Urgent need for countries to provide a network of community mental health services

The World Health Organization (WHO) signalled the urgent need for countries to provide a network of community mental health services at its Global Forum for Community Mental Health (Geneva, 30-31 May 2007).

For the first time, WHO invited people living with mental disorders to attend the Forum, sending a message to countries that it is important to give a voice to this excluded group to claim their rights and secure their participation in society.

"Not only are community mental health services more accessible to people living with severe mental disabilities, these are also more effective in taking care of their needs compared to mental hospitals. Community mental health services are also likely to have less possibilities for neglect and violations of human rights, which are too often encountered in mental hospitals" said Dr Benedetto Saraceno, Director of the WHO Mental Health and Substance Abuse.

There are nearly 54 million people around the world with severe mental disorders such as schizophrenia and bipolar affective disorder (manic-depressive illness),. In addition, 154 million people suffer from depression. People living in developing countries are disproportionately affected. Mental disorders are increasingly prevalent in developing countries, the consequence of persistent poverty-driven conditions, the demographic transition, conflicts in fragile states and natural disasters. At the same time, more than 50% of developing countries do not provide any care for persons with mental disorders in the community. These disorders bring significant hardship not only to those who suffer from them, but also to their caregivers -- often the family, given the lack of mental health resources found in developing countries. As a result, 90% of people with epilepsy and more than 75% of people with major depressive disorder in developing countries are inadequately treated.

The call for community mental health services is especially timely since, in spite of a clear message from WHO in 2001, only a few countries have made adequate progress in this area. Also, in many countries, closing of mental hospitals is not accompanied by the development of community services, leaving a service vacuum.

"This topic should matter to everyone, because far too many people with mental disorders do not receive any care. The immediate challenge for low income countries is to use primary health care settings, particularly through community approaches that use low-cost, locally available resources to ensure appropriate care of these disorders" said Dr Catherine Le Galès-Camus, Assistant Director-General of WHO's cluster on Noncommunicable Diseases and Mental Health. "The challenge is to enhance systems of care by taking effective local models and disseminating them throughout a country. The WHO Global Forum for Community Mental Health was about showcasing models which are proving effective in delivering mental health care in resource-challenged situations," she added.

The Forum provided a foundation for sharing information, providing mutual support, and a sense of belonging for users, families and providers, and all who are interested in shifting mental health care from long-term institutions to effective community-based care. Forum partners included non-governmental organizations, professional associations and interested individuals. Prominent among them were BasicNeeds, the Christoffel Blindenmission and the World Association for Psychosocial Rehabilitation. The UK Department of Health actively assisted in the Forum, which was convened by WHO's Mental Health and Substance Abuse Department.

Viable options available to communities to improve the lives of people living with mental disorders and exercise their rights to community-level detection and treatment of mental disorders include:

• Integrating mental health care within the primary health care system;
• Rehabilitating long-stay mental hospital patients in the community;
• Implementing anti-stigma programmes for communities;
• Initiating population-based effective preventive interventions; and
• Ensuring full participation and integration of people with mental disorders within the community.

To implement these effective interventions, governments need to establish clear policies articulating these measures and then develop systematic plans with dedicated budget and agreed timelines. WHO provides technical support to developing countries to take these steps towards making community mental health care available within their countries.