WHO/DG/SP/
Dr Gro Harlem Brundtland
Director-General
World Health Organization
World Health Day Celebrations
Mathari National Mental Hospital, Nairobi 4th April 2001
Minister Ongeri,
Secretary Meme,
Dr Samba,
Director Muga,
Commissioner Maina,
Mayor Ndirangu,
Dear friends,
I am very happy to see so many of you on this celebration of World Health Day, even though we are three days early.
Here in Kenya, this day is special. This is the first time that so many visitors have come to Mathari. For most of you, it is the first time you are setting your feet inside a hospital for those suffering from mental illness. For some of you, it will not be the last.
For mental illness doesn’t only happen to “other people”. One person in every four will be affected by a mental disorder at some stage of life. It is a rare family that will never have an encounter with it. I would ask you all to use this opportunity to talk to the patients, the doctors and nurses, and the family members of those who are treated here.
What you will find is that mental illness has nothing to do with personal failure. It is a set of mostly curable, but crippling diseases that attack our most vulnerable possession: our sense of self. Hopefully, when you leave here this afternoon – or in some weeks, if you are a patient – mental illness will be less misconceived and less threatening. You will learn that all cases of disease have a history, and most patients have a positive future waiting when the disease is brought under control or cured altogether.
Not long ago, it was hard to speak about AIDS – and before that about cancer. It still is, in some places, but gradually, these taboos are being broken down. Yet many of us shy away from talking about mental illness. We don’t want to know and we don’t want to see. We don’t dare to understand and to care.
We treat mental illnesses differently from physical ones. We don’t always accept that as any other illness, mental disease and brain disorders have causes, certain symptoms and treatment. Where there is no recognition, there is no awareness – and there is no action.
This might have been understandable if we were facing an insignificant public health problem. But mental disorders affect an vast amount of people, causing tremendous suffering and also economic costs.
Today, more than 400 million people world-wide are estimated to be suffering at any given time from some kind of mental and neurological disorder, including alcohol and substance abuse disorders.
Mental disorders account for more than 10 % of the burden of all disease in 1999. It is one of the dominating causes of years lost to disease, something too few people realize. The share was greater in high income countries at 23%, than in middle income countries at 11%. The overall figure is expected to increase to 15% over the next 20 years.
Five of the ten leading causes of disability are mental problems such as depression, schizophrenia, bipolar disorders, alcohol dependence, and obsessive- compulsive disorders.
Depression is ranked fourth among the 10 leading causes of the global burden of disease, which includes the developing world. By 2020, it will have jumped to second place. The world over, there are on the average twice as many women who are suffering from depression than men. Between ten and 20 million people attempt suicide each year. One million die. That death toll is as high as from malaria!
Mental illness and brain disorders can be a very heavy economic burden on families. The main bread winner may not be able to work for long periods of time. Or one or several family members will be tied up caring for someone who is not able to take care of himself or herself.
For centuries, there was little to do to treat mental and brain disorders. But today, we have cost-effective interventions to treat the majority of mental and neurological disorders. Yet, there is a great gap between the number of people who suffer from these diseases and the number who receive treatment and care.
· 70% of those suffering from Depression can fully recover if treated with antidepressant medications and cognitive psychotherapy but fewer than 25% of those affected receive treatment. This gap also occurs in industrialized countries.
· The relapse rate of Schizophrenia can decrease up to 60% if patients receive proper medication and families receive proper education and support. Still, only 25% of those suffering receive such treatment.
· 80% of those suffering from Epilepsy can live a normal life if treated with anticonvulsivants but 90% of cases in developing countries do not get treatment!
· Severe Mental Retardation can be easily prevented through iodine supplementation of salt but still many countries don’t use this cheap and effective method.
A global survey WHO has carried out among 181 of its 192 Member States show that seventy-eight countries – or 43% – have no mental health policy at all. Thirty-seven countries – or 23% – have no legislation on mental health. Sixty-nine countries – or 38% – have no community care facilities, and in 73 countries – or 41% – treatment of severe mental disorders is unavailable in primary health care.
