from to

Recommendations

Info

the effectiveness of task sharing by non-specialist health workers working with specialist mental health professionals is suggesting new approaches to health workforce capacity development. 27,28,29 WHO has supported these trends by providing guidance regarding interventions for mental, neurological and substance use disorders in non-specialized health settings, 30 which presents a series of protocols and tools which are currently being implemented to a greater or lesser extent in over 80 countries. 31 There has also been a substantial increase in the funding of global mental health research, about US$ 50 million in the last five years alone, which has enabled the generation and dissemination of new evidence on the impact and viability of a range of intervention strategies for addressing mental disorders in low- and middle-income countries. 32,33 That national governments are also taking note is borne out by the most recent WHO Mental Health Atlas survey, 34 which shows that over two thirds of countries now have a specific policy or plan for mental health, and that over half have a standalone mental health law. and Crime (UNODC) Programme on Drug Dependence Treatment and Care (currently operational in more than 15 less-resourced countries), as well as the generation of new WHO guidelines and tools on identification and management of substance use disorders. 19,20,21,22,23 Mental disorders were not included in the WHO Global Action Plan for the Prevention and Control of NCDs 2013– 2020 or the political declaration arising from the United Nations High-level Meeting on NCDs. 24 Their absence in these strategically important documents was a factor in the decision of a number of WHO Member States to push for the development of a dedicated WHO action plan on mental health. 17 The political declaration, however, recognized the important contribution of harmful use of alcohol as one of the four major risk factors for NCDs and the WHO Action Plan for the Prevention and Control of NCDs 2013–2020 reinforced the WHO global strategy by calling for at least a 10% reduction by 2025 in the harmful use of alcohol compared to 2010. The UN General Assembly has also passed a resolution to hold a special session on the world drug problem in 2016. Progress is also being driven by the emerging global consensus regarding which evidence-based interventions should be singled out for prioritized scale-up, based on an analysis of their cost-effectiveness, affordability and feasibility. For example, evidence that the cost of delivering a treatment package for conditions such as depression, bipolar disorder and schizophrenia would require only a modest investment is driving the scaleup of key interventions. 25,26 Similarly, evidence regarding There has also been progress on the monitoring front, notably with regard to the epidemiology of mental disorders using common instruments for assessment and consistent analytical methods; several major multicountry initiatives are in progress. 35 These studies have provided more comparable estimates of the extent, distribution and nature of mental disorders in all regions of the world, thereby helping to define the burden better, and have also contributed to better classification of mental health conditions. 36,37,38,39 CHALLENGES Despite the achievements mentioned above and the factors that have contributed to the successes, several significant challenges remain. Lack of funding: While the political will to invest in mental health continues to grow, it is still far from adequate. Public spending on mental health continues to be very low at 2% or less of total health-care spending in most low- and middle-income countries, or less than US$ 2 per capita. 35 This funding is mainly spent on inpatient care. Similarly, while development assistance for mental health increased between 2007 and 2013, both in relative and absolute terms, reaching US$ 134 million annually on average, as a proportion of overall development assistance for health it was less than 1%. 40 Global dementia epidemic: Prevalence and incidence projections indicate that the number of people with dementia will continue to grow, particularly among the 158 HEALTH IN 2015: FROM MDGs TO SDGs
