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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 conse￾quences of these health tosses are equally large: a recent study estimated thai 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 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 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￾lions for many more peopLe, 15 The number of specialized and general health workers dealing with meniaL 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. 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
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