Mental health: a public health priority in the Americas
Mirta Roses Periago
Director, Pan American Sanitary Bureau, Washington, D.C., United States of America
I am pleased to present to you this special issue of the Revista Panamericana de Salud Pública/Pan American Journal of Public Health, which is devoted to two closely related subjects: mental health and the abuse of psychoactive substances. Depression, anxiety, and other mental disorders often occur in association with dependency on alcohol or other substances. This depend-encywhich by itself is a mental health problemis an important risk factor for other mental disorders. In turn, mental imbalances impel the progression toward alcoholism and drug addiction. In addition, patients with mental health problems and patients with substance abuse problems both face the stigma and the discrimination associated with those illnesses, and those persons' access to health services is equally limited.
Health authorities recognize that mental disorders and substance abuse are important public health problems. Nevertheless, research carried out in recent years on those problems' prevalence, impact, and associated costs demonstrate that their magnitude has been underestimated. It is projected that the number of people with mental disorders in the Region of the Americas will increase from 114 million in 1990 to 176 million in 2010 (1). In 2000 these disorders comprised 24% of the burden of disease in the Region of the Americas (2), with depression being the principal component of that burden (3). When analyzing these figures, it should be taken into account that mental health problems affect both adults and children. Nearly 20% of children and adolescents suffer from disorders that require the support of or intervention by mental health care services, and those disorders lead to both social stigma and discrimination (4).
According to the World Health Report 2002, alcohol abuse is the risk factor that most influences the burden of disease in the Americas (more than 10% of the overall disease burden); in 2000 it caused at least 225 000 deaths and represented 10 250 000 disability-adjusted life years (5). Alcohol continues to be the factor that most contributes to traffic accidents and to deaths from external injuries and violence, and it causes an immeasurable amount of chronic disease. Illegal drugs are consumed much less often than is alcohol in the Region of the Americas, but drug use has increased and is associated with the transmission of HIV and of infectious diseases transmitted by injecting drug use.
Thanks to scientific advances in recent decades we now understand much better the causes of mental disorders and substance abuse, and new, effective interventions for treating and preventing these health problems have been devised. However, most people still do not have access to these therapies. The first results from mental health surveys conducted in several countries of Latin America show that nearly 80% of the people with mental health problems do not have access to health services (6).
The Pan American Health Organization (PAHO) has been working with the countries of the Americas to build their capacity to gather information on mental health and substance abuse, develop and apply appropriate policies, strengthen services, and improve national legislation, in order to enhance systems to prevent and control these problems.
The Caracas Declaration, adopted in 1990 at the Conference on Restructuring Psychiatric Care in Latin America (7), proposed the integration of mental health services into primary care and local health systems. That Declaration was an important milestone in the process of reforming mental health services. Since the 1990 Conference, PAHO has given special attention to the reform of mental health services and to the protection of the human rights of people with mental disorders. In 2001, when the World Health Organization (WHO) decided to make mental health one of its public health priorities, new initiatives were introduced, including a network for research on mental health services in Latin America and the Caribbean, a project on mental health and human rights that was developed in collaboration with the Organization of American States, and several country and subregional projects intended to develop policies and specific services.
In the area of substance abuse, recent epidemiological data demonstrate the enormous impact that alcohol consumption has on the health and social well-being of the people of the Americas. Therefore, PAHO has given special importance to work on this subject, by increasing its support for national policy development and fostering research projects on this issue. Among the recent PAHO efforts aimed at strengthening the work in this area are the translation and publicationin collaboration with the Inter-American Drug Abuse Control Commissionof WHO's Neuroscience of Psychoactive Substance Use and Dependence report (8); fostering several multicenter studies on the damage that alcohol causes to health, and its negative effects on culture, gender violence, and indigenous populations; the dissemination of brief intervention models aimed at working in primary care to combat the excessive consumption of alcohol; and supporting policy development to reduce alcohol consumption. Supporting policy development has been the most effective measure of all the ones applied for preventing and controlling alcohol consumption in the Americas. The objective of these and other initiatives has been to contribute in the most effective way possible to the fulfillment in the Americas of Resolution 58.26, which was adopted by WHO in May 2005 and which will serve as a guide for PAHO's work in the coming years (9). This resolution urges WHO Member States to develop, implement, and evaluate effective strategies and programs that make it possible to reduce the harmful effects of alcohol consumption.
The principal measures proposed to respond to the mental health needs of the populations of the Americas are to integrate mental health into primary care, develop services in the community, and combat the stigma that mental disorders carry. Therefore, actions geared toward disseminating the knowledge that has been developed on mental illness should be encouraged. As is known, the most effective policies to prevent and control alcohol consumption in the Americans envision increasing the taxes on alcoholic beverages, reducing both the number of hours when and the number of places where alcohol can be sold, controlling advertising, and limiting who can buy alcoholic beverages. In addition, measures should be put into place to prevent people who are under the influence of alcohol from driving.
In terms of disseminating the knowledge that has been developed on these health problems, much remains to be done. There needs to be more research that aims at developing more effective treatments and interventions, improving the services targeting people with mental health and substance abuse problems, and designing and implementing policies that make it possible to better control these problems.
The goal of this special issue of the Revista/Journal is to increase the level of awareness that public health authorities and professionals have of the gaps and the challenges in these areas, and to disseminate studies that can help increase our knowledge of the problems with mental health and substance abuse in the Americas. We hope that the excellent pieces that are presented here are useful for policy-makers, researchers, and the general public, and that they help to speed the urgent changes that are needed in the Americas.
1. Kohn R, Levav I, Caldas de Almeida JM, Vicente B, Andrade L, Caraveo Anduaga J, et al. Los trastornos mentales en América Latina y el Caribe: asunto prioritario para la salud pública. Rev Panam Salud Publica. 2005;18(4/5):229-240.
2. Organización Mundial de la Salud. Informe sobre la salud en el mundo 2001. Salud mental: nuevos conocimientos, nuevas esperanzas. Ginebra: OMS; 2001.
3. Organización Panamericana de la Salud. Informe mundial sobre la violencia y la salud. Washington, D.C.: OPS; 2003.
4. World Health Organization. Child and adolescent mental health policies and plans. Geneva: WHO; 2005.
5. World Health Organization. World health report 2002. Reducing risks, promoting healthy life. Geneva: WHO; 2002.
6. Medina-Mora ME, Borges G, Lara Muñoz C, Benjet C, Blanco-Jaimes J, Fleiz-Bautista C, et al. Prevalencia de tratornos mentales y uso de servicios: resultados de la Encuesta Nacional de Epidemiología Psiquiátrica en México. Salud Ment. 2003;26(4):1-16.
7. González Uzcátegui R, Levav I, eds. Reestructuración de la atención psiquiátrica: bases conceptuales y guías para su implementación. Washington, D.C.: Organización Panamericana de la Salud; 1991.
8. Organización Panamericana de la Salud. Neurociencia del consumo y dependencia de sustancias psicoactivas. Washington, D.C.: OPS; 2005.
9. Organización Panamericana de la Salud. Resoluciones y otras acciones de la 58.a Asamblea Mundial de la Salud de interés para el Comité Regional [Internet page]. Available from: http://www.paho.org/spanish/gov/cd/cd46_33_s.pdf. Accessed 20 October 2005. (Document CD46/33).