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7/27/2019 Investigar en Salud Mental
1/36
INVESTING IN
MENTAL HEALTH:
E VIDENCE FOR ACTION
7/27/2019 Investigar en Salud Mental
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WHO Library Cataloguing-in-Publication Data
Investing in mental health: evidence or action.
1.Mental disorders economics. 2.Mental health
services economics. 3.Financial support. 4.
Health promotion economics. I.World Health
Organization.
ISBN 978 92 4 156461 8
(NLM classifcation: WM 30)
Wor Hah Oraizaio 2013
All rights reserved. Publications o the World
Health Organization are available on the WHO web
site (www.who.int) or can be purchased rom WHO
Press, World Health Organization, 20 Avenue
Appia, 1211 Geneva 27, Switzerland (tel.: +41 22
791 3264; ax: +41 22 791 4857;
e-mail: [email protected]).
Requests or permission to reproduce or translate
WHO publications whether or sale or or non-
commercial distribution should be addressed to
WHO Press through the WHO web site
(www.who.int/about/licensing/copyright_orm/en/index.html).
The designations employed and the presentation
o the material in this publication do not imply the
expression o any opinion whatsoever on the part
o the World Health Organization concerning the
legal status o any country, territory, city or area or
o its authorities, or concerning the delimitation o
its rontiers or boundaries. Dotted lines on maps
represent approximate border lines or which there
may not yet be ull agreement.
The mention o specifc companies or o cer tain
manuacturers products does not imply that they
are endorsed or recommended by the World
Health Organization in preerence to others o a
similar nature that are not mentioned. Errors and
omissions excepted, the names o proprietary
products are distinguished by initial capital letters.
All reasonable precautions have been taken by theWorld Health Organization to veriy the inormation
contained in this publication. However, the
published material is being distributed without
warranty o any kind, either expressed or implied.
The responsibi lity or the interpretation and use o
the material lies with the reader. In no event shall
the World Health Organization be liable or
damages arising rom its use.
Printed in Switzerland
AcknOWledgements
This report was prepared by Dan Chisholm,
working under the direction o Shekhar Saxena
(Department o Mental Health and Substance
Abuse, WHO). The eedback and comments on a
drat version o the report by WHO colleagues
(Natalie Drew, Devora Kestel, Matt Muijen,Sebastiana Nkomo, Nicole Valentine, Mark Van
Ommeren) and external experts (Pamela Collins,
Mary de Silva, Oye Gureje, Crick Lund, David
McDaid, Alredo Pemjean, Marc Suhrcke, Mark
Tomlinson, Harvey Whiteord) are very warmly
acknowledged.
Technical editing:
David Bramley (Switzerland)
Graphic design and layout:
Erica Lestad (Germany)
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INVESTING IN
MENTAL HEALTH:
EV IDENCE FOR ACTION
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2
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CONTENTS
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SuMMAry
What is mental health?
What is the value o mental health?How might dierent social values inluence investment in mental health?
What can governments do to improve population mental health?
Conclusion
What is the current state o investment?
What is the basis or renewed investment into mental hea lth systems?
Human rights protection
Public health and economic burden
Cost and cost-eectiveness
Equitable access and inancial protection (universal health coverage)
Conclusion
Mental health and social values
Mental health action and innovation
rEfErENCES
Appendix 1. Six perspectives on the value base or individual or
collective decision-making
Appendix 2. Market ai lures with respect to mental health and health care
Appendix 3. Identi ying interventions that are cost-e ective, aordable and easible
Appendix 4. Summary o evidence o e ectiveness or mhGAP prior ity condit ions
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4
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5
SuMMAry
Mental health and well-being are undamental to
our collective and individual ability as humans to
think, emote, interact with each other, earn a
living and enjoy lie. They directly underpin the
core human and social values o independence o
thought and action, happiness, riendship and
solidarity. On this bas is, the promotion, protection
and restoration o mental health can be regarded
as a vital concern o individuals, communities andsocieties throughout the world.
However, current reality presents a very di erent
picture. The ormation o individual and collective
mental capital especially in the earlier stages o
lie is being held back by a range o avoidable
risks to mental health, while individuals with
mental health problems are shunned,
discriminated against and denied basic rights,
including access to essential care. Accentuated
by low levels o service availability, the current
and projected burdens o mental disorders are o
signiicant concern not only or public health but
also or economic development and social
welare.
In this report, potential reasons or this apparent
contradiction between cherished human values
and observed socia l actions are explored with aview to better ormulating concrete steps that
governments and other stakeholders can take to
reshape social attitudes and public policy.
The repor t shows that a strong case can be
made or investing in mental health whether to
enhance individual and population health and
well-being, protect human rights, improve
economic e iciency, or move towards universal
health coverage. The report also identiies a
number o barriers that continue to inluence
collective values and decision-making including
negative cultural attitudes towards mental illnessand a predominant emphasis on the creation or
retention o wealth (rather than the promotion o
societal well-being).
In partnership with all relevant stakeholders,
governments have a lead role to play in reshaping
the debate about mental health, addressing
current barriers and shortcomings, and
responding to the escalating burden o mental
disorders. Key actions that would mark a
renewed commitment to promote, protect and
restore mental health include: better inormation,
awareness and education about mental health
and illness; improved health and social services
or persons with mental disorders; and enhanced
legal, social and inancial protection or persons,
amilies or communities adversely aected by
mental disorders.
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1. INTrOduCTION
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7
INVESTING IN MENTAL HEALTH: EVIDENCE FOR ACTION
Mental health or psychological well-being is an
integral part o an individuals capacity to lead
a ulilling lie, including the ability to orm and
maintain relationships, to study, work or pursue
leisure interests, and to make day-to-day
decisions about education, employment, housing
or other choices. Disturbances to a persons
mental well-being can adversely compromise
this capacity and the choices made, leading notonly to diminished unctioning at the individual
level but also to broader welare losses or the
household and society.
Adding up these losses within or across countries
results in some very large and disconcerting
numbers. For example, mental, neurological and
substance use disorders account or nine out o
the 20 leading causes o years lived with disability
worldwide (more than a quarter o all measured
disability) and 10% o the global burden o disease
(which includes deaths as well as disability) (1, 2).
A recent analysis by the World Economic Forum
estimated that the cumulative global impact o
mental disorders in terms o lost economic output
will amount to US$ 16 trillion over the next 20
years (3). Such an estimate marks mental health
out as ahighly signifcant concern not only
or public health but also or economicdevelopment and societal welare.
