whr 2001 final-part i

8/7/2019 WHR 2001 FINAL-Part I

1/74

W

O

R

L

D

H

E

A

L

TH

R

E

P

OR

T

20

01

Department of Mental Health and Substance Dependence, WHO Geneva 1

F

O

C

U

S

New understandingSubstantial burden

Effective careImproving policies

Reducing stigma

Multi-sector approach

Increasing research

2001


2/74

W

O

R

L

D

H

E

A

L

TH

R

E

P

OR

T

20

01


O

B

J

E

C

T

I

V

E

S

2001

raise awareness of the real burden of mentaldisorders and their costs in human, social andeconomic terms.

help dismantle the barriers - particularly ofstigma, discrimination, and inadequate services

- which prevent millions of people fromreceiving treatment.


3/74

W

O

R

L

D

H

E

A

L

TH

R

E

P

OR

T

20

01


core actions to be immediately undertakento improve the mental health situation incountries.

describes how these actions arecompatible with the reality of individual

country development.

R

E

CO

M

M

E

N

D

A

T

IO

N

S

2001


4/74

W

O

R

L

D

H

E

A

L

TH

R

E

P

OR

T

20

01


Message of the Director-General

Overview

A public health approach to mental health Burden of mental and behavioural disorders

Solving mental health problems

Mental health policy and service provision

The way forward

T

A

B

LE

O

F

C

O

N

TE

N

T

S

2001


5/74

W

O

R

L

D

H

E

A

L

TH

R

E

P

OR

T

20

01


Defining mental health

Different meaning in various cultures

Includes subjective well-being,self-efficacy, autonomy, competence,self-actualization

Broader than absence of mental disorders

CH

A

P

T

E

R

O

N

E

2001


6/74

W

O

R

L

D

H

E

A

L

TH

R

E

P

OR

T

20

01


Combination of abnormal thoughts,emotions, behaviour, and

relationships with others.

Defining mental disorders CHA

P

T

E

R

O

N

E

2001


7/74

W

O

R

L

D

H

E

A

L

TH

R

E

P

OR

T

20

01


Driven by:

advances in neuroscience

advances in behavioural medicine

New Understanding ofMental Health

CH

A

P

T

E

R

O

N

E

2001


8/74

W

O

R

L

D

H

E

A

L

TH

R

E

P

OR

T

20

01


Prenatally and throughout life, genes andenvironment are involved in a series ofinteractions.

Throughout life, every act of learning physicallychanges the brain.

Advances in Neuroscience:Key Findings

CH

A

P

T

E

R

O

N

E

2001


9/74

W

O

R

L

D

H

E

A

L

TH

R

E

P

OR

T

20

01


Changing Understanding of the Brain

Fig1.2

CH

A

P

T

E

R

O

N

E

2001


10/74

W

O

R

L

D

H

E

A

L

TH

R

E

P

OR

T

20

01


Integration ofneuroimaging and

neurophysiology with molecular biologywill lead to greater understanding of normal

and abnormal mental functions,

and more effective treatments.

CH

A

P

T

E

R

O

N

E

2001


11/74

W

O

R

L

D

H

E

A

L

TH

R

E

P

OR

T

20

01


Fundamental connection betweenmental and physical health:

thought, feelings and behaviour influence

physical illnesses physical health status influences mental

health and well-being

Advances in Behavioural Medicine:Key Findings

CH

A

P

T

E

R

O

N

E

2001


12/74

W

O

R

L

D

H

E

A

L

TH

R

E

P

OR

T

20

01


Psychological factors influencephysical illnesses

examples:

Women with breast cancer whoreceive supportive group therapylive longer.

Depression predicts the incidenceand outcome of heart disease.

CH

A

P

T

E

R

O

N

E

2001


13/74

W

O

R

L

D

H

E

A

L

TH

R

E

P

OR

T

20

01


Mental health is crucial to the overall well-being of

individuals, societies and countries.

