University of Nairobi/Africa Mental Health Foundation, Department of Psychiatry, Nairobi, Kenya
Mental health (MH) disorders account for nearly 10% of the global burden of disease, contributing significantly to disability-adjusted life years (DALYs) as reported by the WHO and Global Burden of Disease 2010 study. Challenges related to addressing prevention and treatment of mental disorders and promotion of MH are similar. “Global influences” on MH such as conflict, climate change or macroeconomic policies demand a global perspective. A central focus of global mental health (GMH) is to reduce the overall burden of illness and disability and to reduce/ eliminate inequities within and between countries. The responsibilities for GMH players span beyond national borders, class, race, gender, ethnicity or culture and collective action based on global partnerships required. Similarities between HICs and LMICs: Epidemiological data strongly suggests that all types of mental disorders exist across both High Income Countries (HICs) and LMICs and need for services is essentially similar. Access to MH services is not universal in both HICs and LMICs although unmet needs are worse in LMICs (35% versus 80% respectively). MH literacy in HICs is still sub-optimal although this is worse in LMICs. Emerging epigenetics suggest complex interaction between genetics and the environment in the development and course of mental disorders, whether dealing with either HICs or LMICs. Differences between HICS AND LMICS: A larger treatment gap exists in LMICs (80%). There is poor/limited allocation of financial resources for MH. LMICs are home to >80% of the global population but command <20% of MH resources. Most of these meager resources are spent on ineffective and often inhumane practices due to lack of effective culturally competent evidence-based interventions. Widespread stigmatization, violation of human rights and social exclusion of people with mental illness is common. Human resources are inadequate and inequitably distributed. Early studies integrating MH in primary care have effectively reduced the treatment gap to 33% but scale-up of services is hampered by many barriers.