Yet this concern is not being appropriately
addressed or acted upon. Rather, the plight o
individuals suering rom mental health problems
is all too oten met with indierence or outright
prejudice by the communities and societies they
live in. This neglect is urther reected in the levels
o service provision or these vulnerable persons,
which are abysmally low in many par ts o the
world. Even among those with very serious mental
disorders such as schizophrenia, only one in 10
persons in low-income countries receives the
treatment and care they need (4).
While the extent o unmet need is daunting and the
challenges o scaling up services are many, it is
vital to recognize that there already exists a range
o preventive and treatment strategies that have
been shown to be sae, eective and aordable (5).
Thus it is not the case that lit tle or nothing can be
done. Rather, much can be done with existing
interventions, but to enable their eective
deployment will require a major change in socialattitudes and public policy. That is why this report
in support o WHOs Comprehensive Mental
Health Action Plan 20132020 (6) calls or
renewed public policy commitment to promote,
protect and restore the mental health o
populations.
This repor t is an update o an earlier WHO repor t
that also carried the title Investing in mental health
(7), but it now incorporates new evidence and
additional arguments. As in the earlier report,
the primary aim is to provide national and
international policy-makers, decision-makers
and unding agencies with a synthesis o
the arguments that have been and can be
advanced in support o renewed action and
investment.
Specifcally, the report sets out:
to present key reasons or investing in mental
health rom a range o perspectives, including
public health, economic welare and social
equity (the conceptual case or investment);
to highlight priorities or investment in mental
health (the evidence-based case or investment).
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2. MENTAL HEALTH
ANd SOCIAL VALuES:THE CONCEpTuAL CASE fOr INVESTMENT
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9
INVESTING IN MENTAL HEALTH: EVIDENCE FOR ACTION
What is mental health?
Mental health is an indispensable par t o health,
and has been defned by WHO as a state o well-
being in which every individual realizes his or her
own potential, can cope with the normal stresses
o lie, can work productively and ruit ully, and is
able to make a contribution to her or his
community (8).
Mental illness, on the other hand, reers to
suering, disability or morbidity due to mental,
neurological and substance use disorders, which
can arise due to the genetic, biological and
psychological make-up o individuals as well as
adverse social conditions and environmental
actors.
Investing in mental health relates both to the
promotion and protection o mental health and to
the prevention and treatment o mental illness or
disorders.
What is the value of
mental health?
The impor tance o good mental health to individualunctioning and well-being can be amply
demonstrated by reerence to values that are
undamental to the human condition (9, 10). The
ollowing values are particularly important:
Independent thought and actIon:
The capacity o individuals to manage their
thoughts, eelings and behaviour, as well as their
interactions with others, is a pivotal element o the
human condition. Unsurprisingly, health states or
conditions that rob individuals o independent
thought and action such as acute psychosis,
advanced stages o dementia or proound
intellectual disability are regarded as among the
most disabling.
pleasure, happIness and lIe
satIsactIon:
There is a longstanding and recently
re-emphasized argument that happiness
represents the ultimate goal in lie and is the truest
measure o well-being (11). Again, it is difcult, i
not impossible, or a person to ourish and eel
ulflled in lie when he or she is beset, whether
temporarily or permanently, by health problemssuch as depression and anxiety.
amIly rel atIons, rIendshIp and
socIal InteractIon:
Individuals sel-identity and capacity to ourish is
deeply inuenced by their social surroundings,
including the opportunity to orm relationships and
engage with those around them (amily members,
riends, colleagues). Loneliness, social isolation
and difculties with communication all heighten
the risk o developing or prolonging mental illness.
It is in everyones interest to nurture and uphold
these core human values, particularly in the
ormative stages o lie. Since a basic tenet o a
civil society is the provision o mutual support to
the vulnerable and those in need, there is also a
strong value basis or protecting, supporting and
rehabilitating those unortunate enough tosuccumb to mental illness.
A urther social value is the respect with which
dierent people, ideas or customs are accorded
and treated. Discrimination, abuse and
incarceration o the mentally ill all too common in
countries throughout the world y in the ace o
the cherished civic values o social solidarity,
security and tolerance.
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10
world health organization
hoW might differentsocial values influenceinvestment in mentalhealth?
Although the atta inment and preservation o good
mental health corresponds well to the core human
and social values described above, individual and
collective choices or decisions are inuenced by arange o other actors or values too. For example,
individuals may be prepared to do risky or stressul
work in order to increase their income, or
governments may prioritize security or economic
growth over improvements in public health.
Table 1 shows the primary concerns and values
that underpin a range o perspectives on how
social choices and decisions might be ramed:
public health, economic welare, economic
growth, equity, sociocultural inuence, and
political inuence (see Appendix 1 or a more
detailed description).
Table 2 summarizes a number o arguments that
support, and also potentially work against, greater
investment in public mental health rom these
dierent perspectives. The table shows that thereare solid arguments rom all perspectives in avour
o greater investment in public mental health, but
there are also important barriers to consider
especially the sociocultural stigma that surrounds
mental illness (since this can negatively aect
appropriate action by governments) and the act
that macroeconomic perormance oten has
priority over broader measures o societal welare.
pi pi / I
()
Public health Promote, prevent, restore and maintain
health
The attributable and aver table
burden o disease
Economic welare Maximize individual and social well-being Health as a key component o
economic welare
Economic growth
and productivity
Improve the standard o living by
increasing economic output (via more
efcient production)
Eect o reduced health
on production (labour) and
consumption (health care)
Equity Promote airness in equality o opportunity Health and access to health care
as a human right
Sociocultural
infuence
Inuence o belies, customs and attitudes
regarding the way societies perceive andorganize themselves
Perceptions or belies about the
causes o illness (stigma)
Political infuence Formulate and implement state policies,
uphold the law and, where necessary,
intervene in private markets
Market ailures in health care
(e.g. incomplete inormation among
service users)
table 1. dIerent value bases aectIng s ocIal choIces and decIsIons
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INVESTING IN MENTAL HEALTH: EVIDENCE FOR ACTION
pi a i
i i i
pi i
i i i
pi Mental disorders are a major cause o the
overall disease burden; eective strategies
exist to reduce this burden
Mental disorders are not a leading
cause o mortality in populations
ei Mental and physical health are core
elements o individual welare
Other components o welare
are also impor tant (e.g. income,
consumption)
ei
ii
Mental disorders reduce labour
productivity and economic growth
The impact o mental disorders on
economic growth is not well known
(and oten assumed to be negligible)
ei Access to health is a human r ight;
discrimination, neglect and abuse
constitute human rights violations
Persons with a wide range o health
conditions currently lack access to
appropriate health care
si
i
Social support and solidarity are core
characteristics o social groupings
Negative perceptions and attitudes
about mental illness (stigma)
pii i Government policies should address
market ailures and health priorities
Low expressed demand/advocacy
or better services
table 2. supportIng arguments or, and potentIal barrIers agaInst,
Investment In m ental health
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12
world health organization
What can governmentsdo to improve populationmental health?
