GLOBAL
MENTAL HEALTH NEEDS GREAT BUT CARE LIMITED
The
advocacy within Wonca for a special interest group for psychiatry underscores
the recognition of the importance of this field to family doctors.
Psychiatric
conditions cause around only 1% of deaths, yet they account for almost 11% of
the disease burden across the world. In established Western economies mental
illness accounts for more than 15% of the disease burden, more than that associated
with all types of cancer.
According to the 1999 WHO health report, unipolar depression will rise to second in rank order for disability by 2020. Five of the ten leading causes of disability worldwide (major depression, schizophrenia, bipolar disorders, alcohol use and obsessive compulsive disorder) are psychiatric disorders. Common mental health disorders occur at a rate of 20-30% among the general population (and therefore constitute 1:3 G.P. consultations) and up to 40% in those attending out patient clinics. Less than half of those suffering from psychiatric disorders receive adequate treatment. At least one in four people will be affected across their lifespan in both industrialized and developing countries. It is also estimated that as much as 80% of modern illnesses are either psychosomatic in origin or have a psychosomatic dimension.
Mental
Disorders Increased in Developing countries
There
are internationally accepted figures showing the gap between developed and developing
countries in the prevalence of mental health problems and the paucity of care.
In developing countries, natural disasters are more prevalent.
War, violence and forced displacement are common.
African countries are increasingly being used as transit points for illicit
drug trade. These factors, in addition to poverty, contribute to a proportionate increase in the mental disorders
cases presenting for treatment
United
Nation’s resolution 119 states that protection against abuse and treatment of
mental illness are human rights. Yet,
psychiatrists are present in the average ratio of one psychiatrist per one million
people in most African countries except for South Africa, where the ratio is
one per 100,000. In most countries, the few psychiatrists tend
to practice in urban areas.
Sensitivity
to mental health concerns should be the responsibility of all health practitioners.
The family doctor has a special obligation and opportunity to meet people’s mental
health needs. However, if general practice
is to meet these needs in Africa, then urgent action is required. As long as the myth is perpetuated in general
practice of the family doctor’s inability
and negligence in psychological skills, then the stigma of mental illness will
be reinforced. Everyone is a closet psychologist. WHO has collaborative centres for training
and research with which Wonca should liaise to enhance the mental health care
skills of the family doctor.