Addressing the burden of mental, neurological, and substance use disorders: key messages from Disease Control Priorities, 3rd edition

Abstract

The burden of mental, neurological, and substance use (MNS) disorders increased by 41% between 1990 and 2010 and now accounts for one in every 10 lost years of health globally. This sobering statistic does not take into account the substantial excess mortality associated with these disorders or the social and economic consequences of MNS disorders on affected persons, their caregivers, and society. A wide variety of effective interventions, including drugs, psychological treatments, and social interventions, can prevent and treat MNS disorders. At the population-level platform of service delivery, best practices include legislative measures to restrict access to means of self-harm or suicide and to reduce the availability of and demand for alcohol. At the community-level platform, best practices include life-skills training in schools to build social and emotional competencies. At the health-care-level platform, we identify three delivery channels. Two of these delivery channels are especially relevant from a public health perspective: self-management (eg, web-based psychological therapy for depression and anxiety disorders) and primary care and community outreach (eg, non-specialist health worker delivering psychological and pharmacological management of selected disorders). The third delivery channel, hospital care, which includes specialist services for MNS disorders and first-level hospitals providing other types of services (such as general medicine, HIV, or paediatric care), play an important part for a smaller proportion of cases with severe, refractory, or emergency presentations and for the integration of mental health care in other health-care channels, respectively. The costs of providing a significantly scaled up package of specified cost-effective interventions for prioritised MNS disorders in low-income and lower-middle-income countries is estimated at US$3-4 per head of population per year. Since a substantial proportion of MNS disorders run a chronic and disabling course and adversely affect household welfare, intervention costs should largely be met by government through increased resource allocation and financial protection measures (rather than leaving households to pay out-of-pocket). Moreover, a policy of moving towards universal public finance can also be expected to lead to a far more equitable allocation of public health resources across income groups. Despite this evidence, less than 1% of development assistance for health and government spending on health in low-income and middle-income countries is allocated to the care of people with these disorders. Achieving the health gains associated with prioritised interventions will require not just financial resources, but committed and sustained efforts to address a range of other barriers (such as paucity of human resources, weak governance, and stigma). Ultimately, the goal is to massively increase opportunities for people with MNS disorders to access services without the prospect of discrimination or impoverishment and with the hope of atta...

Global Mental Health and systems of diagnostic classification: clinical and cultural perspectives

“…To this, the fact that less than 1% of public budgets in LMICs are devoted to assistance and development of mental health (and neurological) services, adds ingredients of confusion and despondency. Worse yet, such funds are destined mostly to the small percent of chronic, long-term hospitalized mental patients than to acute cases or the growing younger populations, much less to the implementation of mental health prevention programs (45). The global panorama of mental health is not too encouraging.…”

“…In such context, the future of services provision would require the use of three types of platforms as suggested by Patel et al (45). The first, at the general population level, must be mostly based on legislative measures of, for instance, restriction of the access to self-harm or suicide tools or weapons, and reduction of availability and access to alcohol and drugs.…”

The problem of patient-centred outcome measurement in psychiatry: why metrology hasn’t mattered and why it should

“…One in four people will experience a mental disorder at some point in their lives and 450 million people currently suffer from mental health challenges [1][2][3]. As a result, mental illness is the leading cause of ill-health and disability worldwide [2].…”

Sociodemographic and clinical factors associated with dual disorders in a psychiatric hospital

“…The dual disorders approach is complex and represents a major challenge as regards both diagnosis and pharmacological and psychotherapeutic treatment (Patel et al, 2015). It is therefore necessary to describe the association between the two pathologies in the methods used to treat mental illness in order to explain the associated factors and thereby improve the care of this type of patients.…”