As the ultimate guardians o population health,
governments have the lead responsibility to ensure
that needs are met and that the mental health o
the whole population is promoted. A urther
responsibility o and justifcation or action by governments is to orchestrate corrections to
markets that, i let uncontrolled, can give rise to
outcomes that are socially unacceptable. Such
market ailures that governments can address in
the context o mental health and health care
include the impaired understanding o aected
individuals regarding their condition, needs or
rights (incomplete inormation), the unpredictable
need or care (uncertainty), and the impacts o
mental illness on other people or health conditions
(spill-over eects) (12). Appendix 2 elaborates on
these market ailures in the context o mental
health and health care.
Moreover, there is ample international evidence
that mental disorders are disproportionately
present among the poor, either as a resul t o a drit
by those with mental health problems towards
more socially disadvantaged circumstances (dueto impaired levels o psychological or social
unctioning) or because o greater exposure to
adverse lie events among the poor (13). For
governments and international development
partners intent on reducing inequalities in access
to or uptake o health (and other welare-related)
services in short, moving towards universal
health coverage this provides a urther signifcant
justifcation or state intervent ion.
In order to address current shortcomings in the
efcient and air allocation o societal resources,
governments and other stakeholders can
undertake a number o key actions, namely:
provide betterinormation, awareness and
education about mental health and illness;
provide better (and more)health and social
care services or currently underservedpopulations with unmet needs;
provide bettersocial and fnancial protection
or persons with mental disorders, particularly
those in socially disadvantaged groups;
provide betterlegislative protection and social
suppor tor persons, amilies and communities
adversely aected by mental disorders.
The exact nature o these collective actions or
responses (e.g. the extent to which governments
actually oer social protection) will vary according
to prevailing notions o social choice in a country
and the existing health system structures and
constraints. In other words, governments do not
need to pay the entire mental health budget or
provide all services themselves (a
nongovernmental or private entity may also
contribute), but governments do have an obligation
to ensure that appropriate institutional, legal,fnancing and service arrangements are put in
place to protect human rights and to address the
mental health needs o the population.
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INVESTING IN MENTAL HEALTH: EVIDENCE FOR ACTION
conclusion
At a purely conceptual level, a solid case can be
made or investing in mental health, whether on
the grounds o enhancing individual and
population health and well-being, reducing social
inequalities, protecting human rights, or improving
economic efciency. The empirical basis o each o
these our arguments is presented in Section 3 othis report.
To date, these arguments and the evidence
behind them have not been sufciently well
expressed or communicated to key stakeholders.
As pointed out in a recent analysis (14), a number
o steps need to be taken in order to urther the
cause o mental health as a pressing global health
initiative. These steps include: the development o
a unifed voice and common ramework or
engaging in public discourse; the consistent
application o an approach to mental health that is
based on social justice and human rights; and the
generation o an evidence base that not only
includes strategies or treating persons with
mental disorders but also extends to addressing
stigma, the social determinants o mental health,
and the wider impact o mental health
improvements on economic development andsocial well-being.
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3. MENTAL HEALTH
ACTION ANd
INNOVATION:THE EVIdENCE-bASEd CASE fOr
INVESTMENT
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INVESTING IN MENTAL HEALTH: EVIDENCE FOR ACTION
The preceding section highl ighted reasons why
individuals and societies place value or importance
on psychological health and well-being, why these
values do not necessarily lead to action, and why
governments have a responsibility to ensure that
they do. I these reasons are accepted and
governments and other key stakeholders are
prepared to act, policy dialogue within countries
can move on rom the question why? to what?and how? (or indeed, how much?).
What is the current stateof investment?
Many low- and middle-income countries
currently allocate less than 2% or even 1%
o the health budget to the treatment and
prevention o mental disorders (see Figure 1) (15).
Th is is not remotely propor tionate to the burden
they cause, and appears to place a very low
value on the psychological or emotional well-
being o populations. The situation is particularly
bleak in low-income countries where on average
there is only one psychiatrist or every two million
inhabitants (compared to one to every 12 000
inhabitants in high-income countries). Most o
the unds that are made available bygovernments are speciically directed to the
operational costs o specialized but increasingly
outdated mental hospitals (that are commonly
associated with isolation, human rights violations
and poor outcomes) (15). This inevitably curbs
the development o more equitable and cost-
eective community-based services.
%o
ftotal
healthspendingonmenthalhea
lth 6%
5%
4%
3%
2%
1%
0
Low-income
countries
0.5 %
Lower middle-
income countries
1.9 %
Upper middle-
income countries
2.4 %
High-income
countries
5.1 %
Igure 1. mental health spendIng as a proportIon o
total he alth spendIng (15)
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16
world health organization
What is the basis forreneWed investment inmental health systems?
Decisions on investment or priorities in public
health are usually based on the ollowing criteria:
human rIghts protectIon:
This criterion relates to the extent to whichinvestment and action directly contribute to
upholding human rights or tackling human rights
violations or inringements.
publIc health and economIc burden:
Here the ocus is the burden at tributable to
dierent disorders, both now and in the uture. In
other words, how serious are the health and
economic consequences o not investing in mental
health?
cost and cost-eectIveness:
Since resources or health are fnite or scarce, it is
important to assess the costs as well as social and
economic outcomes associated with an
investment o societal resources in health
technologies or policies. Thus, the question here is
how efcient is it to invest in mental health
services and interventions?
equItable access and Ina ncIal
protectIon:
This criterion relates to the extent to which invest-
ment improves equitable access and airness in
fnancial contribution to essential services. In other
words, to what extent does the investment move
the population closer to universal health coverage?
human rights protection
Individuals with mental health problems (together
with their amilies) are subject to stigma,
discrimination and victimization, and are vulnerable
to violation o their rights (16). For example,
individuals may encounter restrictions in the
exercise o their political and civ il rights, including
their right to participate in public aairs anddecision-making processes on issues that aect
them. Unortunately, much o this discrimination
goes unreported, making it virtually impossible to
accurately assess the size o the problem. In
conict situations or disasters, persons with
mental health problems are at particular risk o
having their rights abused (17).
