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Countries of the Americas Face Major Challenges in Mental Health

November 10, 2011 - Funding for and organization of mental health services are woefully inadequate to address the growing burden of mental health problems in countries throughout the Americas, experts said during a Nov. 10 panel discussion at the Pan American Health Organization (PAHO). As a consequence, effective treatment remains out of reach for millions who could benefit from it.

“In Latin America and the Caribbean, on average 60-65 percent of people suffering mental health problems are not receiving any kind of care from the health services,” said Dr. Jorge Rodriguez, PAHO’s senior advisor on mental health. “The treatment gap is enormous. It’s one of the biggest challenges facing our region.”

“The wide gap that exists between those who need mental health care and those who receive it exists despite the fact that the means of intervention for this group of disorders are available,” said PAHO Assistant Director Socorro Gross. “Almost 20 years after the Declaration of Caracas, it is imperative that this gap be reduced.”

The Declaration of Caracas, signed by Latin American governments in 1990, called for legislative reforms to promote the rights of people with mental health problems and to restructure psychiatric care toward community-based and primary health care. Since then, nearly all countries in Latin America have developed policies on mental health reform, many with technical assistance from PAHO/WHO. However, implementation of these reforms is estimated at less than 50 percent in most countries, Rodriguez observed.

One of the reasons for the current treatment gap is that the burden of mental health problems has increased in the Region over the past three decades. According to PAHO estimates, mental and neurological conditions have more than doubled their share of the total burden of disease in Latin America and the Caribbean, from less than 9 percent in 1990 to 21 percent. But less than 2 percent of national health budgets in the Region, on average, are today devoted to mental health. Moreover, in many countries, said Rodriguez, the largest share of mental health spending goes to psychiatric hospitals instead of community-based primary health care, as called for by proponents of mental health reform.

The United States also faces a serious treatment gap as well as other challenges in the area of mental health, said Winnie Mitchell, of the U.S. Substance Abuse and Mental Health Services Administration (SAMHSA). Of the estimated 45 million people in the United States who suffer some form of mental disorder, only 17 million, or 38 percent, receive treatment, she said. Other problems include continuing stigma and discrimination, a tendency for governments and communities to view mental health problems as social problems rather than a public health issue, and a lack of understanding of the role of trauma in generating and perpetuating mental health problems throughout people’s lives.

Vijay Ganju, secretary general of the World Federation for Mental Health, noted the importance of collective action by experts and advocates to raise awareness of problems and solutions in mental health. Such efforts, he said, were responsible for getting mental health included in the final political declaration of the United Nations High Level Meeting on Non-communicable Diseases in September. The declaration recognized “that mental and neurological disorders, including Alzheimer’s disease, are an important cause of morbidity and contribute to the global non-communicable disease burden, for which there is a need to provide equitable access to effective programs and health care interventions.”

Ganju urged continuing advocacy to keep mental health “on the table” at both the national and global levels.

The Nov. 10 panel discussion was organized to observe World Mental Health Day, which officially took place on Oct. 10. PAHO Director Mirta Roses participated in a special World Mental Health Day event in Panama, along with Minister of Health Dr. Franklin Vergara, and PAHO Senior Advisor Jorge Rodriguez participated in a similar event at the Center for Addiction and Mental Health at the University of Toronto.

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