Statistics : global burden of diseases

1. Mental in the Primary Health Care: a situation analysisF2F Morges, April 8th 2014Nicolas Perone, MD

2. Statistics: global burden of diseases Question: how stat. measure non-fatal impact of disease? how stat. help to measure C/E of interventions? Mortality - Morbidity – Qalys- Dalys Global burden of disease: measurehealthstatus Quantifies the numberof deathsand the impact of prematuredeathand disabilityon a population, and combines theseinto a single unit of measurement of the overall « burdenof disease »

3. Global burden of mental health • The burdens of mental illnesses, such as depression, alcohol dependence and schizophrenia, have been seriously underestimated by traditional approaches that take account only of deaths and not disability. • While psychiatric conditions are responsible for little more than one per cent of deaths, they account for almost 11 per cent of disease burden worldwide. • DALYs: the 1990 WHO report indicated that 5 of the 10 leading causes of disability were psychiatric conditions. • Psychiatric and neurologic conditions account for 28% of all years lived with disability, but only 1.4% of all deaths and 1.1% of years of life lost. • Thus, psychiatric disorders, while traditionally not regarded as a major epidemiological problem, are shown to have a huge impact on populations.

4. Why mental health initiatives? • Situation of MH in the world; the burden, the raising prevalence and projection for 2020 • Budget for mental health, per country • High prevalence of psychological problems as the population still affected by the consequences of the war • High prevalence of signs and symptoms of post-traumatic stress disorders (PTSD) • Both elderly and internally displaced persons to be high-risk groups for mental health problems, even several years after armed conflict ended • Consequence for the youth population: risky behaviors

5. Why mental health initiatives? • Humanrights violations of people with mental disabilities • Stigma and discrimination against patients and families • Mental disorders are important riskfactors for otherdiseases • Key barriers to MH services access Ref: Mental health: a state of well-being, WHO December2013

6. Historical background Threeperiods • Rise of asylum (1880 – 1950) • Decline of asylum (from 1950) Caused by progressive loss of life skills, institutionalism, ill-treatment to patients, geographicaland professional isolation of institutions and their staffs, poorreporting and accountingprocedures, failures of management, leadership and administration and inadequate inspection and quality assurance -> deinstitutionalization • Balanced care Incorporatesa range of community-based services within local settings

7. The balanced care Incorporatesa range of community-based services within local settings, continues providingall the benefits of hospital care whileavoidingitsnegativeaspects: • close to home, including modern hospitals for acute admissions and long-termresidentialfacilities in the community; • mobile, includinghome treatment; • addressdisabilities as well as symptoms; • care specific to diagnosis, needsand priorities of patient • coordinatedamong mental health care providers and agencies.

8. Components of a balanced care mental health service • Primary care mental health with specialist backup • Mainstream mental health care • Outpatient/ambulatory clinics • Community mental health care teams (CMHTs) • Case management • Acute inpatient care • Long-term community-based residential care • Coordination • Specialized and differentiated mental health services • eating disorders, dual diagnoses, treatment-resistant psychotic disorders,  specialized forms of psychotherapy

9. Mental health service components Ref: WHO’sWorld health report on mental health

10. Conclusion: main points • Burden of mental health • Financing mental health • Fighting stigma • Integration of mental health services • Earlydetection and management • Care coordination