1 Mental Health: Global and Regional perspective Dr. Jorge Rodriguez No Health without Mental Health

Burden of Mental Disorders (Global Burden of Disease, 2006) 13.5 % of the Global Burden of Disease (GBD) measured in Disability Adjusted Life Years (DALYS) is due to mental, neurological and substance use disorders (DALYS = years lost to early death + years lost due to disability) 2

Latin America and the Caribbean Percent Total DALYs, 2006

(WHO World Mental Health Consortium) Gap in treatment: Serious cases receiving no treatment during the last 12 months Developed countriesDeveloping countries Lower rangeUpper rangeLower rangeUpper range 35% 50% 76% 85%

Leading Causes of Mortality and Burden of Disease world, 2006 % 1.Ischaemic heart disease Cerebrovascular disease Lower respiratory infections COPD Diarrhoeal diseases HIV/AIDS Tuberculosis Trachea, bronchus, lung cancers Road traffic accidents Prematurity, low birth weight 2.0 % 1.Lower respiratory infections Diarrhoeal diseases Depression4.3 4.Ischaemic heart disease HIV/AIDS3.8 6.Cerebrovascular disease Prematurity, low birth weight Birth asphyxia, birth trauma Road traffic accidents Neonatal infections and other 2.7 MortalityDALYs

World1HIV/AIDS 2Depression 3Ischaemic heart dis. High-income countries1 Depression 2 Ischaemic heart disease 3 Alzheimer Middle-income countries1 HIV/AIDS 2 Depression 3 Cerebrovascular Low-income countries1 HIV/AIDS 2 Perinatal 3 Depression 2030 rankings: The leading causes of DALYs

Financing: mental health from total health budget

% of Mental Health Budget dedicated to Mental Hospitals (Atlas 2011)

MH budget and its used by psychiatric hospitals 9

Financing: Spending per capita

Human Resources for Mental Health Care per population Rate of professionals per 100,000 population

Distribution of psychiatric beds

13 Number of psychiatric beds per 10,000 population ATLAS WHO 2011 RegionNumber Africa0.6 America2.6 Europe7.1 World3.2 Proportion of psychiatrist beds in different settings Settings% Mental Hospitals45 General Hospitals21 Other33

Distribución de camas psiquiátricas en diferentes tipos de dispositivos Regiones del Mundo / Atlas 2011

Plans, legislation and services Problems / Region of Americas / Response of Health Sector (ATLAS WHO 2011 / AIMS 2011) 65.6% of the countries in the Region have a national mental health plan; 74% approved or Revised these plans in 2005 or later. 56.3% of the countries in the Region have legislation on mental health; but, in many cases, these laws are incomplete, scattered, and do not meet international standards. There is a median of 2.6 psychiatric beds per 10,000 population; an assessment of their distribution found that 45% are in psychiatric hospitals. The indicators for mental health human resources lag far behind those of high-income countries and are inequitably distributed. The psychoactive drugs are not within the reach of most of the population. Countries have major limitations in their information systems regarding mental health, such that we can also speak of an information gap. The PHC team is not prepared to handle mental health problems. MH programs and services for children and adolescent are very limited. There are few actions in mental health promotion and prevention. Mental health research is poor or nonexistent. The mental health protection of the vulnerable populations is not a priority of the services and programs.

Mobilizing a global response: Setting the agenda Helsinki Brasilia mhGAP country implementation

Mental Health Gap Action Programme Scaling up care

3% 13% 0% 5% 10% 15% Budget Burden Burden/budget gap to be reduced

Mental health services organized rationally Mental health services through primary health care Community mental health services Psychiatric services in General Hospitals Mental Hospitals & Specialist Services High Cost Low Self-care Informal community care Frequency of need

Child and Adolesce nt Mental Disorders Depressio n Developm ental disorders Behaviou ral disorders

mhGAP Intervention Guide Launched on 7th of October 2010 Based on systemtic review of evidence of effective treatments for priority conditions For use by non-specialized health providers in low resource settings Includes both pharmacological and psychosocial interventions

Carga versus respuesta Ante la carga muy significativa que representan los trastornos mentales, aún la respuesta de los programas y servicios es insuficiente. Se evidencia: 1) persistencia, en gran medida, del modelo hospitalario asilar; y 2) pobre desarrollo de un modelo comunitario, descentralizado, integrado a la red de servicios y basado en la APS.

El modelo comunitario 1.La atención de salud mental se debe proporcionar mediante los servicios de salud general y en entornos comunitarios. Las grandes instituciones psiquiátricas centralizadas deben ser reemplazadas. 2.El modelo comunitario integra los servicios de SM en la atención general de salud y en otros ámbitos externos (por ejemplo, los de educación, vivienda, empleo, justicia y bienestar social). 3.La combinación óptima de los servicios de salud mental por niveles de atención hace hincapié en la atención comunitaria y destaca los nexos necesarios entre los diferentes niveles. 4.Podemos entrenar al personal de APS para atender apropiadamente una amplia franja de problemas relacionados con la SM. Se requiere un buen sistema de referencia, de manera que los espcialistas puedan ser consultados cuando sea necesario.