Legislation that protects vulnerable citizens reects
a society that respects and cares or its people.
Legislation that places policies and plans in the
context o internationally accepted human rights
standards and good practices can be an eective
tool or promoting access to mental health care as
well as or promoting and protecting the rights o
persons with mental disorders. However, nearly
two-thirds o countries either have no mental
health legislation or have legislation that is over 10
years old (15). A lot o outdated mental healthlegislation actually violates rather than protects the
rights o people with mental disorders because it
is geared towards saeguarding members o the
public rom dangerous patients (with the eect o
isolating them rather than promoting their rights as
people and citizens). Other legislation allows
persons with mental disorders to be placed in
long-term custodial care and to be given
systematic treatment without inormed consent,
thus seriously impinging on their right to liberty
and security o person and their right to exercise
legal capacity.
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INVESTING IN MENTAL HEALTH: EVIDENCE FOR ACTION
The inringement o basic rights and entit lements
represents the strongest single reason or
appropriate corrective action by governments and
civil society (including engagement and
empowerment o organizations o people with
mental disorders as well as amilies and carers). In
particular, rigorous and ongoing procedural
saeguards need to be in place to protect against
the overuse and abuse o involuntary admissionand treatment. To this end, the WHO QualityRights
tool kit sets key human rights and quality standards
that need to be met in all inpatient and outpatient
mental health and social care acili ties (18).
public health and
economic burden
Mental, neurological and substance use disorders
are major contributors to morbidity and premature
mortality throughout the world. Over 10% o the
global burden o disease, measured in terms o
years o healthy lie lost, can be at tributed to these
disorders (2); when only years lived with disability
are counted, the proportion more than doubles to
25% o the global burden (1). Not only do these
conditions result in signifcant levels o disability or
impaired unctioning but they are highly prevalent.For instance, more than 650 million people
worldwide are estimated to meet diagnostic
criteria or common mental disorders such as
depression and anxiety (1). Almost three quarters
o this burden is in low- and middle-income
countries.
The onset or presence o a mental disorder also
increases the risk o disability and premature
mortality rom other diseases including
cardiovascular disease, diabetes, HIV/AIDS and
other chronic conditions (11) due to neglect o
the persons physical health (by themselves,
amilies or care providers), elevated rates o
psychoactive substance use, diminished physical
activity, an unhealthy diet and, in many cases, the
side-eects o medication. Along with suicide,
these chronic diseases produce a level o
premature mortality ar in excess o that o the
general population; even in the relatively auent
context o Nordic countries, this mortality gap has
been estimated at 20 years or men and 15 years
or women (19).
Despite (and in no small part due to) low
government health expenditures on mental health,
the overall economic costs o mental disorders are
also very high. At the household level, these costs
come most directly in the orm o reduced
earnings plus additional and sometimes
catastrophic out-o-pocket expenditure on
health serv ices (oten leading to cuts in spending
and investment in other areas or giving up
household assets and savings). An analysis or
India, or instance, ound that hal o the out-o
pocket expenditures made by households or
psychiatric disorders came rom loans and a
urther 40% rom household income or savings
(20). The potentially catastrophic impact o private
out-o-pocket payments or health services on the
income and savings o households that include a
person with mental illness has rarely been
assessed. However, one study in the state o Goain India ound that 15% o women with a common
mental disorder spent more than 10% o household
income on health-related expenditures (21).
In terms o the impact on the national economy,
mental disorders are associated with high rates o
unemployment and also under-perormance while
at work. These both limit labour participation and
output (a critical component o economic growth).
A recent study by the World Economic Forum
estimated that the cumulative global impact o
mental disorders in terms o lost economic output
will amount to US$ 16 trillion over the next 20
years, equivalent to more than 1% o global gross
domestic product (GDP) over this period (3).
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world health organization
Studies rom specifc countries provide similarly
sobering fndings: health care costs and lost
earnings amount to at least US$ 50 billion in
Canada and US$ 75 billion in the United Kingdom
(both equivalent to more than 2.5% o national GDP)
(22, 23). For childhood mental health problems
alone, the lietime costs to the USA are expected to
exceed US$ 2 trillion as a result o diminished
educational achievement and earnings (24).
cost and cost-effectiveness
The magnitude o the current and projected
burden o mental, neurological and substance-
use disorders might be considered a sufcient
reason alone or investment, but only i that
investment can be channelled towards eective
and aordable solutions. The knowledge base
on what to do about the escalating burden o
mental disorders has improved substantially
over the past decade, with a growing body o
evidence demonstrating both the efcacy and
cost-eectiveness o key interventions or priority
mental disorders in countries at dierent levels
o economic development.
In order to choose specifc evidence-based
interventions or priority disorders that can be
readily scaled up and oer good value or money,
inormation is required on cost-eectiveness,
aordability and easibility (see Box 1 or
defnitions o these terms).
This inormation is available at the global level i.e.
or countries o dierent income levels or alcoholuse (as a risk actor or disease), epilepsy,
depression and psychosis (see Appendix 3 or
details). From these interventions, a subset can be
identifed that is not only highly cost-eective but
also easible, aordable and appropr iate or
implementation within the constraints o the local
health system:
epIlepsy:
Diagnosis and treatment o epilepsy with frst-line
antiepileptic drugs is one o the most cost-
eective interventions or noncommunicable
diseases. The treatment is very aordable and can
easibly be undertaken at the level o primary care.
cost-eectIveness summarizes the efciency with which an intervention produces health
outcomes. A very cost-eective intervention can be defned as one that generates an extra
year o healthy lie or a cost that alls below the average annual income per person.
aordabIl It y is defned in terms o the actual cost o implementing interventions, with US$
0.50 per capita used as a threshold or considering an intervention to be very aordable/low-
cost, and US$ 1 or quite aordable/low-cost.
easIbIlItyis defned by: (i) reach (capacity o the health system to deliver an intervention to the
target population); (ii) technical complexity (technologies needed or an intervention); (iii) capital
intensity (amount o capital required); and (iv) acceptability (including airness and human rights).
box 1. crIterIa used to IdentI y mental health Investment prIorItIes
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INVESTING IN MENTAL HEALTH: EVIDENCE FOR ACTION
depressIon:
Depression is among the leading causes o
disability in the world. The key interventions
are treatment with (generically produced) anti-
depressant drugs and brie psychotherapy.