oldest old, and countries in demographic transition will experience the greatest growth. 7 The huge cost to health systems will be just one aspect of the challenge faced. For 2010, the costs were estimated at US$ 604 billion per year 41 and costs are set to expand even faster than dementia prevalence. Lack of quality data: Country health information systems do not routinely collect data on a core set of mental health indicators in over two thirds of countries, and are unable to provide reliable information on the extent of service coverage for even severe mental disorders. Stigmatization: Negative attitudes to people living with mental and substance use disorders abound, both among the general public and health-care providers. 42 Such attitudes have been compounded by the lack of “objective” markers or diagnostic tests for mental illnesses, which is often interpreted as evidence for these not being “real” diseases. There is a lack of awareness and understanding of dementia in most countries, resulting in stigmatization and barriers to diagnosis and care, which negatively impact both the affected person and their families. Lack of advocacy: The lack of strong advocacy groups, such as the civil society organization movements that have been remarkably successful for HIV, prevents mental health issues being brought to the fore. Health workforce: The human resource challenges remain immense with regard to mental and substance use disorders, and in particular with regard to dementia. Investments are needed in training carers to recognize mental disorders, and in particular in supporting the non-specialist healthcare workers that are essential for the full integration of a package of interventions in primary or general health-care settings. Developing these collaborative care models for mental disorders and dementia with shifting tasks to nonspecialists with the right skills to scale up services will be a huge challenge. Ease of access: In the particular case of alcohol use, an additional challenge relates to “profit driven disease” as policies and regulations that govern commercial interests interfere with public health objectives. The constantly changing market of illicit drugs and transit routes, along with new psychoactive substances regularly being reported, pose additional challenges in tackling this problem. 12 STRATEGIC PRIORITIES The way forward for mental health and substance use primarily lies in the appropriate and effective implementation of the already approved WHO Mental Health Action Plan 2013–2020 and the global strategy to reduce the harmful use of alcohol. Concerning other drug use, the 2016 United Nations special session devoted to the world drug problem is expected to provide the strategic direction and actions for the years to come. While investment in mental health research has grown over the last five years, in making the case for mental health with regard to sustainable development, it is necessary to undertake more nuanced research and analyses of the relationship between mental health, poverty and inequality leading to the development of what has been referred to as the “political economy of mental health”. The effects of poverty on mental health in settings of particular inequality need to be studied, and the impact of poverty alleviation strategies on mental health better understood. 43 The WHO Mental Health Action Plan 2013–2020 has the following objectives and targets: • To strengthen effective leadership and governance for mental health: --Target: 80% of countries will have developed or updated their policies/plans for mental health in line with international and regional human rights instruments (by 2020). --Target: 50% of countries will have developed or updated their laws for mental health in line with international and regional human rights instruments (by 2020). MENTAL HEALTH AND SUBSTANCE USE 159
Page 1:
from M I L L E N N I U M DEVELOPMEN
Page 4 and 5:
WHO Library Cataloguing-in-Publicat
Page 6 and 7:
CONTENTS vii Abbreviations 1 1 From
Page 8 and 9:
7 153 Mental health and substance u
Page 10 and 11:
IHR IPCC ITN LLIN MCV MDG MDR TB mh
Page 13 and 14:
SUMMARY This report aims to describ
Page 15 and 16:
sourced development finance. 11 The
Page 17 and 18:
Despite their overall success, the
Page 19 and 20:
The 13 targets that underpin the br
Page 21 and 22:
Box 1.1 Life expectancy improvement
Page 23:
40 Advanced research on European he
Page 27 and 28:
SUMMARY The SDGs position health as
Page 29 and 30:
Figure 2.2 Trends in fertility by r
Page 31 and 32:
Ageing Populations around the world
Page 33 and 34:
The recent influx of refugees into
Page 35 and 36:
and implementing policies and progr
Page 37 and 38:
that dialogue is to demonstrate an
Page 39 and 40:
One of the challenges we face as we
Page 41 and 42:
Most recently, the right to health
Page 43 and 44:
2100 Figure 2.15 Global average sur
Page 45 and 46:
Figure 2.17 Proportion of health fa
Page 47 and 48:
42 World development report 2014: r
Page 49:
3 UNIVERSAL HEALTH COVERAGE
Page 52 and 53:
UHC is coverage that provides peopl
Page 54 and 55:
Figure 3.4 Per capita government he
Page 56 and 57:
living in poverty, are pushed furth
Page 58 and 59:
integration of all SDG health targe
Page 60 and 61:
GOVERNANCE Governance in the health
Page 62 and 63:
HEALTH FINANCING A country’s heal
Page 64 and 65:
HEALTH WORKFORCE Health systems and
Page 66 and 67:
MEDICAL PRODUCTS Access to quality
Page 68 and 69:
HEALTH INFORMATION Health informati
Page 70 and 71:
SERVICE DELIVERY In order to achiev
Page 72 and 73:
RESEARCH FOR UHC Research evidence
Page 74 and 75:
NOTES AND REFERENCES 1 World health
Page 76 and 77:
89 Implementing the Commission on I
Page 78 and 79:
173 Labrique A, Vasudevan L, Chang
Page 81 and 82:
SUMMARY Deaths among pregnant women
Page 83 and 84:
Figure 4.3 MDG and SDG targets rela
Page 85 and 86:
have declined from 25% to 14% betwe
Page 87 and 88:
Chapter 5). As noted above, there h
Page 89 and 90:
Figure 4.8 Wealth-related inequalit
Page 91 and 92:
young children. 61 Specific indicat
Page 93 and 94:
CHALLENGES Access to skilled care a
Page 95 and 96:
CHALLENGES Scaling up effective int
Page 97 and 98:
CHALLENGES Leaving no country behin
Page 99 and 100:
CHALLENGES Endemic countries: Polio
Page 101 and 102:
Figure 4.22 Prevalence of stunting
Page 103 and 104:
CHALLENGES Spurring action in count
Page 105 and 106:
CHALLENGES Ending child marriage: D
Page 107 and 108:
43 Financing global health 2014: sh
Page 109:
5 INFECTIOUS DISEASES
Page 112 and 113:
Infectious and parasitic diseases a
Page 114 and 115:
Figure 5.4 Global number of deaths
Page 116 and 117:
International TB funding increased
Page 118 and 119: Improving quality of care: The qual
Page 120 and 121: Table 5.1 Summary of specific targe
Page 122 and 123: HIV/AIDS More than 30 years since t
Page 124 and 125: TUBERCULOSIS TB is a treatable and
Page 126 and 127: MALARIA Almost half the world’s p
Page 128 and 129: NEGLECTED TROPICAL DISEASES NTDs 89
Page 130 and 131: HEPATITIS Viral hepatitis is caused
Page 132 and 133: WATERBORNE DISEASES Waterborne dise
Page 134 and 135: CHOLERA Cholera is an acute diarrho
Page 136 and 137: SEXUALLY TRANSMITTED INFECTIONS STI
Page 138 and 139: NOTES AND REFERENCES 1 Global Healt
Page 140 and 141: 84 Dye C, Maher D, Weil D, Espinal
Page 143 and 144: SUMMARY NCDs are included as a spec
Page 145 and 146: Figure 6.2 Probability of death fro
Page 147 and 148: as task sharing using community hea
Page 149 and 150: The stated aim of the strategy is p
Page 151 and 152: CHALLENGES Despite declines in mort
Page 153 and 154: CHALLENGES Lack of access to effect
Page 155 and 156: CHALLENGES Diabetes is an increasin
Page 157 and 158: CHALLENGES Increasing use in some r
Page 159 and 160: CHALLENGES Air pollution remains a
Page 161 and 162: 40 From burden to “best buys”:
Page 163: 7 MENTAL HEALTH AND SUBSTANCE USE
Page 166 and 167: Mental disorders, including dementi
Page 170 and 171: • To provide comprehensive, integ
Page 172 and 173: DEPRESSION AND SUICIDE Mental disor
Page 174 and 175: DEMENTIA The world’s population i
Page 176 and 177: SUBSTANCE USE AND SUBSTANCE USE DIS
Page 178 and 179: NOTES AND REFERENCES 1 Global Healt
Page 181: 8 INJURIES AND VIOLENCE
Page 184 and 185: Injuries, whether sustained acciden
Page 186 and 187: due to limited data. However, the s
Page 188 and 189: aiming to stop the predicted increa
Page 190 and 191: ROAD TRAFFIC INJURIES Every year, a
Page 192 and 193: VIOLENCE AND HOMICIDE There were an
Page 194 and 195: WAR AND CONFLICT In 2012, an estima
Page 196 and 197: DISASTERS Disasters are often assoc
Page 198 and 199: NOTES AND REFERENCES 1 Global repor
Page 201 and 202: SUMMARY In September 2015, heads of
Page 203 and 204: A 10-page declaration precedes the
Page 205 and 206: THE PLACE OF HEALTH IN THE SDGs 1 H
Page 207 and 208: that health systems providing integ
Page 209 and 210: FOLLOW-UP AND REVIEW 9 Monitoring t
Page 211 and 212: NOTES AND REFERENCES 1 Transforming
Page 213 and 214: WHO South-East Asia Region: Banglad
Page 216: ISBN 978 92 4 156511 0
show all

from to

Create successful ePaper yourself

Delete template?

Save as template?