Brasil: Centros de Atención Psicosocial (CAPS Los CAPS constituyen recursos novedosos en la atención de salud mental, por medio de servicios de puertas abiertas y atención clínica y actividades diarias para personas con trastornos mentales, se evitan las internaciones innecesarias y el aislamiento social en los hospitales psiquiátricos. Los CAPS se articulan con la APS, con el sistema de urgencia y con otras instituciones para fortalecer los vínculos sociales de los usuarios en sus barrios. Desde fines del año 2010, los CAPS están presentes en 1,118 ciudades del Brasil, con 1,620 unidades, dando así cobertura a 60% de la población. Esto se compara favorablemente con el año 2001, cuando se promulgó la Ley de Reforma Psiquiátrica. En ese año el país contaba con 295 servicios y una cobertura de 21% de la población.

Brasil: # de CAPS

Cuba: red de centros comunitarios de salud mental

29

2010

Mental Health Draft Mental Health Action Plan An Overview

" Global burden of mental disorders and the need for a comprehensive, coordinated response from health and social sectors at the country level" World Health Assembly WHA 65.4 (25 May 2012) WHA 65.4 requests the Director-General: To strengthen advocacy, and develop a comprehensive mental health action plan… Resolution on Mental Health (2012)

Process for developing the action plan Background paper on vulnerabilities and risks- June 2012 Working paper on the mental health action plan- July 2012 Regional technical consultations on Working paper/Zero draft action plan April – SEARO July - EMRO August - AFRO September - EURO October- PAHO Web consultation with all stakeholders – 27 th August to 19th October 2012 Discussion in Regional Committees Face to face consultation with all stakeholders in Geneva on World Mental Health Day on 10 th October 2012 Informal Consultation with Member States (Geneva) 2 nd November 2012 Submission – 12 th November 2012

Draft Mental Health Action Plan Structure and Contents Introduction Global situation Determinants and consequences of mental disorder Health system resources and responses Vision and Cross cutting principles Goal and Time frame Objectives Actions for member states and secretariat (by objective) Actions by international and national partners Appendix 1: links to other global and regional action plans and strategies Appendix 2: conceptual overview of global mental health action plan Appendix 3: options for the implementation of the global mental health action plan (by objective)

Vision A world in which mental health is valued, mental disorders are effectively prevented and in which persons affected by these disorders are able to access evidence-based health and social care and exercise the full range of human rights to attain the highest possible level of health and functioning free from stigma and discrimination.

Cross-cutting principles Universal access and equity Human rights Evidence-based practice Life course approach Multisectoral approach Empowerment of persons with mental disorders

Goal The overall goal of the Global Mental Health Action Plan is to promote mental well-being, prevent mental disorders, and reduce the mortality and disability for persons with mental disorders.

Objectives 1.To strengthen effective leadership and governance for mental health 2.To provide comprehensive, integrated and responsive mental health and social care services in community-based settings 3.To implement strategies for mental health promotion and protection, including actions to prevent mental disorders and suicides 4.To strengthen information systems, evidence and research for mental health

Actions Example: Resource planning Member states Allocate a budget that is commensurate with identified human and other resources needed to implement agreed mental health plans and actions. WHO Offer technical assistance to countries in resource planning, tracking and budgeting for mental health.

Actions Example: Human resource development: Member states Build and sustain human resource capacity to deliver mental health and social care services, especially in non-specialized care settings. WHO Support countries in the formulation of a human resource strategy for mental health, including the specification of gaps and needs, training requirements and core competencies.

Actions Example: Suicide prevention Member states Develop suicide prevention programmes, with special attention to young people. WHO Provide technical support to countries in strengthening their suicide prevention programmes with special attention to young people.

Actions Example: Information systems Member states Identify, collate, routinely report and use core mental health indicators (including on completed and attempted suicides). WHO Provide guidance and technical assistance on surveillance/information systems to capture information on core mental health indicators, and augment the WHO global health observatory by establishing baseline data for and monitoring of the global mental health situation (including progress on reaching the targets laid out in this action plan).

Targets Examples 80% of countries will have updated their mental health policies and laws (within the last 10 years) by year The number of beds used for long-term stays in mental hospitals will decrease by 20% by year 2020, with a corresponding increase in the availability of places for community-based residential care and supported housing Rates of suicide in countries will be reduced by year % of countries will be collecting and reporting at least a core set of mental health indicators annually by year 2020

" Some 350 million people of all ages, incomes and nationalities suffer from depression. Millions more - family, friends, co-workers - are exposed to the indirect effects of this under-appreciated global health crisis." "On World Mental Health Day, let us pledge to talk more openly about depression. This is the first critical step to removing one of the barriers to treatment and helping to reduce the disability and distress caused by this global crisis." United Nations Secretary-General Message on World Mental Health Day 10 October 2012

45 Gracias Merci Obrigada Thanks Working for the right of health in the Americas! Gracias Thanks!