Economic analysis has indicated that treating
depression in primary care is easible, relatively
aordable (less than US$ 1) and very cost-eective.
psychosIs:
Treating people with psychosis with older
antipsychotic drugs plus psychosocial support is a
quite cost-eective public-health intervention. It is
easible to implement it in primary care. However,
some reerral support is required, making it less
aordable. Nevertheless, human rights
considerations add to the need to make these
interventions available.
harmul alcohol use:
Harmul use o alcohol is a leading risk actor or
disease globally. It contributes not only to
substance use, mental disorders and injuries but
also to noncommunicable conditions such as liver
cirrhosis, certain cancers and cardiovascular
diseases. Taxation o alcoholic beverages and
restriction o their availability and marketing are
among the most cost-eective, aordable andtechnically easible strategies to implement.
A range o eective measures also exists or
prevention o suicide, prevention and treatment o
mental disorders in children, prevention and
treatment o dementia, and treatment o substance
use disorders (see Appendix 4 or details). More
inormation is urgently needed about the expected
costs and impacts, particularly in low- and middle-
income countries. In the United Kingdom,
evidence has already been assembled on the
impact and return on investment or a variety o
mental health promotion and prevention strategies.
From a societal perspective, the pay-o or certain
interventions including early intervention or
psychosis, suicide prevention, and learning
programmes or conduct disorder exceeds a
ratio o 10 (i.e. or every 1 spent, there is more
than 10 o beneft) (25).
What about the resources that are needed to
implement an integrated package o cost-eective
care and prevention? A recent estimate o US$34 per head o population has been derived or
the scaled-up delivery o a defned package in two
geographical contexts (sub-Saharan Arica and
South Asia), based on a comparative cost-
eectiveness analysis o 44 individual or combined
interventions (26). The package comprised the
treatment o epilepsy (with older frst-line
antiepileptic drugs), depression (with generic
antidepressant drugs and psychosocial treatment),
bipolar disorder (with the mood-stabilizer drug
lithium), schizophrenia (with neuroleptic
antipsychotic drugs and psychosocial treatment),
and heavy alcohol use (via increased taxation and
its enorcement, reduced access and, in sub-
Saharan Arica, advertising bans and brie advice
to heavy drinkers in primary care).
The impact o such an investment is reected above
all in improved health an estimated 5001000healthy years o lie or every million dollars spent.
Placing even a very modest value on a healthy year
o lie such as the average income per person
makes the return on investment highly avourable.
Over and above the health gains, such an investment
also brings other non-health benefts, most notably
in terms o restored capacity to work (productivity
gains) and reduced welare support payments.
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world health organization
equitable access andfinancial protection(universal healthcoverage)
An exercise carr ied out by the United States
National Institute o Mental Health to identiy a
number o grand challenges in global mental
health ound that improved treatment and accessto care was the single most pressing concern (27).
Indeed, an overarching fnancing goal o many
health systems currently undergoing transition is
the pursuit o universal health coverage, which can
be defned in terms o access to key promotive,
preventive, curative and rehabilitative health
interventions or all at an aordable cost, thereby
achieving equity in access (28). The concept o
universal health coverage can be broken down into
three dimensions (see Figure 2):
depth
(The range o services or interventions available
to members o the pool o insured persons):
This can be appropriately assessed by consider ing
the cost and cost-eectiveness o services and
interventions (as discussed above).
breadth
(The proportion o the population covered by
some orm o fnancial protection):
It is well established that in low- and middle-
income countries there is a sizeable gap in mental
health service and fnancial coverage. For severe
mental disorders, the treatment gap is at least
70% (4) and or common mental disorders it is
even higher.
heIght
(The proportion o total costs covered by
prepayment):
Private out-o-pocket spending represents a substantial
proportion o total mental health expenditure in low- and
middle-income countries, particularly when the largest
element (mental hospital spending) is excluded (29).
Direct out-o-pocket spending is an unair and
regressive way o paying or health care because it
penalizes those least able to aord care (28).
In short, current coverage o essential mental health
care can be characterized as inadequate, both in
terms o access or those in need and in terms o
fnancial protection or beneft inclusion. Accordingly,
eorts to scale up community-based public mental
health services can be expected to contribute
strongly to the objective o greater equality in accessbecause more people in need will be served and with
less reliance on direct out-o-pocket spending.
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INVESTING IN MENTAL HEALTH: EVIDENCE FOR ACTION
In practical terms, there are several critical issues
that need to be addressed in order to move closer
to the goal o universal coverage in mental health.These are:
InancIng/Insurance
A defned set o mental health conditions and
interventions should be explicitly recognized and
included in the essential list or package o health
benefts oered to all citizens by governments,
whether as part o the national tax-based health
service or under the provisions o social or private
insurance schemes (see Box 2 or an example
rom Chile).
servIce delIvery
Specialized secondary care should be available or
reerral cases and mental health care should beintegrated into primary health care, maternal and
reproductive health care, internal medicine and
paediatrics, and emergency medicine, so that the
majority o persons with mental health needs can
enjoy local access to treatment and care.
human resources
Clinical tasks should be shared with nonspecialists
so that the provision o essential care and support
is not thwarted by the absence o specialist mental
health providers.
Igure 2. pathways to unIversal health coverage (28)
Direct costs:
proportion of the
costs covered
Services:
which services are
covered?Population: who is covered?
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world health organization
There is a strong international consensus that the
shortage o fnancial and human resources or
mental health requires a policy to integrate mental
health care into general health care. Such
integration provides opportunities or reducing the
stigma o mental health problems, which in itsel is
a major barrier to accessing care. A recent report
presents the justifcation or, and advantages o,
providing mental health services in primary care,
and describes how a range o health systems have
successully undertaken this transormation (31).
Because o the current shortage o specialist
mental health personnel a well-established
barrier to scaling up mental health services a key
proposal to improve access to treatment is by
task-sharing with nonspecialist health workers.
There is an emerging evidence base that
demonstrates how task-sharing with nonspecialist
health workers can improve access to care. A
study carried out or KwaZulu-Natal province in
South Arica, or example, concluded that a task-
sharing approach to the integration o mental
health into primary health care can substantially
reduce the number o health-care providers who
would otherwise be needed to provide this care.
Furthermore, the study ound that the cost o
additional community-based workers and a mental
health counsellor at primary level can be oset by
a reduction in the number o other specialist and
nonspecialist heal th personnel (32).
