What Do We Know About Mental Illness? Part 3

We know that mental illness is a global problem, not just restricted to developed nations.  Statistics show that the suicide rate in the United States is up 18% since 2000, while in the rest of the world it has been falling.  In its article about this trendThe Economist  gives an analysis of why and what more can be done (see below).  But this is a superficial analysis.  The issue needs a much more in-depth study of the disparities which exist in access to and quality of care, including in the United States.  Here the British medical journal The Lancet has stepped in.  Long engaged in issues of global health concerns, it has announced a new initiative Countdown Global Mental Health.   It is an ambitious project, which will be years in the implementation, but it brings more crucial research to bear on this major health issue.  Below are excerpts from their announcement.

“Today, we announce the establishment of Countdown Global Mental Health, an independent, multistakeholder monitoring and accountability collaboration for mental health, within an initial timeframe of the UN Sustainable Development Goals (SDGs). The scope of the Countdown will be global since mental health is an issue relevant to all countries. The unit of analysis will be countries or states or provinces within large federated countries. Given the huge disparities between and within countries, we expect the Countdown to be a strong instrument for accountability to decrease population-level disparities for mental health.
. . . .The main reason [for the Countdown] is that mental health is one of the most neglected of all health concerns with adverse consequences on individuals, families, societies, and countries. . . . Countdown Global Mental Health will build on the work done by WHO through the Mental Health Atlas, Mental Health Action Plan, and other initiatives. . . .

Last year’s Lancet Commission on Global Mental Health and Sustainable Development reframed mental health as a dimension, emphasising mental health promotion and prevention of mental disorders for the entire population, alongside quality treatment and care for those who have a mental health condition. The Commission also proposed mental health as a global public good and recommended a rights-based approach to protect people at risk of poor mental health and to protect the dignity of people with mental health problems. The Commission recommended strengthening of monitoring and accountability for global mental health.

The Commission identified three domains that should be considered for Countdown Global Mental Health. These domains are mental health determinants (eg, demographic, economic), mental health system and service components (eg, financing, workforce capacity), and mental health outcomes and risk protection (eg, social and financial risk protection). These domains are aligned with the dimensional concept of mental health within the framework of sustainable development, and go beyond crude indicators such as suicide rate . . . .The Countdown will give particular attention to mental health treatment coverage as an essential component of universal health coverage. . . .

“Quality of services and satisfaction with care will be an integral part of monitoring. The Countdown group will expand on the work of WHO and the Lancet Commission to determine the measurement and accountability framework, including the set of indicators that follow criteria such as feasibility, reliability, and usefulness. Data on the selected set of indicators will be collected from all countries using, as far as possible, existing global and national sources. Analysis will include aggregating the indicators, exploring correlations and clusters, and, ultimately, developing an index for comparability across countries and time.

“The primary partners in the countdown will be Global Mental Health at Harvard (GMH@H), WHO, United for Global Mental Health (UnitedGMH), Global Mental Health Peer Network (GMHPN), and The Lancet. This partnership brings expertise from a leading academic initiative devoted to the discipline that will house the secretariat, the world’s leading intergovernmental organisation, a major new civil society organisation aiming to mobilise political and financial resources for global mental health, and a global network representing people with lived experience. We intend to work collaboratively with other partners and with countries to collect and validate data, and disseminate findings. Countdown Global Mental Health will publish biennial reports in The Lancet that track national, regional, and global progress from 2020 through 2030. . . .

“As the global community begins to mobilise resources towards addressing the goals of promoting mental health, preventing mental disorders, and providing quality care for people with mental health conditions, there is an urgent imperative for a comprehensive and transparent monitoring mechanism to catalyse global and national action and hold diverse actors accountable.

“Countdown Global Mental Health seeks to realise this aspiration.

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Urbanisation, fewer forced marriages and more curbs on the means of self-destruction

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