New UnderstandingMental Health

CH

A

P

T

E

R

O

N

E

2001


14/74

W

O

R

L

D

H

E

A

L

TH

R

E

P

OR

T

20

01


New UnderstandingMental Disorders

influenced by a combination of biological,

psychological, and social factors

have a physical basis in the brain

can be treated effectively

CH

A

P

T

E

R

O

N

E

Sufferers have new hope of living full and productive lives.Sufferers have new hope of living full and productive lives.

2001


15/74

W

O

R

L

D

H

E

A

L

TH

R

E

P

OR

T

20

01


Old Thinking: Genetics versus Environment

New thinking:

Genetics plus environment

CH

A

P

T

E

R

O

N

E

New UnderstandingMental Disorders

2001


16/74

W

O

R

L

D

H

E

A

L

TH

R

E

P

OR

T

20

01


Continuum of depressivesymptoms in the populationCH

A

P

T

E

R

O

N

E

Fig1.3

2001


17/74

W

O

R

L

D

H

E

A

L

TH

R

E

P

OR

T

20

01


Development of mental disorders - interaction ofbiological, psychological and social factors

Biologicalfactors

Psychologicalfactors

Mental andbehaviouraldisorders

Social factors

C

H

A

P

TE

R

ON

EFig.1.1

2001


18/74

W

O

R

L

D

H

E

A

L

TH

R

E

P

OR

T

20

01


Biopsychosocial relationshipexamples:

Exposure to stress during early development is

associated with depression later in life.

Behaviour therapy/interpersonal therapy fordepression results in brain changes similar totreatment with medication.

Socio-economic status influences the onset andcourse of mental disorders.

CH

A

P

T

E

R

O

N

E

2001


19/74

W

O

R

L

D

H

E

A

L

TH

R

E

P

OR

T

20

01


We have at our disposal the

knowledge and powertosignificantly reduce the

burden of mental disorders,

world-wide.

CH

A

P

T

E

R

O

N

E

2001


20/74


21/74

W

O

R

L

D

H

E

A

L

TH

R

E

P

OR

T

20

01


Mental and behaviour disordersin children and adolescents

CH

A

P

T

E

R

T

W

O

T

able2.2

2001


22/74

W

O

R

L

D

H

E

A

L

TH

R

E

P

OR

T

20

01


Psychiatric disorders in primary health carehelp seekers

Table2.1

CH

A

P

T

E

R

T

W

O

2001


23/74

W

O

R

L

D

H

E

A

L

TH

R

E

P

OR

T

20

01


Burden of disease% attributed to mental and behavioural disordersof total DALYs lost world-wide

1990 10 %

2000 12.3 %

2020 (projected) 15 %

CH

A

P

T

E

R

T

W

O

2001


24/74


25/74

W

O

R

L

D

H

E

A

L

TH

R

E

P

OR

T

20

01


Leading causes of DALYsboth sexes, all ages

FromFig.2.2

CH

A

P

T

E

R

T

W

O

2001


26/74

W

O

R

L

D

H

E

A

L

TH

R

E

P

OR

T

20

01


Leading causes of DALYsmales, all ages

CH

A

P

T

E

R

T

W

OFromFig.2.2

2001


27/74

W

O

R

L

D

H

E

A

L

TH

R

E

P

OR

T

20

01


Leading causes of DALYsfemales, all agesCH

A

P

T

E

R

T

W

OFromFig.2.2

2001


28/74

W

O

R

L

D

H

E

A

L

TH

R

E

P

OR

T

20

01


Leading causes of DALYsboth sexes,15-44 yearsCH

A

P

T

E

R

T

W

OFromFig.2.2

2001


29/74

W

O

R

L

D

H

E

A

L

TH

R

E

P

OR

T

20

01


Leading causes of DALYsmales, 15-44 yearsCH

A

P

T

E

R

T

W

OFromFig.2.2

2001


30/74

W

O

R

L

D

H

E

A

L

TH

R

E

P

OR

T

20

01


Leading causes of DALYsfemales, 15-44 yearsCH

A

P

T

E

R

T

W

OFromFig.2.2

2001


31/74

W

O

R

L

D

H

E

A

L

TH

R

E

P

OR

T

20

01


DISABILITY Mental and neurological conditions account

for 30.8% of all years lived with disability

(YLD).