Adequate training, supervision and suppor t are o
course paramount to the success o such an
approach. This means that sufcient fnancial or
other incentives need to be put in place to ensure
sustainability o the approach. In addition,treatment guidance and training materials need to
be geared towards nonspecialists; this has been
achieved with the development and roll-out o
WHOsmhGAP Intervention Guide (5).
conclusion
By putting together an overall picture o these
dierent criteria, as shown in Box 3, one sees a
compelling case or urgent action and investment.
As part o a broader process o health reorm, in 2005 the Chilean parliament passed the
Regime o Explicit Guarantees in Health Law which provides universal coverage or all citizens
with regard to a package o medical benefts consisting o a prioritized list o diagnoses and
treatments or 56 health conditions. This list o conditions (which is still growing) includes
depression, alcohol/drug dependence and schizophrenia. The regime is enorceable by law andincludes a set o guarantees concerning access, quality and fnancial protection such as
maximum waiting times, co-payments, and the mandatory oer ing o the benefts package by
both private and public providers (30).
box 2. InclusIon o mental dIsorders In chIles
unIversal health-care plan
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INVESTING IN MENTAL HEALTH: EVIDENCE FOR ACTION
human rIghts protectIon
Individuals with mental health problems (together with their amilies) are commonly
subjected to stigma, discrimination and victimization.
Well-ormulated and properly enorced policies and laws that are oriented to human rights
prevent abuse and protect rights.
publIc health and economIc burden
Globally, more than 25% o all years lived with disability and over 10% o the total burden o
disease is attributable to mental, neurological and substance use disorders.
Let unaddressed, lost economic output due to these disorders will increase signifcantly romthe already enormous levels.
cost and cost-eectIveness
Feasible, aordable and cost-eective measures are available or preventing and treating
mental, neurological and substance use disorders.
An integrated package o cost-eective care and prevention can be delivered in community-
based settings o low- and middle-income countries or US$ 34 per capita.
equItable access and InancIal protectIon
Most persons with mental ill-health do not have adequate access to the essential mental
health care they need; those who do use the services end up paying much o the bill.
Integration o mental health care into publicly-unded primary care and task-sharing with non-
specialist health-care providers are appropriate and viable strategies or enhancing access.
box 3. summary o key arguments and evIdence or
dIerent Investment crIterIa
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4.SuMMAry Of kEy
fINdINGS
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INVESTING IN MENTAL HEALTH: EVIDENCE FOR ACTION
This report set out to descr ibe the place o mental
health as a valued source o human capital or well-
being in society, and to assess its suitability as a
target or greater investment and action. The main
points can be summarized as ollows:
mental health and
social values
From a range o dierent analytical perspectives,
there are sound arguments that support greater
attention to and investment in mental health,
including the protection o human rights,
improved health and well-being, reduced social
inequalities, and enhanced economic
productivity and eiciency.
Negative cultural attitudes towards mental
illness persist and governments tend to
emphasize the creation or retention o wealth
rather than the promotion o societal well-
being. This situation can be countered by
presenting a stronger and more uniied voice
and insisting that the health and human r ights
o persons with mental health problems can
and should be appropriately protected.
As the ultimate guardians o population hea lth,
governments in partnership with other key
stakeholders have a lead role to play in the
enactment o national mental health action
plans, including: the provision o better
inormation, awareness and education about
mental health and illness; improved services;
and enhanced legal, social and inancial
protection or persons, amilies or communities
adversely aected by mental disorders.
mental health actionand innovation
Judged against core criteria or priorities in
health (i.e. human rights, public health,
economic eiciency and social equity) there is
a compelling evidence-based case or investing
in mental health. For each year o inaction and
underinvestment, the health, social andeconomic burden will continue to rise. Doing
nothing is thereore not a viable option.
Mental health can be considered a ocus o
renewed investment not just in terms o human
development and dignity but also in terms o
social and economic development.
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26
rEfErENCES
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(DALYs) or 291 diseases and injuries in 21
regions, 19902010: a systematic analysis orthe Global Burden o Disease Study 2010.
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3. Bloom DE et al. The global economic burden o
noncommunicable diseases.
Geneva, World Economic Forum, 2011.
4. Lora A et al. Service availability and utilization
and treatment gap or schizophrenic disorders:
a survey in 50 low- and middle-income
countries. Bulletin o the World Health
Organization, 2012, 90:4754.
5. mhGAP Intervention Guide or mental,
neurological and substance use disorders in
non-special ized health settings. Geneva, World
Health Organization, 2011.
6. Comprehensive Mental Health Action Plan20132020. Geneva, World Health Organization,
2013.
7. Investing in mental health. Geneva, World Health
Organization, 2003.
8. Promoting mental health: concepts, emerging
evidence, practice. Geneva, World Health
Organization, 2005.
9. Schwartz SH. Basic human values: theory,
measurement, and applications. Revue ranaise
de sociologie, 2006, 47:249288.
10. Nussbaum MC. Women and human
development: the capabilities approach.
Cambridge, Cambridge University Press, 2000.
11. Helliwell J, Layard R, Sachs J. World happiness
report. New York, NY, The Earth Institute,
Columbia University, 2012.
12. Beeharry G et al. Outlining the scope or publicsector involvement in mental health. (HNP
Discussion Paper). Washington, DC, The World
Bank, 2002.
13. Lund C et al. Poverty and mental disorders:
breaking the cycle in low- and middle-income
countries. Lancet, 2011, 378:15021514.
14. Tomlinson M, Lund C. Why does mental health
not get the attention it deserves? An application
o the Shiman and Smith Framework. PLoS
Medicine, 2012, 9:e1001178.
15.Mental Health ATLAS 2011. Geneva, World
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16. Thornicrot G et al (INDIGO study group). Global
pattern o experienced and anticipated
discrimination against people withschizophrenia: a cross-sectional survey. Lancet,
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17. Silove D, Steel Z, Mollica RF. Detention o asylum
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18.WHO QualityRights tool kit. Geneva, World
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19. Wahlbeck K et al. Outcomes o Nordic mental
health systems: lie expectancy o patients with
mental disorders. British Journal o Psychiatry,
2011, 199:453458.
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INVESTING IN MENTAL HEALTH: EVIDENCE FOR ACTION
20. Mahal A, Karan A, Engelgau M. The economic
impl ications o non-communicable disease or
India. (HNP Discussion Paper). Washington, DC,
The World Bank, 2010.
21. Patel V et al. Prioritizing health problems in
women in developing countries: comparing the
fnancial burden o reproductive tract inections,
anaemia and depressive disorders in acommunity survey in India. Tropical Medicine
and International Health, 2007, 12:130-139.
