Wednesday, July 6, 2011

Grand challenges in global mental health

An article published in the July 7th edition of the journal, Nature:
Schizophrenia, depression, epilepsy, dementia, alcohol dependence and other mental, neurological and substance-use (MNS) disorders constitute 13% of the global burden of disease (Table 1), surpassing both cardiovascular disease and cancer (ref. 1). Depression is the third leading contributor to the global disease burden, and alcohol and illicit drug use account for more than 5% (ref. 2). Every seven seconds, someone develops dementia (ref. 3), costing the world up to US$609 billion in 2009 (ref. 4). By 2020, an estimated 1.5 million people will die each year by suicide, and between 15 and 30 million will make the attempt (ref. 5).

The absence of cures, and the dearth of preventive interventions for MNS disorders, in part reflects a limited understanding of the brain and its molecular and cellular mechanisms. Where there are effective treatments, they are frequently not available to those in greatest need. In 83% of low-income countries, there are no anti-Parkinsonian treatments in primary care; in 25% there are no anti-epileptic drugs (ref. 6). Unequal distribution of human resources — between and within countries — further weakens access: the World Health Organization’s European region has 200 times as many psychiatrists as in Africa (ref. 7). Across all countries, investment in fundamental research into preventing and treating MNS disorders is disproportionately low relative to the disease burden (ref. 8).

To address this state of affairs, the Grand Challenges in Global Mental Health initiative has identified priorities for research in the next 10 years that will make an impact on the lives of people living with MNS disorders. The study was funded by the US National Institute of Mental Health (NIMH) in Bethesda, Maryland, supported by the Global Alliance for Chronic Diseases (GACD), headquartered in London. Answers to the questions posed will require a surge in discovery and delivery science. We use the term ‘mental health’ as a convenient label for MNS disorders. We exclude conditions with a vascular or infectious aetiology (such as stroke or cerebral malaria), because these fell within the scope of the two previous grand challenges initiatives — in global health and in chronic non-communicable diseases (ref 9).

This initiative differs from previous priority-setting exercises for mental health (refs. 10–12) in four ways. First, its scope is global. Second, it is the first to employ the Delphi method (ref. 13), a structured technique using controlled feedback to arrive at consensus within a dispersed panel of many participants. Third, it covers the full range of MNS disorders. Finally, the effort hopes to build a wide-ranging community of research funders — much as the challenge for non-communicable diseases led to the creation of the GACD.

Bold emphasis above is mine.

  1. World Health Organization The Global Burden of Disease: 2004 Update (WHO, 2008).
  2. WHO Atlas on Substance Use (WHO, 2010).
  3. Ferri, C. P. et al. Lancet 366, 2112–2117 (2005).
  4. Wimo, A., Winblad, B. & J├Ânsson, L. Alzheimer’s & Dementia 6, 98–103 (2010).
  5. Bertolote, J. & Flieschmann, A. Suicidologi 7, 6–8 (2002).
  6. WHO Country Resources for Neurological Disorders 2004 (WHO, 2004).
  7. WHO Mental Health Atlas (WHO, 2005).
  8. Saxena, S., Thornicroft, G., Knapp, M. & Whiteford, H. Lancet 370, 878–889 (2007).
  9. Daar, A. S. et al. Nature 450, 494–496 (2007).
  10. Lancet Mental Health Group Lancet 370, 1241–1252 (2007).
  11. Sharan, P. et al. Br. J. Psychiatry 195, 354–363 (2009).
  12. Tomlinson, M. et al. Bull. WHO 87, 438–446 (2009).
  13. Jones, J. & Hunter, D. Br. Med. J. 311, 376–380 (1995).
To download the entire article, please click here (PDF).

Also see:

Thinking Globally to Improve Mental Health

Mental Health: Think Globally, Act Locally

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