Supporting governments to adopt mental health policies. Jenkins, R. World psychiatry : official journal of the World Psychiatric Association (WPA), 2(1):14-9, 2003.
Supporting governments to adopt mental health policies. [pdf]Paper  Supporting governments to adopt mental health policies. [link]Website  abstract   bibtex   
It is important to support governments to adopt mental health policies and to integrate mental health policy into public health policy and general social policy (1), because mental disorder causes a heavy burden for societies (2), impedes the development of other health and development targets, contributes to poverty and differentially affects the poor (3,4) and, last but not least, because mental health itself is of intrinsic value as is physical health. In developing mental health policy, it is impor-tant to include consideration of stigma about mental health issues and mental illness. In a pre-vious issue of this journal, the impact of stigma on people with mental illness was discussed (5). Stigma results in a lack of attention from minis-ters and the public, which then results in a lack of resource and morale, decaying institutions, lack of leadership, inadequate information sys-tems, and inadequate legislation. By resulting in social exclusion of people with mental illness, stigma is detrimental not just to people with men-tal illness, but also to the health of society as a whole. All too often our services are departure points for exclusion when they should be step-ping stones for social inclusion. In 2001, the World Health Organization (WHO) devoted both its annual health day and its annual health report to mental health, which called on countries to develop mental health policies (6-8). In the same year, the Institute of Medicine in Washington launched a scientific report on neurological, psychiatric and develop-mental disorders in low income countries, which called for immediate strategic action to reduce the burden of brain disorders (3). The European Commission plays an important role both in Europe and elsewhere and has recently produced a public health framework for mental health (9). At national level, various govern-ments, national non-governmental organiza-tions (NGOs), professional bodies and the media have played important roles in prioritis-ing mental health in their countries (10-12). THE NEED FOR LOCALLY TAILORED SOLUTIONS Epidemiology is fundamental to the overall goals of mental health policy (13). Mental health policy will need to take account of con-textual factors, the epidemiology (range, severi-ty, frequency and duration) of disorders, their accompanying social disability, their mortality and relationship to sociodemographic variables, including geographic variation. A few countries are embarking on a specific rolling programme of detailed national mental health surveys (14) and the WHO is coordinating a world mental health survey programme in a variety of partici-pating countries. Cultural and religious issues are very impor-tant. They influence the value placed by society on mental health, the presentation of symp-toms, illness behaviour, access to services, path-ways through care, the way individuals and fam-ilies manage illness, the way the community responds to illness, the degree of acceptance and support experienced on the one hand, and the degree of stigma and discrimination on the other hand experienced by the person with mental illness. Thus, each country is very differ-ent, with different context, culture, resources and type of existing service structures, and each will require its own mental health strategy, con-taining locally tailored solutions for addressing both the general and specific challenges and issues (15-17).
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