10 October 2018
A new Lancet Commission report released today at the first-ever Global Ministerial Mental Health Summit in London exposes a collective failure in the global response to on mental health, causing long-lasting and preventable harm to people, communities and economies.
The Lancet Commission on Global Mental Health and Sustainable Development brought together 28 global experts in psychiatry, public health, neuroscience and advocacy, as well as people with first-hand experience of mental health conditions.
The Commission outlines that mental and neurological conditions, including Alzheimer’s disease and other dementias, are on the rise in every country in the world and will cost the global economy $16 trillion by 2030. Previous research published by Alzheimer’s Disease International evidences that dementia already costs the global economy $1 trillion annually, and by 2030 this will rise to $2 trillion.
The report warns that major demographic and epidemiological transitions, in particular a steadily ageing global population, is leading to an increased number of people entering risk periods for the onset of mental disorders, highlighting the example of dementia in older people. Further, dementia is the dominant contributor to the mental disorder burden in older people with prevalence doubling with every 5-year increase in age. Yet the diagnosis gap for dementia is as high as 50% in many high-income countries and can exceed 90% in low and middle income countries (LMICs).
Under-served global development issue
The Commission’s report presents mental health and neurological conditions as an under-served global development issue, reflecting that government investment and development assistance for mental health remains pitifully small.
“When it comes to mental health, says Commission Joint Lead Editor, Professor Vikram Patel of the Harvard Medical School, “every country is a developing country.”
Mental health is explicitly recognised in Sustainable Development Goal (SDG 3). The Commission reflects that the promotion of mental health and wellbeing, and the prevention and treatment of conditions, requires action on the other SDGs, and can also contribute to the achievement of them. An example citied is the need for mental health in older adults to be understood from a life course perspective. People who have received more formal education in early life have a lower risk of developing dementia than those with less education. Improving access to quality education is vital because education develops cognitive reserve and is protective against common conditions like dementia.
Human rights violations
The report shows that in many countries, people with mental disorders still routinely suffer gross human rights violations – including shackling, torture and imprisonment, highlighting adults with dementia as a particularly vulnerable group. Bringing attention to these kinds of abuse and discrimination, the Commission calls for a human rights-based approach to ensure that people with mental health conditions are not denied any of their fundamental human rights – not just to health but also to employment and education, among others.
Concerns are also raised at the number of people with mental health conditions living in institutions, despite evidence from deinstitutionalisation in high-income countries unequivocal — when hospital closure programmes have been done reasonably well, and not used as a reason to reduce the overall mental health budget, the overall quality of life, satisfaction, and met needs of people with long-term mental disorders who move from hospital to community care is improved. In terms of the overall global picture regarding deinstitutionalisation, the Commission recommends a wholesale shift to community-based care. It finds that community-based models of care are not inherently more costly than institutions, once the needs of individuals and the quality of care are taken into account.
The Commission’s recommends the key principles of dementia care are the need for care to continue from diagnosis to death, to be holistic and person-centred, and to be well integrated from primary to specialist care (and also between health and social care sectors).
Health system strengthening
In response to the challenge facing governments and health systems – how to increase the very low coverage of diagnostic, treatment, and continuing care services, while maintaining or improving quality and keeping costs under control in the face of rising numbers of older people affected by mental disorders, the Commission offers solutions. In high-resource settings, the focus should be on increasing the efficiency of service provision through integration, coordination, and task sharing. Across most low-resource settings, specialist multidisciplinary care for older people has been slow to develop, and primary and community care are ill-equipped to offer age-appropriate services, including support for carers. This reinforces the need for dementia and wider mental health to be included in health system strengthening.
Among the Commission’s key recommendations is a new Global Partnership to mobilise funds, help drive on-the-ground change and hold governments accountable. This Partnership would bring together allies from across the diverse global mental health community and beyond.
As the Commission asserts, the sustainable development framework provides an opportunity to reframe mental health and make it an integral component of the broader global development agenda.
Without action we risk leaving some of the most under-served and vulnerable people with disabilities behind.
Via the Global Alzheimer’s & Dementia Action Alliance (GADAA) we are calling for iNGOs working on disability rights and inclusive development to recognise and respond to people with dementia. Forging partnerships and working together is at the heart of GADAA, a network of iNGOs seeking to champion global action on dementia.
Join GADAA and help keep dementia a priority in the inclusive development agenda.