MENTAL HEALTH ACTION PLAN 2013-2020 World Health Organization
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WHO Library Cataloguing-in-Publication Data Mental health action plan 2013-2020. 1.Mental health.2.Mental disorders-prevention and control.3.Mental health services. 4.Health planning.I.World Health Organization. 1SBN9789241506021 (NLM classification:WM 101) World Health Organization 2013 All rights reserved.Publications of the World Health Organization are available on the WHO web site(www.who.int)or can be purchased from WHO Press,World Health Organization,20 Avenue Appia,1211 Geneva 27,Switzerland (tel:+41 22 791 3264; fax:+41 22 791 4857:e-mail:bookorders@who.int). Requests for permission to reproduce or translate WHO publications -whether for sale or for non-commercial distribution- should be addressed to WHO Press through the WHO web site(www.who.int/about/licensing/copyright_form/en/index.html). The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country,territory,city or area or of its authorities,or concerning the delimitation of its frontiers or boundaries.Dotted lines on maps represent approximate border lines for which there may not yet be full agreement. The mention of specific companies or of certain manufacturers'products does not imply that they are endorsed or recom- mended by the World Health Organization in preference to others of a similar nature that are not mentioned.Errors and omis- sions excepted,the names of proprietary products are distinguished by initial capital letters. All reasonable precautions have been taken by the World Health Organization to verify the information contained in this publica- tion.However,the published material is being distributed without warranty of any kind,either expressed or implied.The responsibility for the interpretation and use of the material lies with the reader.In no event shall the World Health Organization be liable for damages arising from its use. Printed by the WHO Document Production Services,Geneva,Switzerland
WHO Library Cataloguing-in-Publication Data Mental health action plan 2013-2020. I.Mentat health. 2.Mental disorders - prevention and control. 3.Mental health services. 4.Health planning. I.World Health Organization. ISBN 978 92 4 150602 1 © World Health Organization 2013 (NLM classification: WM 101) All rights reserved. Publications of the World Health Organization are available on the WHO web site (www.who.int) or can be purchased from WHO Press, World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland (teL +41 22791 3264; fax: +41 22791 4857; e·mail: bookorders@who.inti. Requests for permission to reproduce or translate WHO publications -whether for sale or for non·commercial distributionshould be addressed to WHO Press through the WHO web site {www.who.int/about/licensing/copyrightform/en/index.htmlJ. The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any cou ntry, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement. The mention of specific companies or of certain manufacturers' products does not imply that they are endorsed or recom· mended by the World Health Organization in preference to others of a similar nature that are not mentioned. Errors and omis· sions excepted, the names of proprietary products are distinguished by initial capital letters. All reasonable precautions have been taken by the World Health Organization 10 verify the information contained in this publica· lion. However, the published material is being distributed without warranty of any kind, either expressed or implied. The responsibility for the interpretation and use of the maleriallies with the reader. In no event shall the World Health Organization be liable for damages arising from its use. Printed by the WHO Document Production Services, Geneva, Swilzerlond
03 CONTENTS 1.Foreword 05 2.Mental Health Action Plan 2013-2020 Setting the scene 06 Overview of the global situation 07 Structure of the Action Plan 09 Proposed actions for Member States and international and national partners and actions for the 11 Secretariat Appendix 1:Indicators for measuring progress towards defined targets of the comprehensive mental 20 health action plan 2013-2020 Appendix 2:Options for the implementation of the comprehensive mental health action plan 2013-2020 23 3.Overview of the Mental Health Action Plan 2013-2020 32 Annexes: I.World Health Assembly Resolutions: Resolution of the Sixty-sixth World Health Assembly (May 2013] 34 WHA66.8 Comprehensive mental health action plan 2013-2020 Resolution of the Sixty-fifth World Health Assembly (May 2012) 34 WHA65.4 The global burden of mental disorders and the need for a comprehensive,coordinated response from health and social sectors at the country level Il.Background material: Glossary of main terms 38 Links to other global action plans,strategies and programmes 40 International and regional human rights treaties 43 Selected WHO technical materials and resources on mental health 44
CONTENTS 1. Foreword 05 2. Mentat Health Action Plan 2013-2020 Setting the scene 06 Overview of the global situation 07 Structure of the Action Plan 09 Proposed actions for Member States and international and national partners and actions for the 11 Secretariat Appendix 1: Indicators for measuring progress towards defined targets of the comprehensive mental 20 health action plan 2013-2020 Appendix 2: Options for the implementation of the comprehensive menIal health action plan 2013-2020 23 3. Overview of the Mental Health Action Plan 2013-2020 32 Annexes: I. World Health Assembly Resolutions: Resolution of the Sixty-sixth World Health Assembly (May 2013) WHA66.8 Comprehensive mental health action plan 2013- 2020 Resolution of the Sixty-fifth World Health Assembly (May 2012) WHA65.4 The global burden of mental disorders and the need for a comprehensive, coordinated response from health and social sectors at Ihe country level II. Background material: Glossary of main terms links to other global action plans, strategies and programmes lnternalional and regional human rights treaties Selected WHO technical materials and resources on menial health 34 34 38 40 43 44 03
05 FOREWORD Mental well-being is a fundamental component of WHO's definition of health.Good mental health enables people to realize their potential,cope with the normal stresses of life,work productively. and contribute to their communities. Mental health matters,but the world has a long way to go to achieve it.Many unfortunate trends must be reversed-neglect of mental health services and care,and abuses of human rights and discrimination against people with mental disorders and psychosocial disabilities. Drctor-Gemerni This comprehensive action plan recognizes the essential role of mental health in achieving health for all people.It is based on a life-course approach,aims to achieve equity through universal health coverage and stresses the importance of prevention. Four major objectives are set forth:more effective leadership and governance for mental health:the provision of comprehen- sive,integrated mental health and social care services in community-based settings:implementation of strategies for promo- tion and prevention:and strengthened information systems,evidence and research. Although the targets of this action plan are ambitious,WHO and its Member States are committed to fulfilling them. hML人a Dr Margaret Chan Director-General World Health Organization