Depression causes the largest amount ofdisability(12%).

6 neuropsychiatric conditions figure in thetop 20 causes of disability.

CH

A

P

T

E

R

T

W

O

C

H

A

P

T

ER

T

WO

2001


32/74

W

O

R

L

D

H

E

A

L

TH

R

E

P

OR

T

20

01


Leading causes YLDsboth sexes, all ages

FromFig.2.3

CH

A

P

T

E

R

T

W

O

2001


33/74

W

O

R

L

D

H

E

A

L

TH

R

E

P

OR

T

20

01


Leading causes of YLDsmales, all ages CH

A

P

T

E

R

T

W

OFromFig.2.3

2001


34/74

W

O

R

L

DH

E

A

L

TH

R

E

P

OR

T

20

01


Leading causes of YLDsfemales, all ages CH

A

P

T

E

R

T

W

OFromFig.2.3

2001


35/74

W

O

R

L

DH

E

A

L

TH

R

E

P

OR

T

20

01


Leading causes of YLDsBoth sexes, 15-44 years

C

H

A

P

T

E

R

T

W

OFromFig.2.3

2001


36/74

W

O

R

L

DH

E

A

L

TH

R

E

P

OR

T

20

01


Leading causes of YLDsmales, 15-44 yearsC

H

A

P

T

E

R

T

W

OFromFig.2.3

2001


37/74

W

O

R

L

DH

E

A

L

TH

R

E

P

OR

T

20

01


Leading causes of YLDsfemales, 15-44 years

C

H

A

P

T

E

R

T

W

OFromFig.2.3

2001


38/74

W

O

R

L

DH

E

A

L

TH

R

E

P

OR

T

20

01


Economic impactof mental disordersexamples:

aggregate yearly cost in USA of $148 billion,

equal to 2.5% of gross national product

expenditure as proportion of all health servicecosts:

United Kingdom: 22%

Netherlands: 23%

C

H

A

P

T

E

R

T

W

O

2001


39/74

W

O

R

L

DH

E

A

L

TH

R

E

P

OR

T

20

01


Mental Disorders:Impact on Quality of Life (QOL)

substantial and sustained negative impact

QOL continues to be poor even after recoverydue to stigma and discrimination

QOL poorer for those living in institutions ascompared to those in community

C

H

A

P

T

E

R

T

W

O

2001


40/74

W

O

R

L

DH

E

A

L

TH

R

E

P

OR

T

20

01


Burden of caring Economic difficulties

Emotional stress

Disruption of household routine

Restriction of social activities

Poor physical health

Stigma and discrimination

C

H

A

P

T

E

R

T

W

O

2001


41/74

W

O

R

L

DH

E

A

L

TH

R

E

P

OR

T

20

01


DepressionBurden

fourth leading cause of burden among

all diseases (4.4% of total DALYs)

secondleading cause among15-44 year age group (8.6% of DALYs)

among women in 15-44 year age group, theamount reaches 10.6% of DALYs

C

H

A

P

T

E

R

T

W

O

2001


42/74

W

O

R

L

DH

E

A

L

TH

R

E

P

OR

T

20

01


SchizophreniaBurden

third most disablingcondition among15-44 years age group (YLDs)

about 10% of persons with schizophrenia die

by suicide

reduces life span by an average of 10 years

C

H

A

P

T

E

R

T

W

O

2001


43/74

W

O

R

L

DH

E

A

L

TH

R

E

P

OR

T

20

01


Epilepsy: Magnitude50 million people suffer world wide

40 million of the 50 million live in developing countries

C

H

A

P

T

E

R

T

W

O

So

urce:TheInternationalLeague

AgainstEpilepsy(ILAE)1999

2001


44/74

W

O

R

L

DH

E

A

L

TH

R

E

P

OR

T

20

01


Burden of Alcohol Use Disorders(DALYs)

