Mental Health

Mental Health

    Overview

    Mental health is defined as a state of well-being in which every individual realizes his or her own potential, 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. It is related to the promotion of overall health, the prevention of disease, and the treatment and rehabilitation of people negatively affected by illness.

    Disease Outbreak

    There is no Disease Outbreak data at this time

    Message of the WHO Regional Director for Africa, Dr Matshidiso Moeti, on World Mental Health Day 2015

    On 10 October 2015, we join the rest of the world in commemorating World Mental Health Day under the theme: “Dignity in mental health”. The theme draws attention to the crucial need to ensure that dignity is preserved in all aspects of mental health, ranging from care for patients to the attitudes of the general public.

    In the African Region, it is estimated that one out of every six people suffers from some form of mental disorder. Unfortunately, in the course of treatment, some patients are subjected to undignified treatment, such as being chained to trees or beds, locked in a cage, left without food for many hours, deprived from family support and inadequate personal hygiene. Mental health patients deserve respect and compassion as they cope with their disease, as it is expected of those who suffer from any other disease.

    Some countries in the African Region have implemented a range of measures to improve awareness, restore dignity, and access to mental health services at all levels of the health care system. This includes revision of their mental health legislation in order to protect the rights and dignity of persons affected by the condition. Despite these measures, the promotion of good mental health and understanding of its challenges, together with early detection, treatment, and dignity for the patients are still a concern in many countries of the Region. Furthermore, there is still lack of trained and motivated personnel in the area of mental health and psychiatry.

    In recognition of the need for action to address mental health needs, WHO through its Mental Health Gap Action Programm (mhGAP), supports countries to improve the quality of life and well-being of persons suffering from mental health disorders.

    As we commemorate World Mental Health Day, I appeal to governments and partners to improve mental health by tackling discrimination through individual and community initiatives, as well as  strengthen national programmes, policies and legislative measures. Intensified support from partners, civil society and donors, as well as strengthening the capacity of health care providers will contribute immensely towards addressing this growing problem in the communities and in the Region.

    WHO is committed to continue working and supporting all governments and stakeholders by providing the needed technical support to address and restore dignity in mental health.

    Thank you.

     

    Suicide

    Key facts

    • Close to 800 000 people die due to suicide every year.
    • For every suicide there are many more people who attempt suicide every year. A prior suicide attempt is the single most important risk factor for suicide in the general population.
    • Suicide is the second leading cause of death among 15–29-year-olds.
    • 78% of global suicides occur in low- and middle-income countries.
    • Ingestion of pesticide, hanging and firearms are among the most common methods of suicide globally.

    Introduction

    Every year close to 800 000 people take their own life and there are many more people who attempt suicide. Every suicide is a tragedy that affects families, communities and entire countries and has long-lasting effects on the people left behind. Suicide occurs throughout the lifespan and was the second leading cause of death among 15–29-year-olds globally in 2015.

    Suicide does not just occur in high-income countries, but is a global phenomenon in all regions of the world. In fact, over 78% of global suicides occurred in low- and middle-income countries in 2015.

    Suicide is a serious public health problem; however, suicides are preventable with timely, evidence-based and often low-cost interventions. For national responses to be effective, a comprehensive multisectoral suicide prevention strategy is needed.

    Who is at risk?

    While the link between suicide and mental disorders (in particular, depression and alcohol use disorders) is well established in high-income countries, many suicides happen impulsively in moments of crisis with a breakdown in the ability to deal with life stresses, such as financial problems, relationship break-up or chronic pain and illness.

    In addition, experiencing conflict, disaster, violence, abuse, or loss and a sense of isolation are strongly associated with suicidal behaviour. Suicide rates are also high amongst vulnerable groups who experience discrimination, such as refugees and migrants; indigenous peoples; lesbian, gay, bisexual, transgender, intersex (LGBTI) persons; and prisoners. By far the strongest risk factor for suicide is a previous suicide attempt.

    Methods of suicide

    It is estimated that around 30% of global suicides are due to pesticide self-poisoning, most of which occur in rural agricultural areas in low- and middle-income countries. Other common methods of suicide are hanging and firearms.

    Knowledge of the most commonly used suicide methods is important to devise prevention strategies which have shown to be effective, such as restriction of access to means of suicide.

