Asia Maselko and Kristen Shirey

09 October 2012

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MortalityDALYsYLDPrevalenceFoot-print

Cost of careLoss of productivity Loss of income Family, community, and country costs

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Disease %

Ischemic heart disease 13.4

Cerebrovascular disease

9.5

Lower respiratory infections

6.4

HIV/AIDS 4.2

COPD 4.2

Diarrhoeal diseases 4.1

Perinatal conditions 4.0

Tuberculosis 2.8

Lung cancer 2.3

Road traffic accidents 2.2WHO, 2002

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Disease %

Lower respiratory infections

6.7

HIV/AIDS 6.2

Perinatal conditions 6.2

Diarrhoeal diseases 5.0

Depression 4.1

Ischaemic heart disease

4.1

Cerebrovascular disease

3.5

Malaria 3.1

Road traffic accidents 2.8

COPD 2.7WHO, 20024

WHO, 20025

BMJ 2002;325:947

Disease %

Depression 10.7

Iron-deficiency anaemia 4.7

Falls 4.6

Alcohol use 3.3

Chronic Obstructive Pulmonary Disease

3.1

Bipolar disorder 3.0

Congenital anomalies 2.9

Osteoarthritis 2.8

Schizophrenia 2.6

Obsessive-compulsive disorder

2.2

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WHO Mental Health Survey Initiative26 countries (6 are classified as less-developed*)100,000+ respondents

Results12-month prevalence of any disorder 4.3-26.4%12-month prevalence of moderate-severe disorder

1-16%Leading spectrum disorders

Anxiety (2.4-18.2%)Mood (0.8-9.6%)Substance use (0.1-6.4%)

Challenges?

* Mexico, Colombia, Nigeria, Lebanon, China, Ukraine 7

15% of those with mental illness in low-income countries receive the treatment they need

54% of those with mental illness in high-income countries receive the treatment they need

The gap is large, but is treatment good anywhere?

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Mental Health Gap Action Programme (mhGAP)Aims at scaling up services for mental,

neurological and substance use disorders for countries especially with low- and middle-income. The programme asserts that with proper care, psychosocial assistance and medication, tens of millions could be treated for depression, schizophrenia, and epilepsy, prevented from suicide and begin to lead normal lives– even where resources are scarce.

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In addition to recommendations for policy, infrastructure development, and financing, published implementation/treatment guide for primary care providers in resource-limited settings

Guide is 121 pages, includes modules on treatment of the eight priority conditions as well as bipolar disorder and other significant emotional or medically unexplained complaints

Each module provides basic algorithms for feasible assessment and treatment of the conditions… example:

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WHO identified 8 priority mental, neurological, and substance use conditions:DepressionSchizophrenia and other psychotic disordersSuicideEpilepsyDementiaDisorders due to alcohol useDisorders due to illicit drug useMental disorders in children

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Video

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