FOREWORD Menial welt-being is a fundamental component of WHO's definition of health. Good menial health enables people to realize their potential, cope with the normal stresses of life, work productively, and contribute to their communities. Menial health mailers, but the world has a long way to go to achieve it. Many unfortunate trends must be reversed-neglect of mental health services and care, and abuses of human rights and discrimination against people with mental disorders and psychosocial disabilities. This comprehensive action plan recognizes the essential role of menial health in achieving health for all people. It is based on a life-course approach, aims to achieve equity through universal health coverage and stresses the importance of prevention. Four major objectives are set forth: more effective leadership and governance for mental health; the provision of comprehensive. integrated mental health and social care services in community-based settings; implementation of strategies for promotion and prevention; and strengthened information systems, evidence and research. Although the targets of this action plan are ambitious, WHO and its Member Slates are committed to fulfilling them. Dr Margaret Chan Director-General World Health Organization 05
Mental Health Action Plan 2013 2020 SETTING THE SCENE 01 In May 2012,the Sixty-fifth World Health Assembly adopted resolution WHA65.4 on the global burden of mental disorders and the need for a comprehensive,coordinated response from health and social sectors at the country level.It requested the Director-General,inter alia,to develop a comprehensive mental health action plan,in consultation with Member States,cover- ing services,policies,legislation,plans,strategies and programmes. 02 This comprehensive action plan has been elaborated through consultations with Member States,civil society and interna- tional partners.It takes a comprehensive and multisectoral approach,through coordinated services from the health and social sectors,with an emphasis on promotion,prevention,treatment,rehabilitation,care and recovery.It also sets out clear actions for Member States,the Secretariat and international,regional and national level partners,and proposes key indicators and targets that can be used to evaluate levels of implementation.progress and impact.The action plan has,at its core,the globally accepted principle that there is"no health without mental health" 03 The action plan has close conceptual and strategic links to other global action plans and strategies endorsed by the Health Assembly,including the global strategy to reduce the harmful use of alcohol,the global plan of action for workers'health. 2008-2017,the action plan for the global strategy for the prevention and control of noncommunicable diseases,2008-2013,and the global action plan for the prevention and control of noncommunicable diseases (2013-2020).It also draws on WHO's regional action plans and strategies for mental health and substance abuse that have been adopted or are being developed.The action plan has been designed to create synergy with other relevant programmes of organizations in the United Nations system,United Nations interagency groups and intergovernmental organizations. 04 The action plan builds upon,but does not duplicate,the work of WHO's mental health gap action programme (mhGAP).The focus of the latter was to expand services for mental health in low resource settings.The action plan is global in its scope and is designed to provide quidance for national action plans.It addresses,for all resource settings,the response of social and other relevant sectors,as well as promotion and prevention strategies. 05 In this action plan,the term"mental disorders"is used to denote a range of mental and behavioural disorders that fall within the International Statistical Classification of Diseases and Related Health Problems,Tenth revision (ICD-10).These include disorders that cause a high burden of disease such as depression,bipolar affective disorder,schizophrenia,anxiety disorders, dementia,substance use disorders,intellectual disabilities,and developmental and behavioural disorders with onset usually occurring in childhood and adolescence,including autism.For dementia and substance use disorders,additional prevention strategies may also be required (as described,for example,in a WHO report on dementia issued in early 20122 and in the global strategy to reduce the harmful use of alcohol).Furthermore,the plan covers suicide prevention and many of the actions are also relevant to conditions such as epilepsy.The term "vulnerable groups"is used in the action plan to refer to individuals or groups of individuals who are made vulnerable by the situations and environments that they are exposed to(as opposed to any inherent weakness or lack of capacity).The term"vulnerable groups"should be applied within countries as appropriate to the national situation. 06 The action plan also covers mental health,which is conceptualized as a state of well-being in which the individual realizes his or her own abilities,can cope with the normal stresses of life,can work productively and fruitfully,and is able to make a contribution to his or her community.With respect to children,an emphasis is placed on the developmental aspects.for instance,having a positive sense of identity,the ability to manage thoughts,emotions,as well as to build social relationships. and the aptitude to learn and to acquire an education,ultimately enabling their full active participation in society. Annex ll provides a glossary of main terms links to other global oction plans strategies and programmes intemational and regional humon nights treaties and selected WHO technical materials and resources on mental heaith Alzheimer's Disease International Dementia a public health probtem.Genevo.World Health Organization,2012