    Prevention and control

    Suicides are preventable. There are a number of measures that can be taken at population, sub-population and individual levels to prevent suicide and suicide attempts. These include:

    • reducing access to the means of suicide (e.g. pesticides, firearms, certain medications);
    • reporting by media in a responsible way;
    • introducing alcohol policies to reduce the harmful use of alcohol;
    • early identification, treatment and care of people with mental and substance use disorders, chronic pain and acute emotional distress;
    • training of non-specialized health workers in the assessment and management of suicidal behaviour;
    • follow-up care for people who attempted suicide and provision of community support.

    Suicide is a complex issue and therefore suicide prevention efforts require coordination and collaboration among multiple sectors of society, including the health sector and other sectors such as education, labour, agriculture, business, justice, law, defense, politics, and the media. These efforts must be comprehensive and integrated as no single approach alone can make an impact on an issue as complex as suicide.

    Challenges and obstacles

    Stigma and taboo

    Stigma, particularly surrounding mental disorders and suicide, means many people thinking of taking their own life or who have attempted suicide are not seeking help and are therefore not getting the help they need. The prevention of suicide has not been adequately addressed due to a lack of awareness of suicide as a major public health problem and the taboo in many societies to openly discuss it. To date, only a few countries have included suicide prevention among their health priorities and only 28 countries report having a national suicide prevention strategy.

    Raising community awareness and breaking down the taboo is important for countries to make progress in preventing suicide.

    Data quality

    Globally, the availability and quality of data on suicide and suicide attempts is poor. Only 60 Member States have good-quality vital registration data that can be used directly to estimate suicide rates. This problem of poor-quality mortality data is not unique to suicide, but given the sensitivity of suicide – and the illegality of suicidal behaviour in some countries – it is likely that under-reporting and misclassification are greater problems for suicide than for most other causes of death.

    Improved surveillance and monitoring of suicide and suicide attempts is required for effective suicide prevention strategies. Cross-national differences in the patterns of suicide, and changes in the rates, characteristics and methods of suicide highlight the need for each country to improve the comprehensiveness, quality and timeliness of their suicide-related data. This includes vital registration of suicide, hospital-based registries of suicide attempts and nationally representative surveys collecting information about self-reported suicide attempts.

    WHO response

    WHO recognizes suicide as a public health priority. The first WHO World Suicide Report “Preventing suicide: a global imperative” published in 2014, aims to increase the awareness of the public health significance of suicide and suicide attempts and to make suicide prevention a high priority on the global public health agenda. It also aims to encourage and support countries to develop or strengthen comprehensive suicide prevention strategies in a multisectoral public health approach.

    Suicide is one of the priority conditions in the WHO Mental Health Gap Action Programme (mhGAP) launched in 2008, which provides evidence-based technical guidance to scale up service provision and care in countries for mental, neurological and substance use disorders. In the WHO Mental Health Action Plan 2013-2020, WHO Member States have committed themselves to working towards the global target of reducing the suicide rate in countries by 10% by 2020.

     

    Mental health: strengthening our response

    Key facts

    • Mental health is more than the absence of mental disorders.
    • Mental health is an integral part of health; indeed, there is no health without mental health.
    • Mental health is determined by a range of socioeconomic, biological and environmental factors.
    • Cost-effective public health and intersectoral strategies and interventions exist to promote, protect and restore mental health.

    Mental health is an integral and essential component of health. The WHO constitution states: "Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity." An important implication of this definition is that mental health is more than just the absence of mental disorders or disabilities.

    Mental health is a state of well-being in which an individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and is able to make a contribution to his or her community.

    Mental health and well-being are fundamental to our collective and individual ability as humans to think, emote, interact with each other, earn a living and enjoy life. On this basis, the promotion, protection and restoration of mental health can be regarded as a vital concern of individuals, communities and societies throughout the world.

    Determinants of mental health

    Multiple social, psychological, and biological factors determine the level of mental health of a person at any point of time. For example, persistent socio-economic pressures are recognized risks to mental health for individuals and communities. The clearest evidence is associated with indicators of poverty, including low levels of education.

