and where services can be received Train staff at all levels of care to recognize and manage depression Ensure supply of anti-depressant drugs at all levels of the system Do's and Don'ts in Mental Health For more information Services HNP Anchor: Florence Baingana DO create demand for mental and neurological services by investing in health education programs to combat Public Health Thematic Group: Jumana Qamruddin stigma and raise awareness of what mental and Alcohol: Mariam Claeson neurological disorders are, causes and prevention, that effective interventions exist and where the services are. Disability Thematic Group: Pamela Dudzik DO improve access to services, and integrate mental health into primary health care, community based Health and Population Advisory Services: rehabilitation, early child programs, legal services and healthpop@worldbank.org school health programs. This involves training primary health workers, teachers, social Key references workers, and rehabilitation workers to be able to World Bank Group Note on Alcoholic Beverages, World recognize and/or manage/refer common mental Bank 2001 health problems, establishing a support supervisory system and Alcohol at a glance establishing a referral system within each sector and R. Desjarlais et al, World Mental Health: Problems and across sectors. Priorities in Developing Countries, Oxford University DO ensure that mental health is included in the Health Press, 1995 Policy and Health Sector Strategic Plan, the Social Sector Policy, the Educational Sector Policy and budgets at WHO, Integrating a Mental Health Component into national level and other administrative levels, e.g. district Primary Health Care, 1990 or provincial level. WHO, Global Action for the Improvement of Mental DO encourage development of standards and guidelines Health Care: Policies and Strategies, 1996 for management of common mental disorders for each level of the care delivery system in all relevant sectors. Institute of Medicine, Neurological, Psychiatric and Developmental Disorders: Meeting the Challenge of the DO advocate inclusion of a few mental and neurological Developing World, 2001, Committee on Nervous drugs in the Essential Drug List to help ensure access to Disorders in Developing Countries, Board of Global drugs for all levels of the health care system. Criteria for Health. 4 page summary; full report (458 pages) choosing drugs: safety, cost, ease of administration, and designed to address the most common treatable WHO World Health Report 2001: Mental Health: New disorders. Understanding, New Hope DO explore the role that alternative therapists, including traditional healers, can play in providing mental health Key web sites care. In some parts of Africa, up to 80% of patients consult traditional healers even before consulting with the World Health Organization allopathic system. http://www.who.int/mental_health DO facilitate inter-sectoral linkages such as with World Bank http://www.worldbank.org/mentalhealth education, social welfare, housing, community rehabilitation, NGOs working in mental health; and International Consortium for Mental Health Policy and intra-sectoral linkages with AIDS Control Programs, Services http://www.world-mental-health.org Reproductive Health, Early Child Development, Adolescent Health, Health Education, School Health Programs, Onchocerciasis, Clinical Services, Community Services and Disability Services. A Mental Health Co-ordinating Committee can be important for bringing the various stakeholders together. Expanded versions of the "at a glance" series, with e-linkages to resources and more information, are available on the World Bank Health-Nutrition-Population web site: www.worldbank.org/hnp