Of the 83 countries that provided specific budget details, 42% have less than 1% of their health budget allocated for mental health. More than 25% of the countries do not have the most commonly prescribed anti-psychotic, antidepressant, and anti-epileptic drugs considered essential for the treatment of common mental and neurological disorders at the primary health care level.
Many will be surprised by these figures. But we should not shy away from communicating these facts - we have to do it as part of the vital process of rolling back the many taboos that deter prevention, treatment and care.
The taboos lead to discrimination. In many countries, insurance companies discriminate between physical and mental disorders. Labour policies are less open to welcoming people with a history of mental disorders than those with physical ones. Often, the mentally ill are outcasts in their local society. In many countries, even basic human rights of mental health patients are routinely being violated, mostly in psychiatric hospitals.
With this discrimination follows stigma, to the detriment of those who need help, treatment, care and prevention. Stigma also creates a hidden burden of mental problems, which need to be added to the burden we can measure. Only when we address the stigma and discrimination together will we be able to make real progress.
These are not impossible tasks.
Stigma can be reduced by openly talking about mental disorders in the community, like we do here today. But we also need to constantly counter the negative stereotypes and misconceptions surrounding mental disorders. Governments must review there laws to ensure that legislation to reduce discrimination in the workplace and in access to health and social community services is put in place.
Friends,
This is the second time in WHO’s history that mental health is the theme for the World Health Day. The first time, 42 years ago, in 1959, WHO wrote the following:
“Great numbers of mentally ill still live, shut away behind hopeless walls by the prejudices and incomprehension of society. The efforts (…) to have the mentally ill treated as other sick people who can be cured, are likely to remain fruitless as long as irrational fear of ‘madness’ is not conquered, as long as all the influential members of the social hierarchy do not understand that mental health is not only the business of specialists but must concern the whole community.”
It can seem like we have achieved little during these forty years. But that is not true. The big difference is that, unlike then, we now have effective solutions. Today, we have the means to really make a difference.
We also have a much stronger movement of people who speak for the rights and interests of those suffering from mental illness. More than anything, families of those who suffer are expressing their concerns and are standing up for their loved ones. The cultural attitudes are changing in many countries. Mental health is beginning to “concern the whole community” as we said it must, 42 years ago.
And we have new, effective drugs with fewer and milder side effects. We have much more knowledge about what really works.
We know that psychosocial rehabilitation carried out in communities works. When we place mental health into the general health care services, we reduce the stigma and enable the health services to treat people where they live. We also catch diseases in earlier stages, before they cause total disability and terrible strain on families. There are great examples of such community work here in Nairobi.
We know that in some instances, hospitalization is needed to treat the most serious cases. But we also know that in many countries, mental hospitals consume almost the entire mental health budget. With proper community care and the right use of medication, only a few patients would need hospitalization, and the time they stay can be cut from months or years down to days or weeks. Here at Mathari, you have been pioneers in reducing both patient numbers and the average hospitalization time for your patients. You are an example for other national institutions to follow.
We know that many mental diseases and brain disorders can be prevented: either prevented altogether, or prevented from becoming so serious they destroy lives.
We know that teaching parents and primary health workers how to detect early signs of mental illness and disorders such as epilepsy arrests the problems at an early stage where they can be more easily treated.
We know that although most medicines and the most effective treatments and prevention are all cheap, a large number of countries spend so little on mental health it is impossible to achieve positive results. We know that many governments must make mental health a higher priority than it is today, and that they will have to spend the money in different ways.
On Friday and Saturday, the World Health Day will be celebrated in thousands of different ways in thousands of different places around the world. In many places, the events will continue throughout the year.
Let the new awareness become permanent. Let it lead to real change.
Let us stop exclusion and dare to care!
Thank you.
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