New avenues for public policy in mental health

Mental health disorders affect hundreds of millions of people around the world, but is all too often overlooked in national and international health policies. The World Health Organization (WHO) released a report aimed at facilitating the implementation of practical actions to better care for people with mental disorders. This comprehensive work, led by the University of Geneva (UNIGE), Switzerland, translates scientific results and data from numerous projects in different countries into public policy options. This report also highlights Geneva’s expertise in the field of mental health, which is recognized by the highest international bodies. Furthermore, by placing patients at the centre of their care, Geneva’s scientists take an important step towards robust and dignified mental health care.

While mental well-being, as defined by WHO, is an essential component of health, there is still a long way to go on a global scale to ensure that health systems truly respond to the needs of people with mental disorders. In this context, the World Health Assembly, an international decision-making body comprising 194 states, voted in 2013 to implement a vigorous action programme aimed at filling the gaps in this area, with an emphasis on health systems, stigmatization and human rights violations.  Even before, WHO had launched an open consultation process, with the support of the Calouste Gulbenkian Foundation’s Global Mental Health Platform, which aims to promote the translation of scientific data into public policy. Scientists, policy makers, but also health professionals and those most affected, the patients themselves, participated in the consultation. The report published today, written by UNIGE through its WHO Collaborating Centre for Research and Training in Mental Health, is the result of more than six years of work around the world.

Twenty years of expertise in Geneva

WHO Collaborating Centres are academic institutions designated for their expertise in a specific field to support the organization health programmes. “Our Collaborating Centre has existed for nearly 20 years; it has shown its value in mental health, thanks to the pioneering spirit of Professor Benedetto Saraceno, who led it before me,” says Emiliano Albanese, Professor at UNIGE Faculty of Medicine and Senior Consultant at the Division of Geriatric Psychiatry of the Geneva Huniversity Hospitals, and the Centre Director. “It is in recognition of our expertise that we have been asked to write this important document. Aiming to reduce the global burden of mental health, it constitutes an important milestone for both policy makers and professionals in the social health field, as well as for patients and their families,” he adds.

Five key areas

This report is indeed a source of information and inspiration to strengthen the response of all sectors to the still largely unmet needs of people with mental disorders. It cross-checks the data collected in five key areas: social determinants of health, de-institutionalization of care – i.e. limiting psychiatric hospitalizations to the most serious cases to promote community-based care – integration of mental health care into health systems, the rights of children with psychosocial disabilities, and access to and use of psychotropic drugs. The results of pilot programmes in several countries were also reviewed.

Officially launched in Lisbon on 23 November 2017, this comprehensive document provides 32 pragmatic and achievable options to reduce the burden of mental disorders and, beyond that, to participate in the implementation of the WHO Global Plan on Psychiatric Disorders. “One of these options is to integrate mental health care into a more holistic approach to chronic disease management. This less costly measure is also better suited to patients throughout their lives; indeed, the needs are not the same in adolescence or adulthood”, the Geneva researchers point out. The report also details the funding implications of de-institutionalization programmes, as well as the periodic evaluation measures that need to be put in place to ensure quality care and avoid possible abuses.

In Switzerland too, efforts must be made

Although global in scope, this framework document has also direct implications for Swiss and Geneva health policies. “Although considerable progress has been made in recent years, the 2016-2019 Health Planning Report of the Canton of Geneva specifically addresses the WHO recommendations and the need to implement them. Our work is therefore an important resource for our health authorities at several levels, both in analysing needs, drawing up and implementing policy guidelines and evaluating their results in order to better adapt health care programmes”, highlights Emiliano Albanese. In addition, all health professionals are concerned, in clinical practice as well as in their relations with patients. “This report also has implications for us as trainers of future physicians. Mental health must be present at all training levels, both pre- and post-graduate. At UNIGE, we already offer numerous training courses on the subject, including in a global and international health context.”

2017