    Poor mental health is also associated with rapid social change, stressful work conditions, gender discrimination, social exclusion, unhealthy lifestyle, risks of violence, physical ill-health and human rights violations.

    There are also specific psychological and personality factors that make people vulnerable to mental disorders. Lastly, there are some biological causes of mental disorders including genetic factors which contribute to imbalances in chemicals in the brain.

    Mental health promotion and protection

    Mental health promotion involves actions to create living conditions and environments that support mental health and allow people to adopt and maintain healthy lifestyles. These include a range of actions to increase the chances of more people experiencing better mental health.

    An environment that respects and protects basic civil, political, socio-economic and cultural rights is fundamental to mental health promotion. Without the security and freedom provided by these rights, it is very difficult to maintain a high level of mental health.

    National mental health policies should not be solely concerned with mental disorders, but should also recognize and address the broader issues which promote mental health. These include mainstreaming mental health promotion into policies and programmes in governmental and nongovernmental sectors. In addition to the health sector, it is essential to involve the education, labour, justice, transport, environment, housing, and welfare sectors as well.

    Promoting mental health depends largely on intersectoral strategies. Specific ways to promote mental health include:

    • early childhood interventions (e.g. home visits for pregnant women, pre-school psycho-social activities, combined nutritional and psycho-social help for disadvantaged populations);
    • support to children (e.g. skills building programmes, child and youth development programmes);
    • socio-economic empowerment of women (e.g. improving access to education and microcredit schemes);
    • social support for elderly populations (e.g. befriending initiatives, community and day centres for the aged);
    • programmes targeted at vulnerable groups, including minorities, indigenous people, migrants and people affected by conflicts and disasters (e.g. psycho-social interventions after disasters);
    • mental health promotional activities in schools (e.g. programmes supporting ecological changes in schools and child-friendly schools);
    • mental health interventions at work (e.g. stress prevention programmes);
    • housing policies (e.g. housing improvement);
    • violence prevention programmes (e.g. reducing availability of alcohol and access to arms);
    • community development programmes (e.g. integrated rural development);
    • poverty reduction and social protection for the poor;
    • anti-discrimination laws and campaigns;
    • promotion of the rights, opportunities and care of individuals with mental disorders.

    Mental health care and treatment

    In the context of national efforts to develop and implement mental health policy, it is vital to not only protect and promote the mental well-being of its citizens, but also address the needs of persons with defined mental disorders.

    Knowledge of what to do about the escalating burden of mental disorders has improved substantially over the past decade. There is a growing body of evidence demonstrating both the efficacy and cost-effectiveness of key interventions for priority mental disorders in countries at different levels of economic development. Examples of interventions that are cost-effective, feasible, and affordable include:

    • treatment of epilepsy with antiepileptic medicines;
    • treatment of depression with psychological treatment and, for moderate to severe cases, (generically produced) antidepressant medicines;
    • treatment of psychosis with older antipsychotic medicines and psychosocial support;
    • taxation of alcoholic beverages and restriction of their availability and marketing.

    A range of effective measures also exists for the prevention of suicide, prevention and treatment of mental disorders in children, prevention and treatment of dementia, and treatment of substance-use disorders. The Mental Health Gap Action Programme (mhGAP) has produced evidence based guidance for non-specialists to enable them to better identify and manage a range of priority mental health conditions.

    WHO response

    WHO supports governments in the goal of strengthening and promoting mental health. WHO has evaluated evidence for promoting mental health and is working with governments to disseminate this information and to integrate effective strategies into policies and plans.

    In 2013, the World Health Assembly approved a "Comprehensive Mental Health Action Plan for 2013-2020". The Plan is a commitment by all WHO’s Member States to take specific actions to improve mental health and to contribute to the attainment of a set of global targets.

    The Action Plan’s 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. It focuses on 4 key objectives to:

    • strengthen effective leadership and governance for mental health;
    • provide comprehensive, integrated and responsive mental health and social care services in community-based settings;
    • implement strategies for promotion and prevention in mental health; and
    • strengthen information systems, evidence and research for mental health.

    Particular emphasis is given in the Action Plan to the protection and promotion of human rights, the strengthening and empowering of civil society and to the central place of community-based care.

