Presentation delivered by Dr Khalid Saeed, Director, Noncommunicable Diseases and Mental Health for the Eastern Mediterranean at the 62nd Session of the WHO Regional Committee for the Eastern Mediterranean

1. Scaling up mental health care: a
framework for action
Agenda item 4(b)
62nd session of the WHO Regional Committee for the
Eastern Mediterranean
Kuwait, 58 October 2015
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2. Background and
context
Scaling up mental health care: a framework for action
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3. Source: Lancet. 2012; 380:222460.
Cause Proportion of total
disease burden (%)
Disability (%) Premature
death (%)
Cardiovascular and
circulatory disorders
11.9 2.8 15.9
Neonatal disorders 8.1 1.2 11.2
Cancer 7.6 0.6 10.7
Mental and substance
use disorders
7.4 22.9 0.5
HIV/AIDS/tuberculosis 5.3 1.4 7.0
Unintentional injuries 4.8 3.4 5.5
Leading causes of global burden of
disease 2010
Scaling up mental health care: a framework for action
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4. Treatment gap
• A range of interventions, spanning medicines, psychological
treatments and social interventions, are available to address this
disease burden
• The estimated cost of providing a package of evidence-based and
cost-effective interventions for prioritized mental disorders is:
» US$ 12 per capita per year in low- and lower-middle
income countries
» US$ 35 in upper-middle income countries
• However, coverage is inadequate. Treatment gaps of 35–50% in
developed countries and 76–85% in less developed countries
have been documented for serious disorders.
Scaling up mental health care: a framework for action
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5. Comprehensive mental health action plan 20132020
Vision
A world in which mental health is valued, promoted and protected, mental disorders are
effectively 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, all in order to attain the highest possible level of health
and participate fully in society and at work free from stigma and discrimination
Goal
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
Objectives and targets
1. To strengthen
effective leadership
and governance for
mental health
Targets 1.1 and 1.2
2. To provide
comprehensive,
integrated and
responsive mental
health and social care
services in community-
based settings
Target 2
3. To implement
strategies for mental
health promotion and
prevention in mental
health
Targets 3.1 and 3.2
4. To strengthen
information systems,
evidence and research
for mental health
Targets 4
Scaling up mental health care: a framework for action
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6. Capacities and resources
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7. Mental health governance:
Policies and legislation
 55% of countries have updated their mental health policies or
plans in the past 5 years, but only 32% of countries have
mental health policies that are fully compliant with
international human rights instruments
 73% of countries have mental health legislation, but only 27%
have mental health legislation that is fully compliant with
international human rights instruments
 No country is fully implementing its existing policy while about
45% of countries are partially implementing the relevant
legislation
Scaling up mental health care: a framework for action
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8. Health services
• The median number of mental health beds per 100 000 population is
6.1 across the Region (1.7 to 6.4 and 11.3 in Group 3, 2 and 1
countries). This compares with over 50 in high-income countries in
the rest of the world
• 64% of psychiatric beds are located in mental hospitals and 36% are
located in community settings
• The median number of mental health workers is 14.6 personnel per
100 000 population in the Region; half that reported in the rest of the
world, and there is extreme variation with greater density of mental
health workers in Group 1 countries.
Scaling up mental health care: a framework for action
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9. Promotion and prevention
• 41% of countries have at least two functioning mental health
promotion and prevention programmes, a similar percentage to the
rest of the world
• 60% of Group 2 countries have more than one functioning national
mental health prevention or promotion programme, which is twice
the rate in Group 1 and Group 3 countries
• Only 14% of countries (all in Group 2) have developed national
suicide prevention strategies.
Scaling up mental health care: a framework for action
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10. Surveillance, monitoring and research
Scaling up mental health care: a framework for action
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• Although 52% of countries regularly
compile mental health specific data,
half the countries have not published a
specific mental health information
report in the past 2 years
• Less than 25% of countries were able
to report on the number of suicide
deaths
• Compared with the global average, the
Region produces one sixth of the
expected number of mental health
publications per million population
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Population Publications
EM Region Rest of World

11. Regional framework
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12. Mental health interventions: “Best buys”
Health care Promotion and prevention Emergencies
• Integration of early recognition
and management of
depression, anxiety,
psychosis disorders, epilepsy
in the basic health delivery
package
• Legislative and regulatory
measures that restrict
access to the means for self-
harm/suicide
• Embedding mental health and
psychosocial support in
national emergency
preparedness response and
recovery plans
• Downsizing of long stay
mental institutions and
relocation to community-
based care
• Mass public awareness
campaigns promoting mental
health literacy and reducing
stigma and discrimination
• Provision of psychological
interventions through
community workers in
complex emergencies
• Continuing care for severe
mental disorders (such as
psychosis) through non-
specialist service delivery
• Universal and targeted
social and emotional
learning programmes using
a whole school approach
• Recognition and management
of mental health problems that
are relevant to emergencies
• Provision of care for complex
and severe mental disorders
in psychiatric units in general
hospital settings
• Parenting skills programmes
Scaling up mental health care: a framework for action
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13. Regional framework for scaling up action on mental health
Governance Health care Promotion and prevention
Surveillance, monitoring
and research
• Establish/update a
multisectoral
national policy and
action plan for
mental health
• Establish mental health
services in general hospitals
for outpatient and short-
stay inpatient care
• Provide cost-effective,
feasible and affordable
preventive interventions
through community and
population-based platforms
Integrate the core
indicators within the
national health
information systems
• Embed mental
health and
psychosocial
support in national
emergency plans
• Integrate delivery of cost-
effective, feasible and
affordable evidence-based
interventions for mental
conditions in primary health
care and other priority
health programmes
• Train emergency responders
to provide psychological
first aid
Enhance national
capacity to undertake
prioritized research
• Review legislation
related to mental
health in line with
international
human rights
instruments
• Provide people with mental
health conditions and their
families with access to self-
help and community-based
interventions
• Integrate priority
mental conditions in
the basic health
delivery package
• Downsize the existing long-
stay mental hospitals
Domains and strategic interventions
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14. Conclusions
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15. Key actions
• Accord higher priority to mental health in the health and
social sector policies and plans to minimize stigma and
discrimination faced by persons suffering from mental
disorders
• Enhance the resources allocated for mental health to
bridge the treatment gap
• Scale up evidence-based interventions to protect the
rights of persons with mental disorders and their care
providers
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16. Thank you
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