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Throughout the Americas, Treatment Falls Far Short of Mental Health Needs

On World Mental Health Day, experts urge integrating mental health services into primary care

Washington, D.C., 9 October 2009 (PAHO) — Mental health experts from the United States and Latin America say underfunding of mental health services and their lack of integration into primary health care have resulted in the majority of people in the Americas not getting the mental health care they need.

"This is a universal problem that does not spare any country or society and affects women and men of all ages, the rich and the poor, those living in rural and in urban areas as well," said Dr. José Luis di Fabio, manager of technology, health care, and research at the Pan American Health Organization (PAHO).

About one in four people in the hemisphere will experience some form of mental illness during their lifetime. Thanks to scientific and medical advances, effective treatments are available for most of these illnesses, yet the majority of sufferers in both North and Latin America go without treatment.

"There is a huge gap between what is urgently needed and what is available to reduce the burden of mental disorders," said Di Fabio.

His comments were made during a panel presentation held at PAHO headquarters this week to observe World Mental Health Day, celebrated each year on Oct. 10.

In Latin America and the Caribbean, the mental health "treatment gap"—the percentage of people with a mental disorder who are not receiving treatment for it—ranges from 59 percent for major depression to 71 percent for alcohol abuse or dependence disorders, according to PAHO data. Experts on the panel said the major reasons for these gaps—in countries throughout the hemisphere—were a shortage of funds and human resources for mental health services and the fact that these services are not well integrated into primary health care.

Latin American countries on average spend less than 2 percent of their national health budgets on mental health, said Dr. Jorge Rodriquez, PAHO's senior advisor on mental health. Most of this spending (as much as 90 percent in some countries) goes to mental hospitals rather than to primary health services or community care.

Rodriguez said a top priority should be to reverse this pattern by integrating mental health services into primary care. In this way, people can access mental health services closer to their homes, families can remain together, and both patients and family members can maintain their normal daily activities.

In addition, basing mental health services in primary care minimizes stigma and discrimination, and removes the risk of human rights violations that occur in psychiatric hospitals, said Rodriguez.

The integration of mental health services into primary care is a central focus of PAHO's new Regional Plan of Action on Mental Health, which was approved by ministers of health from throughout the Americas at last month's PAHO Directing Council meeting. 

The new plan focuses on implementing countries' laws and plans for mental health reform, improvements in treatment and care for childhood mental development, mental health services delivery in primary health care, the development of human resources for mental health, and improving access to and use of scientific information in this area.

As a first step toward implementing the new plan, 20 countries in the Latin America and Caribbean region have completed assessments of their own mental health systems, said Rodriguez.

The challenge of integrating mental health services into primary care is equally urgent in the United States, said Dr. Thomas Wise, professor of psychiatry at the George Washington University and head of psychiatry at the Inova Health System in Virginia.

"This is a global problem, but in the United States, we don't have integration at all," said Wise.

In addition to improving access to mental health care, integration of mental health services is also important because of the strong links between mental and physical illness.

For example, in the United States, people with mental disorders live 20 years less on average than people without them, said Dr. Eric Goplerud, research professor at the George Washington University and director of the Center for Integrated Behavior Health Policy at GWU. About 20 percent of this lower life expectancy is due to suicide, said Goplerud. But most is due to higher incidence of chronic diseases such as heart disease and cancer, which in turn is linked to smoking rates as high as 75–85 percent among people with mental illnesses, as well as higher rates of harmful use of alcohol and drugs.

The World Mental Health Day event was organized by PAHO and the World Federation for Mental Health. 

The Pan American Health Organization, founded in 1902, works with all the countries of the Americas to improve the health and quality of life of their peoples. It serves as the Regional Office of the World Health Organization (WHO).

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