Thanks to all of you who have contacted me
with your responses to our new statement on
the Health and Social Care Bill. There is a very solid
consensus coming back from you, with obviously a small number of
people having different and diverse views.
On a different note, I attended a breakfast
meeting recently with the Chief Medical Officer, Dame Sally Davies,
in which Professor Graham Thornicroft talked about the scandal of
mental health. I asked his permission to blog his words, which are
as follows. I have unusually also included the references, as they
look like a must-read.
A new mental health scandal?
Professor Graham Thornicroft,
King’s College London, Institute of Psychiatry
Two critical issues in mental health care are
hardly ever talked about:
1. That most people with mental health
problems receive no treatment whatsoever, and that
2. Such people die up to 20 years
earlier than people without a mental illness.
1. The ‘mental health
Most people in the world who have mental
illnesses receive no treatment1. The proportion of
people with mental disorders who receive health care (so called
‘coverage’) is at best between 27%-30% across the
Europe2 and the United States3, and at worst
the treatment rates is as low as 2% in Nigeria4-6. The
existence and the significance of this ‘treatment gap’ is
increasingly appreciated worldwide7-12. The Department
of Mental Health and Substance Abuse at the World Health
Organization has recognised this challenge by launching the Mental
Health Global Action Programme (mhGAP)13. In the UK we
do not know exactly how what percentage of people with mental
illness receive treatment - our best estimates are that this is
only about a quarter of all cases. Is this acceptable?
2. Vastly reduced life
Compared with people with no mental health
problems, men with mental illness lives 20 years less, and women 15
years less. A combination of life style risk factors (such as
smoking and diet), higher rates of unnatural deaths (such as
suicides and accidents), and poorer physical health care contribute
to this scandal of premature mortality14. What needs to
be done? If such a disparity in mortality rates were to affect a
large segment of the population with a less stigmatised
characteristic, such as diabetes, then we would witness an outcry
against a socially unacceptable decimation of this group. The fact
that life expectancy remains so much lower for people with mental
illness denotes a cynical disregard for these lost lives, and shows
in stark terms by just how much people with mental illness are
categorically valued less in our societies than other
people15. This can justifiably be seen as a violation of
the ‘Right to Health’ as set out in Article 12, “The right to the
highest attainable standard of health” of the International
Covenant on Economic, Social and Cultural Rights16;17.
Further, in 2006, the United Nations General Assembly adopted the
Convention on the Rights of Persons with Disabilities (CRPD) which
explicitly applies to people with mental health problems as well as
people with intellectual disabilities18.Such lower life
expectancies imply , according to the CRPD, a wholesale ‘failure of
social policy and health promotion, illness prevention and care
Are these two issues the real mental health
(1) Thornicroft G. Most people with mental
illness are not treated. Lancet 2007;
(2) Alonso J, Codony M, Kovess V, Angermeyer
MC, Katz SJ, Haro JM et al. Population level of unmet need for
mental healthcare in Europe. Br J Psychiatry 2007;
(3) Kessler RC, Demler O, Frank RG, Olfson M,
Pincus HA, Walters EE et al. Prevalence and treatment of mental
disorders, 1990 to 2003. N Engl J Med 2005;
(4) Wang PS, Aguilar-Gaxiola S, Alonso J,
Angermeyer MC, Borges G, Bromet EJ et al. Use of mental health
services for anxiety, mood, and substance disorders in 17 countries
in the WHO world mental health surveys. Lancet 2007;
(5) Kohn R, Saxena S, Levav I, Saraceno B.
Treatment gap in mental health care. Bull World Health
Organ 2004; 82:858-866.
(6) Ormel J, Petukhova M, Chatterji S,
guilar-Gaxiola S, Alonso J, Angermeyer MC et al. Disability and
treatment of specific mental and physical disorders across the
world. Br J Psychiatry 2008; 192:368-375.
(7) Prince M, Patel V, Saxena S, Maj M,
Maselko J, Phillips MR et al. No health without mental health.
Lancet 2007; 370(9590):859-877.
(8) Saxena S, Thornicroft G, Knapp M,
Whiteford H. Resources for mental health: scarcity, inequity, and
inefficiency. Lancet 2007; 370(9590):878-889.
(9) Patel V, Araya R, Chatterjee S, Chisholm
D, Cohen A, De SM et al. Treatment and prevention of mental
disorders in low-income and middle-income countries.
Lancet 2007; 370(9591):991-1005.
(10) Jacob KS, Sharan P, Mirza I,
Garrido-Cumbrera M, Seedat S, Mari JJ et al. Mental health systems
in countries: where are we now? Lancet 2007;
(11) Saraceno B, Van OM, Batniji R, Cohen A,
Gureje O, Mahoney J et al. Barriers to improvement of mental health
services in low-income and middle-income countries. Lancet
(12) Chisholm D, Flisher AJ, Lund C, Patel V,
Saxena S, Thornicroft G et al. Scale up services for mental
disorders: a call for action. Lancet 2007;
(13) World Health Organization. mhGAP : Mental
Health Gap Action Programme : scaling up care for mental,
neurological and substance use disorders W.H.O. Geneva: W.H.O.
(14) Wahlbeck K, Westman J, Nordentoft M,
Gissler M, Laursen TM. Outcomes of Nordic mental health systems:
life expectancy of patients with mental disorders. Br J
Psychiatry 2011; 199(6):453-458.
(15) Thornicroft G. Shunned: Discrimination
against People with Mental Illness. Oxford: Oxford University
(16) Thornicroft G. Physical health
disparities and mental illness: the scandal of premature mortality.
Br J Psychiatry 2011; 199:441-442.
(17) Callard F, Sartorius N, Arboleda-Florez
J, Bartlett P, Helmchen H, Stuart H et al. Mental Illness,
Discrimination and the Law: Fighting for Social Justice. London:
Wiley Blackwell; 2012.
(18) United Nations. Convention on the Rights
of Persons with Disabilities. New York: United Nations; 2006.
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