06 Mental Health Action Plan iiI1-' 2 of.-' SE IIING THE SCENE 01 In May 2012, the Sixty-fifth World Health Assembly adopted resolution WHA65.4 on the global burden of menial disorders and the need for a comprehensive, coordinated response from health and social sectors at the country level. II requested the Director-General, inter alia, to develop a comprehensive mental health action plan, in consultation with Member States, covering services, policies. legislation. plans, strategies and programmes. 02 This comprehensive action plan has been elaborated through consultations with Member States, civil society and international partners. It lakes a comprehensive and multisectoral approach, through coordinated services from the health and social sectors, with an emphasis on promotion, prevention, treatment, rehabilitation, care and recovery. It also sets out clear actions for Member States, the Secretariat and international, regional and national level partners, and proposes key indicators and targets that can be used to evaluate levels of implementation, progress and impact. The action plan has, at its core, the globally accepted principle that there is "no health without mental health·.1 03 The action plan has close conceptual and strategic links to other global action plans and strategies endorsed by the Health Assembly, including the global strategy to reduce the harmful use of alcohol. the global plan of action for workers' health, 2008-2017, the action plan for the global strategy for the prevention and control of noncommunicable diseases, 2008-2013, and the global action plan for the prevention and control of noncommunicable diseases (2013-2020]. It also draws on WHO's regional action plans and strategies for mental health and substance abuse that have been adopted or are being developed. The action plan has been designed to create synergy with other relevant programmes of organizations in the United Nations system, United Nations interagency groups and intergovernmental organizations. 04 The action plan builds upon, but does not duplicate, the work of WHO's mental health gap action programme [mhGAPj. The focus of the latter was to expand services for mental health in low resource settings. The action plan is global in its scope and is designed to provide guidance for national action plans. It addresses, for all resource settings, the response of social and other relevant sectors, as well as promotion and prevention strategies. OS ln this action plan, the term "mental disorders· is used to denote a range of mental and behavioural disorders that fall within the International Statistical Classification of Diseases and Related Health Problems, Tenth revision lICD-10]. These include disorders that cause a high burden of disease such as depression, bipolar affective disorder, schizophrenia, anxiety disorders, dementia, substance use disorders, intellectual disabilities, and developmental and behavioural disorders with onset usually occurring in childhood and adolescence, including autism. For dementia and substance use disorders, additional prevention strategies may also be required [as described, for example, in a WHO report on dementia issued in early 20122 and in the global strategy to reduce the harmful use of alcohol). Furthermore, the plan covers suicide prevention and many of the actions are also relevant to conditions such as epilepsy. The term "vulnerable groups· is used in the action plan to refer to individuals or groups of individuals who are made vulnerable by the situations and environments that they are exposed to (as opposed to any inherent weakness or lack of capacity]. The term "vulnerable groups" should be applied within countries as appropriate to the national situation. 06 The action plan also covers mental health, which is conceptualized as a state of well-being in which the individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her community. With respect to children, an emphasis is placed on the developmental aspects, for instance, having a positive sense of identity, the ability to manage thoughts, emotions, as well as to build social relationships, and the aptitude to learn and to acquire an education, ultimately enabling their full active participation in society. , Annex 1/ proVideS a glossary of mom terms. Imks to other glOOoI oc/ion pions. strategies and programmes, mtemo/ionol and reglOnol human fights treaties. and selected WHO techmcol molenals and resources on mental health 1 Alzheimer's Dlseose IntemotlOnal DementlO a publIC health problem Genevo. World Health OrgonlZaliOn. 2012
Mental Health Actlon Plan 2013.2020 07 In the light of widespread human rights violations and discrimination experienced by people with mental disorders,a human rights perspective is essential in responding to the global burden of mental disorders.The action plan emphasizes the need for services,policies,legislation,plans,strategies and programmes to protect,promote and respect the rights of persons with mental disorders in line with the International Covenant on Civil and Political Rights,the International Covenant on Economic. Social and Cultural Rights,the Convention on the Rights of Persons with Disabilities,the Convention on the Rights of the Child and other relevant international and regional human rights instruments. OVERVIEW OF THE GLOBAL SITUATION 08 Mental health is an integral part of health and well-being.as reflected in the definition of health in the Constitution of the World Health Organization:"Health is a state of complete physical,mental and social well-being and not merely the absence of disease or infirmity.Mental health,like other aspects of health,can be affected by a range of socioeconomic factors (described below)that need to be addressed through comprehensive strategies for promotion.prevention.treatment and recovery in a whole-of-government approach. Mental health and disorders:determinants and consequences 09Determinants of mental health and mental disorders include not only individual attributes such as the ability to manage one's thoughts,emotions,behaviours and interactions with others,but also social,cultural,economic,political and environ- mental factors such as national policies,social protection,living standards,working conditions,and community social supports Exposure to adversity at a young age is an established preventable risk factor for mental disorders. 10 Depending on the local context,certain individuals and groups in society may be placed at a significantly higher risk of expe- riencing mental health problems.These vulnerable groups may (but do not necessarily]include members of households living in poverty.people with chronic health conditions,infants and children exposed to maltreatment and neglect,adolescents first exposed to substance use,minority groups,indigenous populations,older people,people experiencing discrimination and human rights violations,lesbian.gay.bisexual,and transgender persons,prisoners,and people exposed to conflict,natural disasters or other humanitarian emergencies.The current global financial crisis provides a powerful example of a macroeco- nomic factor leading to cuts in funding despite a concomitant need for more mental health and social services because of higher rates of mental disorders and suicide as well as the emergence of new vulnerable groups (for example,the young unem- ployed).In many societies,mental disorders related to marginalization and impoverishment,domestic violence and abuse,and overwork and stress are of growing concern,especially for women's health. 1I People with mental disorders experience disproportionately higher rates of disability and mortality.For example,persons with major depression and schizophrenia have a 40%to 60%greater chance of dying prematurely than the general population. owing to physical health problems that are often left unattended(such as cancers.cardiovascular diseases,diabetes and HIV infection)and suicide.Suicide is the second most common cause of death among young people worldwide. 12 Mental disorders often affect,and are affected by,other diseases such as cancer,cardiovascular disease and HIV infection/AIDS.and as such require common services and resource mobilization efforts.For example,there is evidence that depression predisposes people to myocardial infarction and diabetes,both of which conversely increase the likelihood of depression.Many risk factors such as low socioeconomic status,alcohol use and stress are common to both mental disorders and other noncommunicable diseases.There is also substantial concurrence of mental disorders and substance use disorders. Taken together,mental,neurological and substance use disorders exact a high toll,accounting for 13%of the total global burden
