Effective treatments for mental illness not being used, WHO says

The World Health Organization this week urged governments worldwide to tackle the heavy and growing burden of mental illness and neurological disease. Effective and affordable treatments exist for many conditions, but they are not being used, said the WHO in its latest annual report on global health assessment, World Health Report 2001.

Currently, psychiatric and neurological disorders account for nearly a third of the world's disability, measured in years lived with a disability. The burden is currently greatest in the industrialised countries, mainly because their populations are older, but as life expectancy in developing nations rises, these countries too are expected to see mental health problems become more prevalent. By 2020, depressive disorders are expected to be the second biggest cause of disease burden worldwide.

Yet many countries lack even the most basic treatment and care, said the WHO. The agency this week also released the first results of an initiative begun last year, Project Atlas, to map mental healthcare resources worldwide.

In sub-Saharan Africa, there is only one psychiatrist for every two million people and only 12000 psychiatric nurses for the entire regional population of 626 million. More than a quarter of countries have no separate budget for mental health in their overall health budget. Of those who do and who provided a breakdown to the WHO, about a third spend less than 1% of the health budget on mental disorders, and most of the rest spend less than 5%.

The WHO recommends that governments should integrate treatment for mental disorders into primary care, if necessary providing basic training for general practitioners, primary nurses, and, where appropriate, traditional healers.

Governments' lists of essential drugs should include antidepressants, antipsychotics, antiepileptics, and tranquillisers, many of which are affordable even in low income countries. Large care institutions should be replaced with properly resourcedcommunity care; the report suggests some options for financing these changes.

The report also calls on governments to launch public education campaigns to increase understanding of mental illness. They should also develop proper policies on mental health and update their legislation on the rights of mentally ill persons.

Benedetto Saraceno, the WHO's director of mental health and substance dependence, said last week that he was "optimistic" that health ministers were now grasping the urgency of the problem.

World Health Report 2001: New Understanding, New Hope is accessible at www.who.int/whr