All Ages and both sexes 1.3 %

All ages, males 2.1 %

15-44 year olds,both sexes 3.0 %

15-44 year olds,males 5.1 %

C

H

A

P

T

E

R

T

W

O

2001

W


45/74

W

O

R

L

DH

E

A

L

TH

R

E

P

OR

T

20

01


Suicide as a leading cause ofdeath in 15-34 year age group

Fig2.5

C

H

A

P

T

E

R

T

W

O

2001

W


46/74

W

O

R

L

DH

E

A

L

TH

R

E

P

OR

T

20

01


Suicide Rate

1996

15.1/100 000 population

Males: 24.0/100 000

Females: 6.8/100 000

C

H

A

P

T

E

R

T

W

O

2001

W


47/74

W

O

R

L

DH

E

A

L

TH

R

E

P

OR

T

20

01


Suicide Rates:wide variations

Mexico: 3.4/ 100 000 (1993-1995)

China: 14.0/100 000 (1996-1998)

Russian Federation: 34.0/100 000 (1996-1998)

C

H

A

P

T

E

R

T

W

O

2001

W


48/74

W

O

R

L

DH

E

A

L

TH

R

E

P

OR

T

20

01


Changes in suicide ratesin mega countries

Fig2.4

C

H

A

P

T

E

R

T

W

O

2001

W


49/74

W

O

R

L

DH

E

A

L

TH

R

E

P

OR

T

20

01


SUICIDE

Variations in suicide rates must beconsidered in the cultural context.

Epidemiological surveillance and

local research required to improvepreventive efforts.

C

H

A

P

T

E

R

T

W

O

2001

W


50/74

W

O

R

L

DH

E

A

L

TH

R

E

P

OR

T

20

01


Attempted suicide

10-20 times higher than the

number of completed suicides

C

H

A

P

T

E

R

T

W

O

2001

W


51/74

W

O

R

L

DH

E

A

L

TH

R

E

P

OR

T

20

01


DeterminantsGender:Women and mental health

at greater risk due to multiple roles

female to male ratio is 1.5 to 2: 1

greatest differences in adult life

C

H

A

P

T

E

R

T

W

O

2001

W


52/74

W

O

R

L

DH

E

A

L

TH

R

E

P

OR

T

20

01


DeterminantsDomestic violence and contemplation of suicide

Table 2.3

% of women who have ever thought of committing suicide(P


53/74

W

O

R

L

DH

E

A

L

TH

R

E

P

OR

T

20

01


DeterminantsDisaster and mental health

Between a third and half of the

population experiencing a disaster

suffer from significant mental distress.

C

H

A

P

T

E

R

T

W

O

2001

W


54/74

W

O

R

L

DH

E

A

L

TH

R

E

P

OR

T

20

01


DeterminantsVicious cycle of poverty and mental disorders

Fig.1.4

C

H

A

P

T

E

R

T

H

R

E

E

2001


55/74

W


56/74

W

O

R

L

DH

E

A

L

TH

R

E

P

OR

T

20

01


ComorbidityMental Disorders and Substance Dependence

In alcohol /drug services, 30-90% havea dual diagnosis.

In mental health services, up to 65%have alcohol and drug use disorders.

C

H

A

P

T

E

R

T

W

O

2001

W


57/74

W

O

R

L

DH

E

A

L

TH

R

E

P

OR

T

20

01


Solving Mental Health problemsthe shifting paradigm

Institutional care replaced by

community-based care largely due to: evidence that people can be

successfully treated in theircommunities

human rights movement

availability of improvedinterventions and treatments

C

H

A

P

T

E

R

T

H

R

E

E

2001

W


58/74

W

O

R

L

DH

E

A

L

TH

R

E

P

OR

T

20

01


The shifting paradigmkey mile stones

UN Principles for the protection of Personswith mental illness and the improvement ofmental health care in 1991