Mental Health Action Plan 2DI J 20n 07 In the light of widespread human rights violations and discrimination experienced by people with mental disorders, a human rights perspective is essentiaL in responding to the global burden of mental disorders. The action pLan emphasizes the need for services, policies, legislation, plans, strategies and programmes to protect, promote and respect the rights of persons with mentaL disorders in Line with the InternationaL Covenant on Civil and PoliticaL Rights, the International Covenant on Economic, Social and Cultural Rights, the Convention on the Rights of Persons with Disabilities, the Convention on the Rights of the Child and other relevant international and regionaL human rights instruments. OVERVIEW OF THE GLOBAL SITUATION 07 08 Mental health is an integral part of health and well-being, as reflected in the definition of health in the Constitution of the World Health Organization, "HeaLth is a state of complete physical, mental and sociaL well-being and not mereLy the absence of disease or infirmity." Mental health, like other aspects of health, can be affected by a range of socioeconomic factors [described below) that need to be addressed through comprehensive strategies for promotion, prevention, treatment and recovery in a whole-of-government approach. Mental health and disorders, determinants and consequences 09 Determinants of mental health and mental disorders include not onLy individual attributes such as Ihe ability to manage one's thoughts, emotions, behaviours and interactions with others, but also social. cultural. economic, political and environmentaL factors such as national policies, sociaL protection, living standards, working conditions, and community sociaL supports. Exposure to adversity at a young age is an established preventable risk factor for mental disorders. 10 Depending on the local context, certain individuals and groups in society may be placed at a significantly higher risk of experiencing mentaL health problems. These vulnerable groups may [but do not necessarily) include members of househoLds living in poverty, people with chronic health conditions, infants and children exposed to maltreatment and neglect, adolescents first exposed to substance use, minority groups, indigenous popuLations, older people, people experiencing discrimination and human rights violations, lesbian, gay, bisexual. and transgender persons, prisoners, and people exposed to conflict, natural disasters or other humanitarian emergencies. The current globaL financial crisis provides a powerfuL example of a macroeconomic factor leading to cuts in funding despite a concomitant need for more mental health and social services because of higher rates of mentaL disorders and suicide as welt as the emergence of new vuLnerable groups [for example, the young unemployed). In many societies, mental disorders related to marginalization and impoverishment, domestic violence and abuse, and overwork and stress are of growing concern, especially for women's health, 11 PeopLe with mental disorders experience disproportionately higher rates of disability and mortality. For example, persons with major depression and schizophrenia have a 40% to 60% greater chance of dying prematurely than the general population, owing to physical health problems that are often left unattended [such as cancers, cardiovascular diseases, diabetes and HIV infection) and suicide. Suicide is the second most common cause of death among young people worldwide. 12 Mental disorders often affect, and are affected by, other diseases such as cancer, cardiovascular disease and HIV infection/AIDS, and as such require common services and resource mobilization efforts. For example, there is evidence that depression predisposes people to myocardial infarction and diabetes, both of which conversely increase the likelihood of depression. Many risk factors such as low socioeconomic status, aLcohoL use and stress are common to both mental disorders and other noncommunicable diseases. There is also substantial concurrence of mental disorders and substance use disorders. Taken together, mental, neurologicaL and substance use disorders exact a high toLL, accounting for 13% of the total gLobaL burden
08 Mental Health Action Plan 2013-2020 of disease in the year 2004.Depression alone accounts for 4.3%of the global burden of disease and is among the largest single causes of disability worldwide [11%of all years lived with disability globally),particularly for women.The economic conse- quences of these health losses are equally large:a recent study estimated that the cumulative global impact of mental disor- ders in terms of lost economic output will amount to US$16.3 million million between 2011 and 2030.3 13 Mental disorders frequently lead individuals and families into poverty.Homelessness and inappropriate incarceration are far more common for people with mental disorders than for the general population,and exacerbate their marginalization and vulnerability.Because of stigmatization and discrimination,persons with mental disorders often have their human rights violated and many are denied economic,social and cultural rights,with restrictions on the rights to work and education,as well as reproductive rights and the right to the highest attainable standard of health.They may also be subject to unhygienic and inhuman living conditions,physical and sexual abuse,neglect,and harmful and degrading treatment practices in health facilities.They are often denied civil and political rights such as the right to marry and found a family.personal liberty,the right to vote and to participate effectively and fully in public life.and the right to exercise their legal capacity on other issues affecting them,including their treatment and care.As such,persons with mental disorders often live in vulnerable situations and may be excluded and marginalized from society,which constitutes a significant impediment to the achievement of national and international development goals.The Convention on the Rights of Persons with Disabilities,which is binding on States Parties that have ratified or acceded to it,protects and promotes the rights of all persons with