22. Lim KL et al. A new population-based measure
o the economic burden o mental illness in
Canada. Chronic Diseases in Canada, 2008,
28:92-98.
23. McCrone P et al. Paying the price: the cost o
mental health care in England to 2026. London,
The Kings Fund, 2008.
24. Smith JP, Smith GC. Long-term economic costs
o psychological problems during childhood.
Social Science and Medicine, 2010, 71:110115.
25. Knapp MRJ, McDaid D, Parsonage M, eds.
Mental health promotion and mental illness
prevention: the economic case. London,Department o Health, 2011.
26. Chisholm D, Saxena S. Cost eectiveness o
strategies to combat neuropsychiatric conditions
in sub-Saharan Arica and South East Asia:
mathematical modelling study. British Medical
Journal, 2012, 344:e609.
27. Collins PY et al. Grand challenges in global
mental health. Nature, 2010, 475:2730.
28.World Health Report. Health systems fnancing;
the path to universal coverage. Geneva, World
Health Organization, 2010.
29.Mental Health ATLAS 2005. Geneva, World
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31.Integrating mental health into primary care: a
global perspective. Geneva and Bangkok, WorldHealth Organization and World Organization o
Family Doctors, 2008.
32. Petersen I et al (Mental Health and Poverty
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requirements and costs or rural settings.
Health Policy and Planning, 2011, doi:10.1093/
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world health organization
appendix 1.six perspectives on thevalue base for individualor collective decision-making
1. Public health perspective: The defning goal
rom this perspective is to protect, improve andoptimize individual and population health,
where to use WHOs defnition health is
defned as a state o complete physical, mental
and social well-being and not merely the
absence o disease or infrmity. Historically, the
main ocus rom this perspective was
premature mortality (and the inectious
diseases that contribute most to it); as a
consequence o increased/longer survival, as
well as greater exposure to unhealthy liestyles,
diseases o a chronic, disabling and
noncommunicable nature are increasing,
thereby prompting a major change in terms o
public health priorities and policies.
2. (Micro)economic welare perspective:
Welare economic theory posits that, subject
to constraints such as income and time,
individuals or populations seek to maximizeutility (a term used to describe pleasure or
economic welare), which they do by
consuming goods and services and by
spending time with amily and riends or in
other orms o leisure. Health contributes to
individual utility or social welare, not only
because people preer to be more healthy
rather than less healthy but also because
being healthy enables them to better enjoy
consumption or leisure activities. Thus health
has an intrinsic value but also supports the
capability o an individual or community to
undertake desired activities or unctions.
3. (Macro)economic growth perspective: The
overarching concern or society rom this
perspective is to improve the standard o living
in a country by increasing economic output
through more efcient production. Ill-health can
aect economic growth through its negative
impact on the supply (and quality) o human
capital or labour. Countries devote an
increasing share o their national product orincome to health care (which could otherwise
be put to potentially more productive use).
Economic growth is typically measured with
reerence to a countrys gross domestic
product (GDP). However, GDP is only a par tial
measure o economic welare (and was not
designed to measure this broader concept),
since it does not include consumption that is
not marketed, or the value o leisure or the
value o health itsel. There has been recent
interest in developing alternative measures to
GDP or income or assessing a countrys
success or progress, including the concept
(and various indices) o gross national
happiness.
4. Equity perspective: In contrast to the notion o
maximizing societa l utility, the ethical
perspective derives rom concerns overairness in equality o oppor tunity (i.e. each
person should be able to achieve a air share o
the opportunities available in society). Such
entitlements are enshrined in international
human rights instruments such as the Universal
Declaration o Human Rights, which declares
that all human beings are born ree and equal in
dignity and rights (including the right to health).
Individuals with health problems who are
prevented rom accessing appropriate care and
support as a result o poverty or
discrimination, or instance experience a
violation o the right to health.
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INVESTING IN MENTAL HEALTH: EVIDENCE FOR ACTION
5. Sociocultural perspective: This perspective
reveals how belies, customs and social
attitudes shape the way societies perceive,
organize and urther themselves (through, or
instance, sociocultural norms governing
kinship, reciprocity and spirituality). In many
cultures, entrenched belies about the causes
o mental illness (e.g. evil spirits or sorcery)
engender negative attitudes and practicestowards persons with mental illnesses.
6. Political perspective: The role o government is
to ormulate and implement state policies. At
least in democratic or republican orms o
government, policies are usually considered to
be made in the national interest, to address
issues where private markets have ailed, and
to reect the demands or wishes o the
electorate (thereby echoing prevailing social
attitudes and values). How decisions actually
get made varies considerably, however. State
representatives are subjected to lobbying by
special interest/advocacy groups which exert
inuence on fnal public policies or choices.
appendix 2.
market failures Withrespect to mental healthand health care
1. Inormation ailures: Many people with mental
illness lack insight into, or even recognition o,
their health condition, needs or rights. This results
in a lower level o demand or help-seeking than
the person may need. The result is an under-
supply o services that only collective action can
redress. The stigma attached to a mental disorder
another orm o inormation ailure produces a
urther impediment to the demand or services.
The stigma that surrounds mental ill-health also
has a negative inuence on the political
processes that determine priority-setting and
resource allocation in health.
2. Risk and uncertainty: There are a number o
concerns regarding paying or or insuring against
mental illness, particularly in the case o chronic
conditions such as schizophrenia or bipolar
aective disorder. First, uninsured persons or
households ace potentially ruinous costs
associated with health care expenses and lack o
income rom paid work. Second, persons who
seek to mitigate this risk by buying private healthinsurance may fnd themselves excluded or
restricted rom receiving the services they need
(because insurance companies remove or limit
entitlements). Other relevant services such as
social care, special educational needs or housing
may also not be covered by insurance or may
be subject to separate charges.
3. Negative spill-over eects: Persons with mental,
neurological or substance use disorders are oten
the victims o abuse and violence by others, but
can also pose a risk o violence or harm to others
(e.g. by a person suering a psychotic episode or
behaving aggressively when under the inuence
o alcohol or illicit drugs). Such spill-over eects or
externalized costs justiy some orm o public
intervention. Spill-over eects oten extend
beyond the immediate victims o violence, abuse
or crime to contact with criminal justice services.In the case o drug-use disorders, the harm may
be to other peoples health (e.g. HIV transmission
via use o shared needles). Mental disorders can
also have adverse impacts on physical health (e.g.
the impact o perinatal depression on inant
development). Furthermore, mental illness aects
amily members and riends who oten provide
inormal care and support as a complement to, or
replacement or, ormal provision o health or
social care. Inormal caregivers may derive
satisaction rom doing this but many also
experience welare losses themselves in the orm
o exhaustion, stress and reduced opportunities
or work or leisure activities.
