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The Royal College of Psychiatrists Improving the lives of people with mental illness

The scandal of mental health

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 gap’

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 expectancy

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 provision.’

Are these two issues the real mental health scandal?

References:

(1) Thornicroft G. Most people with mental illness are not treated. Lancet 2007; 370(9590):807-808.

(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; 190:299-306.

(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; 352(24):2515-2523.

(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; 370(9590):841-850.

(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; 370(9592):1061-1077.

(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 2007; 370(9593):1164-1174.

(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; 370(9594):1241-1252.

(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. Press; 2008.

(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 Press; 2006.

(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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