Introducing the Movement for Global Mental Health (Editorial)
A year ago, the Lancet published a series of five articles on Global Mental Health, with a focus on low and middle income countries (LAMIC) (http://www.theLancet.com/online/focus/mental_health). The articles comprised systematic reviews and secondary analyses, the aim being to draw together the best available evidence to inform action. The target was the global health community, raising awareness of the problems and highlighting potential solutions. The series drew attention to (i) the burden of mental disorder, accounting for 14 per cent of the global burden of disease, 84 per cent of which is in low and middle income countries. Mental disorders affect disproportionately the poor, the disadvantaged and vulnerable, (ii) the inequity in the allocation of healthcare resources. In all regions, the slice of the overall health budget spent on mental health is one third or less what would be expected given their burden, (iii) the scarcity of human resources in low and middle income countries. Across most of Africa, south and south east Asia there is fewer than one psychiatrist per million population, (iv) the inefficient spending on large institutions, usually located in major cities and inaccessible to many of those who could benefit from care, (v) the evidence that low-cost treatments (drugs, psychological treatments, community-based rehabilitation) are feasible, affordable and cost-effective for many mental disorders in developing countries–these could be delivered by community health workers with adequate training and supervision, (vi) the enormous treatment gap, between those that might benefit from interventions, and those that receive them–as high as 90 per cent for serious mental illnesses in LAMIC, (vii) the inextricable links between mental health and other health and social concerns including communicable, non communicable diseases, accidents and injuries–this is why there can be ‘no health without mental health’, and why greater integration of mental healthcare with general healthcare is a key priority, (viii) the discrimination, and stigma experienced by many with mental disorders and their families–reducing the demand for effective treatments, and undermining the potential for networking, lobbying and advocacy, and (ix) the neglect of the human rights of people with mental disorders–there is far too much unnecessary and unmonitored detention, restraint, neglect and exclusion from the rights to good quality healthcare, and full and active social and civil participation.