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No health without mental health [1]

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Date: 2007-09-08

The WHO proposition that there can be “no health without mental health”1 has also been endorsed by the Pan American Health Organisation, the EU Council of Ministers, the World Federation of Mental Health, and the UK Royal College of Psychiatrists. What is the substance of this slogan?

Mental disorders make a substantial independent contribution to the burden of disease worldwide (panel 1).2 WHO's 2005 estimates of the global burden of disease provide evidence on the relative effect of health problems worldwide.3, 4 Non-communicable diseases are rapidly becoming the dominant causes of ill health in all developing regions except sub-Saharan Africa (table 1).4 The Global Burden of Disease report has revealed the scale of the contribution of mental disorders, by use of an integrated measure of disease burden—the disability-adjusted life-year, which is the sum of years lived with disability and years of life lost.4 The report showed that neuropsychiatric conditions account for up to a quarter of all disability-adjusted life-years, and up to a third of those attributed to non-communicable diseases, although the size of this contribution varies between countries according to income level (table 1).4 The neuropsychiatric conditions that contribute the most disability-adjusted life-years are mental disorders, especially unipolar and bipolar affective disorders, substance-use and alcohol-use disorders, schizophrenia, and dementia. Neurological disorders (such as migraine, epilepsy, Parkinson's disease, and multiple sclerosis) make a smaller but still significant contribution. Of the non-communicable diseases, neuropsychiatric conditions contribute the most to overall burden (figure 1 and table 1),4 more than either cardiovascular disease or cancer.

Despite these new insights, ten years after the first WHO report on the global burden of disease, mental health remains a low priority in most low-income and middle-income countries. Developing countries tend to prioritise the control and eradication of infectious diseases and reproductive, maternal, and child health, whereas developed countries prioritise non-communicable diseases that cause early death (such as cancer and heart disease) above those that cause years lived-with-disability (such as mental disorders, dementia, and stroke). If mental disorders are regarded as a distinct health domain, with separate services and budgets, then investment in mental health is perceived to have an unaffordable opportunity cost.

Our first aim is to critically appraise the way that the burden of disability and premature mortality is apportioned, in WHO's estimates of global burden of disease, between underlying conditions within groups of disorder, and, specifically, to assess whether these estimates account for the full contribution of mental disorder to mortality and disability. Our second aim is to review available evidence for interactions between mental disorders and other health conditions (such as medically unexplained somatic symptoms, communicable diseases, maternal and perinatal conditions, non-communicable diseases, and injuries). Our third aim is to discuss the implications of these links for the future orientation of health policies, health systems, and services.

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[1] Url: https://www.sciencedirect.com/science/article/pii/S0140673607612380

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