The article is largely concerned with the integration of mental health care and primary care. Here, however, in order to encourage general reflection on global mental health policy, I will just pick out a few key passages and some alarming statistics.
"Up to 450 million people worldwide experience mental illness; most of whom do not receive treatment (WHO 2001). In both economically developed (high income) and developing (those which have an undeveloped industrial base and a low standard of living but are undergoing economic development) countries, mental health services have been marginalized, stigmatized and disconnected from mainstream health services (WHO 2001)."
Mental Health and Public Health: "Mental health services tend to occupy a low priority on public health agenda, with significant budget, policy and service implications.In most countries, the mental health budget is less than 1% of the total healthcare expenditure (WHO 2001). Approximately40%of countries worldwide have no mental health policy – 30% of countries in the Americas and 50% of countries in Africa (WHO 2001, 2005).
"The largest institutions housing people with mental illness in the United States include the jails of Riker’s Island, Los Angeles and Cook County (Davidson et al. 2006)."
Mental Health Policy in Developing Countries:"Institutionalization of mentally ill persons in developing countries has raised severe human rights concerns: in India, 28 persons in a mental health facility perished in a fire because they were chained to pillars (Murthy 2004); in Ghana, Africa, over one thousand ‘inmates’ were threatened with starvation because of lack of funds for food (Psychiatric Patients Face Imminent Starvation 2006)."
"Sri Lanka is an island off the coast of India where mental health issues are severe; 5–10% of the population experience mental problems requiring clinical intervention, and Sri Lanka registers the highest suicide rate in the world at 49 per 100 000 (WHO 2002). Yet, the country has only 38 psychiatrists for its entire population of 18.5 million (0.2 per 100 000 population as compared with two per 100 000 in the United States and nine per 100 000 in Europe) (WHO 2005).
Conclusions: "The need to address mental health issues from a global perspective cannot be avoided or denied. In both developed and developing countries, the impact of mental illness is compelling. Strategic approaches must consider existing healthcare delivery networks as well as the social, cultural, political and historical contexts of the people for whom health care is designed."
The importance of good mental health policies cannot be overestimated. Improving services and access to services is not an issue solely for developing countries. The prevalence of mental health disorders in the UK is striking. Last month the Guardian ran an article, 'A third of Europeans are suffering from a mental health disorder in any one year.' http://www.guardian.co.uk/society/2011/sep/05/third-europeans-mental-disorder
Research from the European College of Neuropsychopharmacology found there is insufficient treatment for mental disorders. "Only 30-52% of European sufferers have any contact with a health professional and only 8-16% are in contact with a specialist. A tiny minority, 2-9%, "receive minimally adequate treatment", said Wittchen."
Zolnierek's article (discussed above) provides one reason why patients with a mental disorder fail to get the treatment they deserve; the global issue of inadequate funding for mental health services. In the Guardian article, David Nutt, professor of neuropsychopharmacology at Imperial College London, provides the same reason . "We're under-funded by about 50% of what we should be," he said. "This is something that has to change. One of the big challenges is that if you can get in early, you may be able to change the trajectory so it is not inevitable that people go into disability."
The Guardian also ran an interestigng article yesterday; 'World Mental Health Round-Up' : http://www.guardian.co.uk/society/joepublic/2011/oct/10/world-mental-health-day?newsfeed=true