Integrating mental health into primary care - A global perspective
The Offical launch of the WHO-Wonca report 'Integrating mental health into primary care - A global perspective' took place at the opening ceremony of the recent Asia-Pacific Regional Conference in Melbourne.
This report on integrating mental health into primary care, which was developed jointly by the World Health Organization (WHO) and the World Organization of Family Doctors (Wonca), presents the justification and advantages of providing mental health services in primary care. At the same time, it provides advice on how to implement and scale-up primary care for mental health, and describes how a range of health systems have successfully undertaken this transformation.
For too long, mental disorders have been largely overlooked as part of strengthening primary care. This is despite the fact that mental disorders are found in all countries, in women and men, at all stages of life, among the rich and poor, and in both rural and urban settings.
Mental disorders affect hundreds of millions of people and, if left untreated, create an enormous toll of suffering, disability and economic loss. Yet despite the potential to successfully treat mental disorders, only a small minority of those in need receive even the most basic treatment. Integrating mental health services into primary care is the most viable way of closing the treatment gap and ensuring that people get the mental health care they need. Primary care for mental health is affordable, and investments can bring important benefits.
This report is divided into distinct parts, with different needs in mind. Part 1 provides the context for understanding primary care for mental health within the broader health care system. Part 2 explains how to successfully integrate mental health into primary care and highlights 10 common principles which are central to this effort. It also presents 12 detailed case examples to illustrate how a range of health systems have undertaken this transformation. Finally, Annex 1 provides information about the skills and competencies that are required to effectively assess, diagnose, treat, support and refer people with mental disorders.
As this report will show, treating mental disorders as early as possible, holistically and close to the person's home and community lead to the best health outcomes. In addition, primary care offers unparalled opportunities for the prevention of mental disorders and mental health promotion, for family and community education, and for collaboration with other sectors.
Click here to download the report - PDF
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Message from WHO and Wonca
For too long, mental disorders have been largely overlooked as part of strengthening primary
care. This is despite the fact that mental disorders are found in all countries, in women and men,
at all stages of life, among the rich and poor, and in both rural and urban settings. It is also despite
the fact that integrating mental health into primary care facilitates person-centred and holistic
services, and as such, is central to the values and principles of the Alma Ata Declaration.
Common misunderstandings about the nature of mental disorders and their treatment have
contributed to their neglect. For example, many people think that mental disorders affect only
a small subgroup of the population, but the reality is that up to 60% of people attending primary
care clinics have a diagnosable mental disorder. Others think that mental disorders
cannot be treated, but we know that effective treatments exist and can be successfully delivered
in primary care. Some believe that people with mental disorders are violent or unstable, and
therefore should be locked away, while in fact the vast majority of affected individuals are nonviolent
and capable of living productively within their communities.
You will read about several people in this report who have been helped by primary care services
for mental health. Juan from Chile has suffered from schizophrenia his entire adult life.
Before integrated services for mental health in primary care were introduced, his condition
was poorly managed and he was shuffled repeatedly in and out of a psychiatric hospital, where
he endured and witnessed numerous human rights abuses. This part of his story is unfortunately
all too familiar. However with the advent of primary care services for mental health in
his community, Juan’s condition became well-managed and he was able to be reintegrated with
his family. He hasn’t been back to the psychiatric hospital for four years now.
In a different part of the world, Daya from Zimbabwe was diagnosed with HIV/AIDS while
pregnant with her first child. She spiralled into a deep depression, which continued after the
birth of her baby. Thankfully, her primary health worker identified Daya’s depression, initiated
treatment and referred her to additional community-based services. After several weeks
of treatment, Daya finally felt the clouds lifting and was once again able to enjoy her life and
appreciate the miracle of her first child.
As these and other stories in the report poignantly illustrate, primary care starts with people.
And, integrating mental health services into primary care is the most viable way of ensuring
that people have access to the mental health care they need. People can access mental health
services closer to their homes, thus keeping their families together and maintaining their
daily activities. In addition, they avoid indirect costs associated with seeking specialist care in
distant locations. Mental health services delivered in primary care minimize stigma and discrimination,
and remove the risk of human rights violations that occur in psychiatric hospitals.
And, as this report will show, integrating mental health services into primary care generates
good health outcomes at reasonable costs. Nonetheless, general primary care systems must be
strengthened before mental health integration can be reasonably expected to flourish.
Our common humanity compels us to respect people’s universal aspiration for a better life, and
to support their attainment of a state of complete physical, mental and social well-being, and
viii Integrating mental health into primary care: A global perspective
not merely the absence of disease or infirmity. With integrated primary care, the substantial
global burden of untreated mental disorders can be reduced, thereby improving the quality of
life for hundreds of millions of patients and their families.
It is vital that countries review and implement the 10 common principles for successful integration
described in this report. From our side, WHO and Wonca are committed to assisting
countries to implement and scale-up primary care for mental health, and urge the same scale
of commitment from others.
Dr Margaret Chan Professor - Director-General
World Health Organization |
Chris van Weel - World President
World Organization of Family Doctors (Wonca) |
Click here to download the report - PDF
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