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30
world health organization
appendix 3.identifying interventions that are cost-effective,affordable and feasible
h
ii
Ii c-i
(cost per healthy year
of life gained)a
aii
(cost per capita)a
iii
(logistical or other
constraints)
Epilepsy t i (f-i)
iii
+++ +++ i i
i
Depression t i (i)
i
i
i
+++ ++ i i
i
Harmul
alcohol use
ri i
e ii
ri
+++ +++ hi i
Enorce drink-driving laws
(breath-testing)
Oer counselling to drinkers
++ ++ Feasible in
primary care
Psychosis Treat cases with (older)
antipsychotic drugs
plus psychosocial support
++ + Feasible in primary
care; some reerral
needed
key: c-i:
+++ (very cost-eective; cost per healthy year o lie gained < average income per person).
++ (quite cost-eective; cost per healthy year o lie gained < 3 times average income per person).
+ (less cost-eective; cost per healthy year o lie gained > 3 times average income per person).
aii :
+++ (very aordable; implementation cost < US$ 0.50 per person).
++ (quite aordable; implementation cost < US$ 1 per person).
+ (less aordable; implementation cost > US$ 1 per person).
Notes: a Source o data: Chisholm and Saxena, 2012 (25).
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INVESTING IN MENTAL HEALTH: EVIDENCE FOR ACTION
epIlepsy
Diagnosis and treatment o epilepsy with frst-line
antiepileptic drugs is one o the most cost-eective interventions or noncommunicable
diseases. The treatment is very aordable and is
easible in primary care.
depressIon
Depression is currently one o the leading causes
o disability in the world. The key interventions are
treatment with (generic) antidepressant drugs and
brie psychotherapy. Economic analysis has
indicated that treating depression in primary care
is easible, relatively aordable (less than US$ 1
per person) and very cost-eective.
psychosIs
Treating persons with psychosis with older
antipsychotic drugs plus provision o psychosocial
support is a quite cost-eective public-health
intervention. It is easible to implement in primary
care but some reerral suppor t is required, makingit less a ordable. However, human rights
considerations add to the imperative need to make
these interventions available.
harmul alcohol use
(as a rIsk actor or dIsease )
Harmul use o alcohol is a leading risk actor or
disease globally, contributing not only to substance
use and mental disorders but also to injuries and
noncommunicable conditions such as liver cirrhosis,
certain cancers and cardiovascular diseases.
Taxation o alcoholic beverages and restriction o
their availability and marketing are among the most
cost-eective, aordable and technically easible
strategies that can be implemented.
appendix 4.summary of evidence ofeffectiveness for mhgappriority conditions
Suicide is responsible or 1.3% o the global burden
o disease. Around 844 000 deaths occur globally
because o suicide. Eective interventions or
prevention o suicide include restriction o access to
means such as frearms and pesticides, reduction
o the harmul use o alcohol as described above,
and treatment o depression and substance use
disorders. However the cost-eectiveness o these
interventions is not yet established globally.
The evidence-based and eective interventions or
substance use disorders are: brie intervention
or alcohol- use disorders, treatment o opioid
dependence with opioid agonist maintenance
treatment, and reduction o the harmul use o
alcohol as described above. Translating fndings on
interventions or substance use disorders in
developed countries into disease-control priorities
or developing countries presents major challenges
as countries dier in their scale o substance use
and in the resulting disease burden. For drug-use
disorders, some inormation is available on the
cost-eectiveness o some o these interventions in
specifc settings or countries but not globally. In
addition, cultural belies and attitudes inuence
societal responses to drug use and dependence.
Many potential interventions exist or the preventionodevelopmental disorders in children but
evidence on cost-eectiveness, aordability and
easibility is available or only a ew interventions
and rom only some settings. Iodine defciency
disorders (IDD) are an important cause o
developmental disorders in children and it is well-
recognized that the most eective, cost-eective
and sustainable way to achieve the virtual
elimination o IDD is through universal salt
iodization. Folic acid ortifcation o the ood supply
or prevention o neural tube deects was ound to
be highly cost-eective in the USA. In low-income
countries, however, high capital and running costs
may compromise cost-eectiveness, at least in the
short run. Evidence or cost-eectiveness is
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32
world health organization
available also or rubella, haemophilus inuenza and
measles vaccines and the removal o lead rom paint
and uel. Prenatal screening and selective
pregnancy termination to prevent Down Syndrome
are highly cost-eective under some conditions but
raise ethical, social and cultural concerns that may
preclude their applicability in some low- and middle-
income countries. Moreover, screening is not only
expensive but also has some negative healthoutcomes. Neonatal screening and treatment or
congenital hypothyroidism is highly cost-eective in
developed countries, where it provides a low-cost
strategy or preventing intellectual disability.
No frm evidence indicates that any orm o
population-based intervention can prevent
Alzheimers disease or that the progression
o cognitive decline in old age can be halted or
reduced. However, there is some evidence available
on eective interventions or caregivers. Training
amily caregivers in behavioural management
techniques has been shown to reduce the level o
agitation and anxiety in people with dementia.
Interventions that have specifcally targeted stress
and depression among caregivers have shown
positive results but the challenge is to develop
culturally-appropriate interventions that can be
delivered within existing resources in low- andmiddle-income countries. Treating underlying risk
actors or cardiovascular disease can help prevent
uture cerebrovascular disease that could lead to
vascular dementia. More evidence and research is
required to assess the cost-eectiveness,
aordability and easibility o these interventions.
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For more information,
please contact:
Department of Mental Health
and Substance AbuseWorld Health Organization
Avenue Appia 20
CH-1211 Geneva 27
Switzerland
www.who.int/mental_health/en/
Mental health and well-being are fundamental to our collective
and individual ability as humans to think, emote, interact
with each other, earn a living and enjoy life. Yet currently the
formation of individual and collective mental capital especiallyin the earlier stages of life is being held back by a range
of avoidable risks to mental health, while individuals with
mental health problems are shunned, discriminated against
and denied basic rights, including access to essential care.
In this report, potential reasons for this apparent contradiction
between cherished human values and observed social actions
are explored with a view to better formulating concrete steps
that governments and other stakeholders can take to reshape
social attitudes and public policy around mental health.
ISBN 978 92 4 156461 8