    In order to achieve its objectives, the Action Plan proposes and requires clear actions for governments, international partners and for WHO. Ministries of health will need to take a leadership role and WHO will work with them and with international and national partners, including civil society, to implement the plan. As there is no action that fits all countries, each government will need to adapt the Action Plan to its specific national circumstances.

    Implementation of the Action Plan will enable persons with mental disorders to:

    • find it easier to access mental health and social care services;
    • be offered treatment by appropriately skilled health workers in general health care settings; WHO’s Mental Health Gap Action Programme (mhGAP) and its evidence-based tools can facilitate this process;
    • participate in the reorganization, delivery and evaluation of services so that care and treatment becomes more responsive to their needs;
    • gain greater access to government disability benefits, housing and livelihood programmes, and better participate in work and community life and civic affairs.
    For more information contact:

    WHO Media centre
    Telephone: +41 22 791 2222 
    E-mail: mediainquiries [at] who.int

     

    Sexual and intimate partner violence affects millions in Africa

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    Brazzaville, 5 January 2015 – In the African Region, one in five girls have been sexually abused during childhood, with estimates from some countries placing that proportion closer to one in three. This startling statistic is highlighted in the newly released Global status report on violence prevention 2014.

    The report – the first of its kind – features data collected from 27 countries in the African Region and around the world. It highlights some of the key strategies for preventing sexual and intimate partner violence by promoting gender equity, creating a climate of non-tolerance for violence, and starting prevention efforts at a young age.

    According to the report, intimate partner violence is a significant social and public health problem affecting 36.6% of ever-partnered women in the African Region.

    This violence can lead to unintended pregnancies, unsafe abortions, reproductive health problems, and sexually transmitted infections, such as HIV and syphilis – all conditions undermining progress toward the 2015 Millennium Development Goals (MDGs).

    Violence is also associated with other leading causes of death such as heart disease, stroke, cancer and HIV/AIDS as a result of victims adopting behaviours such as smoking, alcohol and drug misuse, and unsafe sex in an effort to cope with the psychological impact of violence.

    Despite strong evidence linking experiences of violence to mental health problems, only 15% of countries in African Region reported the availability of mental health services to address the needs of victims. This demonstrates a critical gap that needs to be filled in health systems throughout the Region.

    “There is no simple or single solution to the problem of violence but there is a growing body of knowledge on how to prevent violence. Countries are investing in prevention programmes but they are not being implemented in a manner or on a level that is necessary to achieve significant and sustainable reductions in violence,” said Dr Luís Sambo, WHO Regional Director for Africa.

    The problem of violence in Africa, highlighted in the African Health Report 2014 and the Global status report on violence 2014 highlights the need to include several violence prevention goals in the post-2015 development agenda. These include halving violence-related deaths everywhere, ending violence against children, and eliminating all forms of violence against women and girls by 2030.

    One WHO recommendation is to integrate known violence prevention strategies into pre-existing health platforms. This is because violence is a risk factor in many health outcomes such as HIV and sexually transmitted diseases, mental health and substance abuse disorders, and many of these platforms may already exist.

    Violence of all types is strongly associated with social determinants of health and cross-cutting risk factors such as excessive use of alcohol. Proven measures to reduce the harmful use of alcohol include restrictions on the sale and serving of alcohol – for example, through excise taxes on beer, wine and spirits, reduced hours or days of sale of alcoholic beverages, minimum age for the purchase of alcohol, and other industry regulations.

    In many countries, knowledge about the true extent of sexual and intimate partner violence is hindered by lack of data. Without such data it is difficult to develop effective national plans of action, policies, prevention programmes and services for victims. 

    The Global status report on violence prevention 2014 is available at: Global status report on violence prevention 2014

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    For more information, please contact:

    Technical contacts:

    Dr Sebastiana Nkomo
    Tel: +472 413 9722
    Email:  nkomos [at] who.int

    Dr Daisy Trovoadad
    Tel: +472 413 9384
    Email:  trovoadad [at] who.int

    Media contacts:

    Dr Cory Couillard
    Tel: + 472 413 9995
    E-mail:  couillardc [at] who.int

    Collins Boakye-Agyemang
    Tel: + 472 413 9420
    E-mail:  boakyeagyemangc [at] who.int

     

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