disabilities,including persons with mental and intellectual impairments,and also promotes their full inclusion in international cooperation including international development programmes. Health system resources and responses 14 Health systems have not yet adequately responded to the burden of mental disorders:as a consequence,the gap between the need for treatment and its provision is large all over the world.Between 76%and 85%of people with severe mental disor- ders receive no treatment for their disorder in low-income and middle-income countries;the corresponding range for high- income countries is also high:between 35%and 50%.A further compounding problem is the poor quality of care for those receiving treatment.WHO's Mental Health Atlas 2011 provides data that demonstrate the scarcity of resources within countries to meet mental health needs,and underlines the inequitable distribution and inefficient use of such resources.Globally,for instance,annual spending on mental health is less than US$2 per person and less than US$0.25 per person in low-income countries,with 67%of these financial resources allocated to stand-alone mental hospitals,despite their association with poor health outcomes and human rights violations.Redirecting this funding towards community-based services.including the integration of mental health into general health care settings,and through maternal,sexual,reproductive and child health. HIV/AIDS and chronic noncommunicable disease programmes.would allow access to better and more cost-effective interven- tions for many more people. 15 The number of specialized and general health workers dealing with mental health in low-income and middle-income coun- tries is grossly insufficient.Almost half the world's population lives in countries where,on average,there is one psychiatrist to serve 200 000 or more people,other mental health care providers who are trained in the use of psychosocial interventions are even scarcer.Similarly,a much higher proportion of high-income countries than low-income countries reports having a policy. plan and legislation on mental health:for instance,only 36%of people living in low income countries are covered by mental health legislation compared with 92%in high-income countries. Wordd Economic Forum the Harvard School of Public Heollh The globol economc burden of non-cummumcuble dseases Genevo.Wortd Economic Forum.2011 Mental health and development,targeting people with mental health conditions as a vulnerable group Geneva,World Heatth Organization,2010
08 Mental Health Action Plan :'0 1 < J _'.: ! of disease in the year 2004. Depression alone accounts for 4.3% of the global burden of disease and is among the largest single causes of disabiLity worldwide (11 % of all years lived with disabiLity gLobaLLy], particularly for women. The economic consequences of these health tosses are equally large: a recent study estimated thai the cumulative global impact of mental disorders in terms of Lost economic output wiLL amount to US$16.3 million million between 2011 and 2030 ,3 13 MeniaL disorders frequently lead individuals and famiLies into poverty.' Homelessness and inappropriate incarceration are far more common for people with mental disorders than for the general population, and exacerbate their marginalization and vuLnerability. Because of stigmatization and discrimination, persons with mentaL disorders often have their human rights violated and many are denied economic, social and culturaL rights, with restrictions on the rights to work and education, as well as reproductive rights and the right to the highest attainable standard of heaLth, They may atso be subject to unhygienic and inhuman living conditions, physical and sexual abuse, neglect, and harmful and degrading treatment practices in health faciLities. They are often denied civiL and poLitical rights such as the right to marry and found a family, personal Liberty, the right to vote and to participate effectively and fully in public life, and the right to exercise their legal capacity on other issues affecting them, including their treatment and care. As such, persons with mental disorders often live in vulnerable situations and may be excluded and marginalized from society, which constitutes a significant impediment to the achievement of nationaL and internationaL development goaLs. The Convention on the Rights of Persons with Disabilities, which is binding on States Parties that have ratified or acceded to it, protects and promotes the rights of all persons with disabilities, including persons with mental and intellectuaL impairments, and also promotes their fuLL inclusion in international cooperation including international development programmes. Health system resources and responses 14 Health systems have not yet adequately responded to the burden of mental disorders; as a consequence, the gap between Ihe need for treatment and its provision is large alL over the worLd. Between 76% and 85% of people with severe mentaL disorders receive no treatment for their disorder in low-income and middle-income countries; the corresponding range for highincome countries is also high: between 35% and 50%. A further compounding problem is the poor quality of care for those receiving treatment. WHO's Mental Health Atlas 2011 provides data that demonstrate the scarcity of resources within countries to meet mentaL health needs, and underlines the inequitable distribution and inefficient use of such resources. GlobalLy, for instance, annual spending on mental health is Less than US$ 2 per person and less than US$ 0.25 per person in low-income countries, with 67% of these financiaL resources aLLocated to stand-alone mental hospitals, despite their association with poor health outcomes and human rights violations. Redirecting this funding towards community-based services, including the integration of mental health into general health care settings, and through maternal, sexual, reproductive and child health, HIV/AIDS and chronic noncommunicabLe disease programmes, wouLd allow access to better and more cost-effective intervenlions for many more peopLe, 15 The number of specialized and general health workers dealing with meniaL health in low-income and middle-income countries is grossly insufficient. Almost half the world's population lives in countries where, on average, there is one psychiatrist to serve 200 000 or more people. other mental health care providers who are trained in the use of psychosocial interventions are even scarcer. Similarly, a much higher proportion of high-income countries than low-income countries reports having a policy, pLan and LegisLation on mental health: for instance, onLy 36% of people living in Low income countries are covered by mental health legislation compared with 92% in high-income countries. J World Economic Forum, Ihe Horvord School of PublIC HeoUh TIle global economic burden of non-communlCoble diseases Geneva, World EconomiC Forum. lOll • Menlol heallh anddevelapmenl largelmg people With menial heallh condillans as a vulnerable group. Geneva, Warld Health Orgafllzallon, 2010
