Mental health in the tropics

Although problems in mental health constitute 14% of the global burden of disease, mental health has been largely missing from the international health agenda. The burden from mental illness is largely attributable to the chronically disabling nature of depression and other common mental disorders, alcohol-use and substance-use disorders, and psychoses. The last decade has seen some progress in addressing this gap. In 2001, the World Health Report, Mental Health: New Understanding, New Hope, drew attention to the situation, with an appeal from the World Health Organization's Director General that 'mental health - neglected for far too long - is crucial to the overall well-being of individuals, societies and countries and must be universally regarded in a new light.' In September 2007, the journal Lancet launched the global mental health series, which highlighted the public-health dimension of mental health, identified barriers to receiving treatment, and gave a call for action to the nations of the world, to make a major commitment to upgrade the quality of mental-health services, to develop evidence-based treatment and preventive measures, to provide support for research in mental health, and to develop indicators to monitor progress. In October 2008, the World Health Organization launched the Mental Health Gap Action Programme, with the aim of scaling up the services for mental, neurological and substance-use disorders in all countries but especially those with low and middle incomes. The programme aims to develop evidence-based packages of care, psycho-social interventions and pharmacotherapy for tens of millions who could be treated for depression, schizophrenia and epilepsy, prevented from suicide, and begin to lead normal lives - even in very poor countries. While there is cause for optimism, much remains to be done. Most of all, there needs to be awareness amongst health providers and planners that mental health is an integral part of general health concerns, and that there can be no health without mental health.