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Mental Health

Why address mental health?
What can be done to improve mental health?
Where to start
Do's and Don'ts
For more information
Key references
Key websites
PDF Versions  (English, Spanish, Russian)

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Why address mental health?

Mental and neurological disorders are prevalent. According to the World Health Report (WHR) 2001, neuropsychiatric disorders account for 12% of the Global Burden of Disease, second only to infectious disorders (23%), and are bigger burden than AIDS, TB and malaria combined (10%). In the WDR 1993, four of the top ten causes of disability were due to mental and neurological disorders. Depression was ranked fourth in 1993, and is projected to be second in 2020 and will be number one for women.

Mental disorders are disabling and costly. They affect the employment and productivity of the person with the disorder, and also of the family/caregiver. Mental disorders lead to high health service utilization, and high rates of utilization of other formally delivered services including social services, housing, education and in some cases, the criminal justice system.

Mental disorders can have catastrophic costs for individuals/families which can tip them into poverty. Poor people are more likely to have symptoms of mental distress (Narayan, 2000).

There are many myths about the causes of mental illness. However, it is now known that mental illnesses are caused by an interaction of social, genetic, traumatic and infectious factors (WHR 2001).

Mental health is linked to physical health (Davis 1996), economic productivity, and employment (Ettner 1994,2000), and to other development issues. Violence against women, alcoholism and HIV/AIDS are some of the areas where social pathologies interact with health problems. The high burden of infectious disorders in children below five years of age and the high burden of peri-natal and maternal mortality are often reflected in high rates of neurological disorders such as epilepsy, cerebral palsy, hydrocephalus and mental retardation.


What can be done to improve mental health?

Depending on the condition, effective treatments exist and patients can lead productive lives. It has been demonstrated that community mental health programs can be effective even in poor populations.

Public health interventions such as immunization and prevention of nutritional disorders will help prevent developmental disorders. School health services, adolescent health services and maternal health services all contribute to the prevention of mental disorders and the promotion of mental health. Alife cycle approach shows how to integrate mental health into other health services.


Where to start

  • Policy/Program development: Establish or strengthen the mental health delivery system within the framework of PHC, community based rehabilitation and school based health care.
  • IEC: Increase awareness of what mental health and mental disorders are, their causes and prevention, and the availability of effective interventions.
  • Training: Increase the numbers of health workers and other relevant personnel (teachers, social workers, community based rehabilitation workers, psychologists) who can recognize and manage or refer patients with mental health problems.
  • Quality: Develop and implement standards and guidelines for the management of common mental health problems.
  • Establish or strengthen a support supervisory system.
  • Establish or strengthen the referral system.
  • Develop and implement a mental health Management Information System.


Do's and Don'ts in Mental Health Services

  • DO create demand for mental and neurological services by investing in health education programs to combat stigma and raise awareness of what mental and neurological disorders are, causes and prevention, that effective interventions exist and where the services are.
  • DO improve access to services, and integrate mental health into primary health care. This involves
    • training primary health workers to be able to manage common mental health problems,
    • establishing a support supervisory system and
    • establishing a referral system.
  • DO ensure that mental health is included in the Health Policy and Health Sector Strategic Plan and budgets at national level and other administrative levels e.g. district or provincial level.
  • DO encourage development of standards and guidelines for management of common mental disorders for each level of the health care delivery system.
  • DO advocate inclusion of a few mental and neurological drugs in the Essential Drug List to help ensure access to drugs for all levels of the health care system. Criteria for choosing drugs: safety, cost, ease of administration, and designed to address the most common treatable disorders.
  • DO explore the role that alternative therapists, including traditional healers can play in providing mental health care. In some parts of Africa, up to 80% of patients consult traditional healers even before consulting with the allopathic system.
  • DO facilitate inter-sectoral linkages such as with education, social welfare, housing, community rehabilitation, NGOs working in mental health; and intra-sectoral linkages with AIDS Control Programs, 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.


For More Information...

  • HNP Anchor: Florence Baingana
  • Public Health Thematic Group: Jumana Qamruddin
  • Alcohol: Mariam Claeson
  • Disability Thematic Group: Pamela Dudzik
  • Health and Population Advisory Services:


Key references

  • World Bank Group Note on Alcoholic Beverages, World Bank 2001
  • Alcohol at a glance
  • R. Desjarlais et al, World Mental Health: Problems and Priorities in Developing Countries, Oxford University Press, 1995
  • WHO, Integrating a Mental Health Component into Primary Health Care, 1990
  • WHO, Global Action for the Improvement of Mental Health Care: Policies and Strategies, 1996
  • Institute of Medicine, Neurological, Psychiatric and Develomental Disorders: Meeting the Challenge if the Developing World, 2001, Committee on Nervous Disorders in Developing Countries, Board on Global Health. 4 page summary; full report (458 pages)
  • WHO World Health Report 2001: Mental Health: New Understanding, New Hope


Key websites


PDF Versions


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