10 best resources on mental health.

At the outset, I must acknowledge the position I take on the topic of mental health, following the example set by Davidson Gwatkin in an earlier article in this series (Gwatkin 2007). My selection of the 10 best resources in mental health is unabashedly influenced by two perspectives which have heavily influenced my work: these are the perspectives of public health interventions (as opposed to clinical interventions) and the international or global perspective which, as a number of my chosen resources emphasize, arises from a massive inequity in the distribution of mental health resources in the world. A reader seeking the 10 best resources on the clinical management of mental disorders may not find this list of resources very helpful; although most of them do contain information on evidence-based treatments, only a couple are devoted to actual mental health care interventions for individuals with disorders (Resources 6 and 8). Mental health is a poor cousin of other health concerns in the global health arena. Despite important reports on the scale of suffering and lack of response dating back to 1995 (Desjarlais et al. 1995, see below), virtually none of the major global health initiatives launched in the past decade have even mentioned mental health. This neglect may hopefully be at least partly addressed by the publication of the Lancet Series on Global Mental Health, a series of six review articles (including one call for action) which were published in September 2007. These six articles focus on mental disorders, and (i) review the interrelationship between mental disorders and other health conditions, making the case that there is ‘no health without mental health’ (Prince et al.); (ii) document the scarcity of mental health resources globally, but also the inequity and inefficiency in their allocation (Saxena et al.); (iii) review the evidence base for effective treatments and prevention of mental disorders in low-middle income countries (Patel et al.); (iv) document the state of mental health systems in all countries of the world, based on United Nations and World Health Organization (WHO) databases and individual country reports (Jacob et al.); and (v) describe the barriers to scaling up evidence-based care for mental disorders at the national and global levels (Saraceno et al.). The final article is a call for action to scale up services for mental disorders, and provides information on three critical elements for scaling up, viz. the cost of scaling up, indicators to monitor scaling up and the research needed to inform scaling up (Lancet Global Mental Health Group). The Lancet Series represents the latest significant step in building of the evidence base on mental health with the aim of stimulating action by global health policy makers, a process whose first major milestone was the remarkable, and in my view classic, World Mental Health report led by authors from the Department of Social Medicine of Harvard Medical School (Desjarlais et al.) and published in 1995. This report was the first to systematically address the wider social and public health issues which are intimately connected with mental health and mental disorders. Its approach was refreshing; instead of chapters on specific disorders as many resources prior to this report were wont to adopt, we had chapters on risk factors for poor mental health like dislocation and violence, and a life course perspective with chapters on children and youth, women and the elderly. The report was, at least in part, spurred by the remarkable and unexpected findings of the first Global Burden of Disease report which found mental disorders were leading causes of disabilityadjusted life years (DALYs), even in low-middle income countries (Murray and Lopez 1996). Its framework of the model of ‘overlapping clusters’ of health problems (which include both mental and physical disorders), exacerbating conditions such as unemployment and poverty, and social pathologies such as violence, remains a relevant theoretical basis for understanding the social origins of mental disorders and offering promising opportunities for possible interventions. Six years after this report, and no doubt spurred by its messages, two leading policy organizations released reports emphasizing the burden, unmet need for care and policy imperatives for global mental health. The WHO’s World Health Report 2001 titled ‘Mental health: new understanding, new hope’ is a comprehensive, policy-oriented review on global mental health and was a landmark publication in a year which saw a number of WHO initiatives focusing on this neglected subject. The report provides a superb text for both general public health and specialist mental health audiences, on the burden, causes, treatment and service provision issues related to mental disorders, and rounds off with 10 specific recommendations on addressing unmet need for care. In the same year, the US Institute of Medicine released its report on Neurological, psychiatric and developmental disorders: meeting the challenge in the developing world. This report took a much broader perspective of ‘nervous system disorders’ or ‘brain disorders’, essentially health conditions arising due to structural or functional disturbances in brain function, thereby including conditions such as stroke, epilepsy and dementia alongside ‘mental’ disorders. This term has since become more popular, for example the Fogarty International Centre of the National Professor of International Mental Health, NPHIRU, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK. E-mail: Vikram.Patel@lshtm.ac. uk Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine The Author 2008; all rights reserved. Advance Access publication 29 March 2008 Health Policy and Planning 2008;23:218–220 doi:10.1093/heapol/czn008