Mental Health Action Plan 2013-2020 09 16 Civil society movements for mental health in low-income and middle-income countries are not well developed.Organiza- tions of people with mental disorders and psychosocial disabilities are present in only 49%of low-income countries compared with 83%of high-income countries;for family associations the respective figures are 39%and 80%. 17 Finally,the availability of basic medicines for mental disorders in primary health care is notably low (in comparison to medi- cines available for infectious diseases and even other noncommunicable diseases).and their use restricted because of the lack of qualified health workers with the appropriate authority to prescribe medications.In addition,the availability of non- pharmacological approaches and trained personnel to deliver these interventions is also lacking.Such factors act as important barriers to appropriate care for many persons with mental disorders. 18 To improve the situation,and in addition to the data on mental health resources in countries (from WHO's Mental Health Atlas 2011,as well as the more detailed profiling obtained through use of WHO's assessment instrument for mental health systems).5 information is available on cost-effective and feasible mental health interventions that can be expanded to a larger scale to strengthen mental health care systems in countries.WHO's Mental Health Gap Action Programme,launched in 2008, uses evidence-based technical guidance.tools and training packages to expand service provision in countries,especially in resource-poor settings.It focuses on a prioritized set of conditions and,importantly,directs its capacity building towards non- specialized health care providers in an integrated approach that promotes mental health at all levels of care. 19 The Secretariat has elaborated other technical tools and guidance in support of countries in developing comprehensive mental health policies,plans and laws that promote improved quality and availability of mental health care (such as the WHO mental health policy and service guidance package);in improving quality and respecting the rights of persons with mental disorders in health services (the WHO QualityRights toolkit):"and for disaster relief and post-disaster mental health system reconstruction (including the Inter-Agency Standing Committee Guidelines in mental health and psychosocial support in emer- gency settings).Knowledge,information and technical tools are necessary but not sufficient;strong leadership,enhanced partnerships and the commitment of resources towards implementation are also required in order to move decisively from evidence to action and evaluation. STRUCTURE OF THE COMPREHENSIVE ACTION PLAN 2013-2020 20 The vision of the action plan is a world in which mental health is valued,promoted and protected,mental disorders are prevented and persons affected by these disorders are able to exercise the full range of human rights and to access high quality. culturally-appropriate health and social care in a timely way to promote recovery,in order to attain the highest possible level of health and participate fully in society and at work,free from stigmatization and discrimination. 21 Its overall goal is to promote mental well-being.prevent mental disorders,provide care,enhance recovery.promote human rights and reduce the mortality,morbidity and disability for persons with mental disorders. WHO-AIMS version 22 World Health Organuzption ossessment instrument for mental heallh systems,Genevo World Health Orgonuzation,200 (document WHO/MSD/MER/052 hllpwrw ntn/menlal hie cbpolicwFsseriaipochnnerennneenom iaccessed 24 May 2013) WHO QualryRights tool kit ossessing and improving quolty and human nghtsn mental health and sre foces Genevo.World Heatth Orgonzaon 2012 Inter-Agency Standing Committee IASC guidelines on mental heaith and psychosocal suppont in emergency settngs Gepeva.inter-Agency Standing Commttee 2007
Mental Health Action Plan 2013 - 2020 16 Civil society movements for mental health in low-income and middle-income countries are not well developed. Organizations of people with mental disorders and psychosocial disabilities are present in only 49% of low-income countries compared with 83% of high-income countries; for family associations the respective figures are 39% and 80%, 17 Finally, the availability of basic medicines for mental disorders in primary health care is notably low (in comparison to medicines available for infectious diseases and even other noncommunicable diseasesJ. and their use restricted because of the lack of qualified health workers with the appropriate authority to prescribe medications. In addition, the availability of nonpharmacological approaches and trained personnel to deliver these interventions is also lacking. Such factors act as important barriers to appropriate care for many persons with mental disorders. 18 To improve the situation, and in addition to the data on mental health resources in countries [from WHO's Mental Health Atlas 2011, as well as the more detailed profiling obtained through use of WHO's assessment instrument for mental health systemsl. ~ information is available on cost-effective and feasible mental health interventions that can be expanded to a larger scale to strengthen mental health care systems in countries. WHO's Menial Health Gap Action Programme, launched in 2008, uses evidence- based technical guidance, tools and training packages to expand service provision in countries, especially in resource-poor settings. It focuses on a prioritized set of conditions and, importantly, directs its capacity building towards nonspecialized health care providers in an integrated approach that promotes mental health at all levels of care. 19 The Secretariat has elaborated other technical tools and guidance in support of countries in developing comprehensive mental health policies, plans and laws that promote improved quality and availability of mental health care [such as the WHO mental health policy and service guidance package);6 in improving quality and respecting the rights of persons with mental disorders in health services [the WHO QualityRights toolki!);? and for disaster relief and post-disaster mental health system reconstruction (including the Inter-Agency Standing Committee Guidelines in mental health and psychosocial support in emergency settingsJ.B Knowledge, information and technical tools are necessary but not sufficient; strong leadership, enhanced partnerships and the commitment of resources towards implementation are also required in order to move decisively from evidence to action and evaluation. STRUCTURE OF THE COMPREHENSIVE ACTION PLAN 2013-2020 20 The vision of the action plan is a wortd in which mental health is valued, promoted and protected, mental disorders are prevented and persons affected by these disorders are able to exercise the full range of human rights and to access high quality, culturally-appropriate health and social care in a timely way to promote recovery, in order to attain the highest possible level of health and participate fully in society and at work, free from stigmatization and discrimination. 21 Its overall goal is to promote mental well-being, prevent mental disorders, provide care, enhance recovery, promote human rights and reduce the mortality, morbidity and disability for persons with mental disorders. , WHO-AIMS versIon 22· Wond Health Drgantzol(on assessment (nstrument tor menial health syslems, Geneva. Wand HeaUh OrQantza((on. 2005 (documenl WHOIMSDIMERJU5 21 • http Iwww who mllmenlal_heallh/pol!Cy/es~'!nliOlpockagel!en/mdex hlml (accessed 24 May 2013} , WHO QuollryRlQhls 1001 kit ossessUlQ ond ImprovUlg quality ond humon nghts UI mentol heolth ond SOCial core {oolltles Genevo, Wand Health DrgantzollOfl, 2012. ' Inter-Agency Siandmg Commlllee IASC gUldelllles on mental heolth ond psychosoclol support m emergency settings Genevo. Inter-Agency Standing Committee, 2007 09