rights of ill individuals

WHO/PAHO Caracas Declaration in 1994

development of psychiatric care closelylinked with primary health care

C

H

A

P

T

E

R

T

H

R

E

E

2001

W


59/74

W

O

R

L

DH

E

A

L

TH

R

E

P

OR

T

20

01


Elements of effective careinclude

early diagnosis and treatment

pharmacological, psychological andpsychosocial interventions

prevention, treatment and rehabilitation

C

H

A

P

T

E

R

T

HR

E

E

2001

W


60/74

W

O

R

L

DH

E

A

L

TH

R

E

P

O

R

T

20

01


Community-based carebenefits services close to home

focus on disabilities as well as symptoms

focus on the individual

wide range of services

ambulatory rather than static services

partnership with carers

better quality of life for ill persons

prevents inappropriate admissions

C

H

A

P

T

E

R

T

HR

E

E

2001


61/74

W


62/74

W

O

R

L

DH

E

A

L

TH

R

E

P

O

R

T

20

01


Primary Prevention

comprises measures to intercept the

causes of a disease before they

involve the individual to avoid the

occurrence of the condition

C

H

A

P

T

E

R

T

HR

E

E

2001

W


63/74

W

O

R

L

DH

E

A

L

TH

R

E

P

O

R

T

20

01


Secondary PreventionTREATMENT

refers to measures to arrest a diseaseprocess already initiated, in order to

prevent further complications and

sequel, limit disability and prevent death

C

H

A

P

T

ER

T

HR

E

E

2001

W


64/74

O

R

L

DH

E

A

L

T

H

R

E

P

O

R

T

20

01


Tertiary PreventionREHABILITATION

involves measures aimed at disabled

individuals, restoring their previoussituation or maximising the use of theirremaining capacities.

comprises both interventions at the levelof the individual and modifications of theenvironment

C

H

A

P

T

ER

T

HR

E

E

2001

W


65/74

O

R

L

DH

E

A

L

T

H

R

E

P

O

R

T

20

01


Effectiveness of interventionsfor depression

Table 3.2

C

H

A

P

T

ER

T

HR

E

E

2001

W


66/74

O

R

L

DH

E

A

L

T

H

R

E

P

O

R

T

20

01


Effectiveness of interventionsfor schizophrenia

Table 3.3

C

H

A

P

T

ER

T

HR

E

E

2001

W


67/74

O

R

L

DH

E

A

L

T

H

R

E

P

O

R

T

20

01


Make psychotropic medicines available

Newer Psychotropic Medicines

The first generation psychotropic drugsfor the treatment of schizophrenia anddepression are as effective as newer

drugs, though the latter have decreasedside effects.

C

H

A

P

T

ER

T

HR

E

E

2001


68/74

W


69/74

O

R

L

D

H

E

A

L

T

H

R

E

P

O

R

T

20

01


Effectiveness of Treatmentfor Drug Dependence

reduces use by 40-60%

comparable to success rates fordiabetes, hypertension and asthma

(NIDA,2000)

C

H

A

P

T

ER

T

HR

E

E

2001

W


70/74

O

R

L

D

H

E

A

L

T

H

R

E

P

O

R

T

20

01


Depression

Up to 60% of patients recover

Substance Abuse

Up to 60% reduction in drug use

Epilepsy

Up to 73% of patients live free from seizures

Schizophrenia

Up to 77% of patients live without relapses

Effectiveness of Treatment

2001

C

H

A

P

T

ER

T

HR

E

EFro

mTa

2001

W


71/74

O

R

L

D

H

E

A

L

T

H

R

E

P

O

R

T

20

01


DeterminantsHIV/AIDSCo-morbidity with:

depression cognitive deficits

anxiety disorders

drug dependence and injection drug use

physical illnesses:TB,STIs,otherinfections

complicates course and adherence to treatment

C

H

A

P

T

ER

T

HR

E

E

2001

W


72/74

O

R

L

D

H

E

A

L

T

H

R

E

P

O

R

T

20

01


EFFECTIVESUICIDE PREVENTION

early recognition and treatment of depression,schizophrenia and alcohol dependence

training of general practitioners and primaryhealth care personnel

de-glamorising suicide

control of firearms and pesticides detoxification of domestic gases

life skills education in schools

C

H

A

P

T

ER

T

HR

E

E

2001

W


73/74

O

R

L

D

H

E

A

L

T

H

R

E

P

O

R

T

20

01


Needs of People with Mental Disorders

Figure3.1

C

H

A

P

T

ER

T

HR

E

E

2001


74/74

whr 2001 final-part i

Documents