10 Mental Health Action Plan 20132020 22 The action plan has the following objectives: 1 to strengthen effective leadership and governance for mental health 2.to provide comprehensive.integrated and responsive mental health and social care services in community-based settings: 3 to implement strategies for promotion and prevention in mental health: 4 to strengthen information systems,evidence and research for mental health. The global targets established for each objective provide the basis for measurable collective action and achievement by Member States towards global goals and should not negate the setting of more ambitious national targets,particularly for those countries that have already reached global ones.Indicators for measuring progress towards defined global targets are provided in Appendix 1. 23 The action plan relies on six cross-cutting principles and approaches 1Universal health coverage:Regardless of age,sex,socioeconomic status.race.ethnicity or sexual orientation,and following the principle of equity.persons with mental disorders should be able to access,without the risk of impoverishing themselves,essential health and social services that enable them to achieve recovery and the highest attainable standard of health. 2.Human rights:Mental health strategies,actions and interventions for treatment,prevention and promotion must be compliant with the Convention on the Rights of Persons with Disabilities and other international and regional human rights instruments. 3 Evidence-based practice:Mental health strategies and interventions for treatment,prevention and promotion need to be based on scientific evidence and/or best practice,taking cultural considerations into account. Life course opproach:Policies,plans and services for mental health need to take account of health and social needs at all stages of the life course,including infancy,childhood,adolescence,adulthood and older age. 5.Multisectoral approach:A comprehensive and coordinated response for mental health requires partnership with multiple public sectors such as health,education,employment,judicial,housing,social and other relevant sectors as well as the private sector,as appropriate to the country situation. Empowerment of persons with mental disorders and psychosocial disabilities:Persons with mental disorders and psychosocial disabilities should be empowered and involved in mental health advocacy.policy,planning.legislation. service provision,monitoring.research and evaluation. 24 The framework provided in this action plan needs to be adapted at regional level in order to take into account region-specific situations.The actions proposed for Member States are to be considered and adapted,as appropriate,to national priorities and specific national circumstances in order to accomplish the objectives.There is no blueprint action plan that fits all countries,as countries are at different stages in developing and implementing a comprehensive response in the area of mental health
10 Mental Health Action Plan :'UI < J _'.: ! 22 The action plan has the following objectives: 1 10 strengthen effective leadership and governance for menial health: 2 to provide comprehensive. integrated and responsive mental health and sociaL care services in community-based settings; 3 to implement strategies for promotion and prevention in menial health; 4 to strengthen information systems, evidence and research for mental health. The global targets established lor each objective provide the basis for measurable collective action and achievement by Member Slates towards global goals and should not negate the selling of more ambitious national targets. particularly for those countries thai have already reached global ones. Indicators for measuring progress towards defined global targets are provided in Appendix 1. 23 The action plan relies on six cross-cutting principles and approaches: 1 Universal health coverage, Regardless of age, sex, socioeconomic status, race, ethnicity or sexual orientation, and following the principle of equity, persons with mental disorders should be able to access, without the risk of impoverishing themselves, essential health and social services that enable them to achieve recovery and the highest attainable standard of health. 2. Human rights: Mental health strategies, actions and interventions for treatment, prevention and promotion must be compliant with the Convention on the Rights of Persons with Disabilities and other international and regional human rights instruments. 3. Evidence-based practice: Mental health strategies and interventions for treatment, prevention and promotion need to be based on scientific evidence and/or best practice, taking cultural considerations into account. 4 Life course approach, Policies, plans and services for mental health need to take account of health and social needs at all stages of the life course, including infancy, childhood, adolescence, adulthood and older age. 5 Muitisectoral approach: A comprehensive and coordinated response for mental health requires partnership with multiple public sectors such as health, education, employment, judicial, housing, social and other relevant sectors as well as the private sector, as appropriate to the country situation. 6 Empowerm ent of persons with mental disorders and psychosocial disabilities: Persons with mental disorders and psychosocial disabilities should be empowered and involved in mental health advocacy, policy, planning, legislation, service provision, monitoring, research and evaluation. 24 The framework provided in this action plan needs to be adapted at regional level in order to take into account region-specific situations. The actions proposed for Member States are to be considered and adapted, as appropriate, to national priorities and specific national circumstances in order to accomplish the objectives. There is no blueprint action plan that fils all countries, as countries are at different stages in developing and implementing a comprehensive response in the area of mental health
Mental Health Action Plan 2013-2020 PROPOSED ACTIONS FOR MEMBER STATES AND INTERNATIONAL AND NATIONAL PARTNERS AND ACTIONS FOR THE SECRETARIAT 25 To achieve the plan's stated vision,goal and objectives,specific actions are proposed for Member States and for international and national partners.In addition,actions for the Secretariat have been identified.Although actions are specified separately for each objective,many of these will also contribute to the attainment of the other objectives of the action plan.Some possible options to implement these actions are proposed in Appendix 2. 26 Effective implementation of the global mental health action plan will require actions by international,regional and national partners.These partners include but are not limited to: development agencies including international multilateral agencies (for example,the World Bank and United Nations development agencies),regional agencies (for example,regional development banks),subregional intergovernmental agencies and bilateral development aid agencies; academic and research institutions including the network of WHO collaborating centres for mental health,human rights and social determinants of health and other related networks,within developing and developed countries: civil society,including organizations of persons with mental disorders and psychosocial disabilities,service-user and other similar associations and organizations,family member and carer associations,mental health and other related nongovernmental organizations,community-based organizations,human rights-based organizations,faith-based organizations,development and mental health networks and associations of health care professionals and service providers. 27 The roles of these three groups are often overlapping and can include multiple actions across the areas of governance. health and social care services,promotion and prevention in mental health,and information,evidence and research (see actions listed below).Country-based assessments of the needs and capacity of different partners will be essential to clarify the roles and actions of key stakeholder groups. Objective 1:To strengthen effective leadership and governance for mental health 28 Planning,organizing and financing health systems is a complex undertaking involving multiple stakeholders and different administrative levels.As the ultimate guardian of a population's mental health,governments have the lead responsibility to put in place appropriate institutional,legal,financing and service arrangements to ensure that needs are met and the mental health of the whole population is promoted. 29 Governance is not just about government,but extends to its relationship with nongovernmental organizations and civil society.A strong civil society,particularly organizations of people with mental disorders and psychosocial disabilities and families and carers,can help to create more effective and accountable policies,laws and services for mental health in a manner consistent with international and regional human rights instruments. 30 Among the key factors for developing effective policies and plans addressing mental health are strong leadership and commitment by governments,involvement of relevant stakeholders,clear elaboration of areas for action,formulation of financially-informed and evidence-based actions,explicit attention to equity,respect for the inherent dignity and human rights of people with mental disorders and psychosocial disabilities,and the protection of vulnerable and marginalized groups
Mental Health Action Plan 2013 2020 PROPOSED ACTIONS FOR MEMBER STATES AND INTERNATIONAL AND NATIONAL PARTNERS AND ACTIONS FOR THE SECRETARIAT 25 To achieve the plan's stated vision, goal and objectives, specific actions are proposed for Member States and for international and national partners. In addition, actions for the Secretariat have been identified. Although actions are specified separately for each objective, many of these will also contribute to the attainment of the other objectives of the action plan. Some possible options to implement these actions are proposed in Appendix 2. 26 Effective implementation of the global mental health action plan will require actions by international, regional and national partners. These partners include but are not limited to: • development agencies including international multilateral agencies [for example, the World Bank and United Nations development agencies), regional agencies (for example, regional development banks), subregional intergovernmental agencies and bilateral development aid agencies; • academic and research institutions including the network of WHO collaborating centres for mental health, human rights and sociat determinants of health and other related networks, within developing and developed countries; • civil society. including organizations of persons with mental disorders and psychosocial disabilities, service-user and other similar associations and organizations, family member and carer associations, mental health and other related nongovernmental organizations, community-based organizations, human rights-based organizations, faith-based organizations, development and mental health networks and associations of health care professionals and service providers. 27 The roles of these three groups are often overlapping and can include multiple actions across the areas of governance, health and sociat care services, promotion and prevention in mental health, and information, evidence and research (see actions listed below). Country-based assessments of the needs and capacity of different partners will be essential to clarify the roles and actions of key stakeholder groups. Objective I, To strengthen effective leadership and governance for mental health 28 Ptanning, organizing and financing health systems is a complex undertaking involving multiple stakeholders and different administrative levels. As the ultimate guardian of a population's mental health, governments have the lead responsibility to put in place appropriate institutional, legat, financing and service arrangements to ensure thai needs are met and the mental health of the whole population is promoted. 29 Governance is not just about government, but extends to its relationship with nongovernmental organizations and civil society. A strong civil society, particularly organizations of people with mental disorders and psychosociat disabilities and families and carers, can help to create more effective and accountable policies, laws and services for mental health in a manner consistent with international and regional human rights instruments. 30 Among the key factors for developing effective policies and plans addressing mental health are strong Leadership and commitment by governments, involvement of relevant stakeholders, clear elaboration of areas for action, formulation of financially-informed and evidence-based actions, explicit attention to equity, respect for the inherent dignity and human rights of people with mental disorders and psychosocial disabilities, and the protection of vulnerable and marginalized groups. 11
