Falling to Pieces

It seems to me that the issues surrounding mental health occasionally crack a mention in the media but rarely receive the sustained attention required to really break the taboos around the topic. Where do we stand on a worldwide basis in terms of service delivery and gaps in services?

The area of mental health service is so enormous that I can’t cover anywhere near enough of it in this blog, rather I will provide a brief review of one article. In “Scale up services for mental disorders: a call for action” the authors summarise the evidence from the series to “provide ammunition for advocacy by stakeholders in global mental health”. (1)

The basic facts presented in the introduction of the article speak for themselves:

  • “Every year up to 30% of the population worldwide has some form of mental disorder.”
  • “In the USA… 31% of people are affected by mental disorders every year, but 67% of them are not treated.”
  • “In Europe, mental disorder affects 27% of people every year, 74% of whom receive no treatment.”
  • In low and middle income countries the figures are worse with only 11.1% of severe cases of mental disorder in China receiving any treatment, and sufferers rarely receiving adequate treatment, “as low as 10.4% in Nigeria”.

The article claims that there is plenty of evidence supporting cost-effective interventions for mental disorders in low and middle-income countries. Although some regional areas have improved services there is a lack of implementation and reporting and monitoring mechanisms are not used effectively to allow progress to be tracked.

It is also claimed that by increasing the investment to between $2 and $8 per person per year for low to middle income countries by 2015 a core package of mental health interventions could be established.

Is this achievable? Well, it will require a significant investment… take Bangladesh as an example: with a population of 160 million this package will require an investment well in excess of $300 million per year!!

Conclusion… “The time to act is now”!

A number of other interesting sources of information about mental health worldwide are available at the following links:

http://www.who.int/mental_health/en/index.html

http://www.who.int/features/factfiles/mental_health/en/index.html

Reference

(1) Lancet Global Mental Health Group. Scale up services for mental disorders: a call for action. Lancet 2007; 370: 1241–52

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Epic

Disasters have been a hot topic in the media recently. I don’t want to address the current issue of media representation here – have we heard enough of one disaster and not enough of others or are we hearing the true message about current disasters – but I will try to provide some evidence for the following questions, expanding on summarised answers given here:

How big a problem are disasters? – Well, they negatively affect somewhere between about 1% and 10% of the world’s population every year…so, I think that we can fairly safely conclude that they are a pretty large problem. And, they have a tendency to hamper development work in low-income countries and affect these areas in a disproportionate manner.

Are they becoming more prevalent? – Over the last 20+ years there may be a trend towards an increase but this is not conclusive.

What are we doing to reduce the risk? – My interpretation is that we are trying really hard but we aren’t really getting very far just yet. A bit like the MDG’s.

Evidence

There are of course imperfections in the data that is available regarding disaster risk. According to a report published by the Centre for Research on the Epidemiology of Disasters (CRED) this is due to a number of reasons including differences in definitions and classification of disasters (1). However, we can look towards the data provided by CRED to give us an idea of the numbers involved. The figure shown below is from CRED’s Annual Disaster Statistical Review 2009 (2).

This data shows that over the last two decades the number of people affected by disasters annually ranges from around 80 million to 660 million, in 2002. The enormous 2002 figure was largely due to around 300 million people being affected by the drought in India (2).

Another major factor here is the apparent disproportionate effect the disasters have on the poor. Data provided in the World Disasters Report 2009 (3) published by the International Federation of Red Cross and Red Crescent Societies (IFRC) shows the imbalance from a simple numbers point of view:

Total number of people affected by disasters between 1999 and 2008, in thousands

–          High human development countries             73 163

–          Medium human development countries      2 434 060

–          Low human development countries             188 590

The trend of the number of reported disasters does appear to have gone up over the last 20+ years. The CRED’s Annual Disaster Statistical Review from 2006 (4) shows that between 1987 and 1997 the number of disasters varied between 200 and 250, but between 2000 and 2006 it was somewhere around the 350 to 450 mark. However, 2008 and 2009 both saw a reduction, and the data does not track back far enough to show us a true trend. In addition to this the data is wildly variable due to single enormous events.

According to AusAID, quoting from the State of the World Report 2007 by the World Watch Institute, “In the last quarter-century, 98% of the people injured or affected by natural disasters were living in 112 countries classified as low income or low-middle income” (5).*

The UN’s International Strategy for Disaster Reduction (ISDR) was launched in 2000. ISDR organised the World Conference on Disaster Reduction in 2005, the outcome of which was the “Hyogo Framework for Action 2005-2015: Building the resilience of nations and communities to disasters” (6).

As I am sure you can imagine this document sets out myriad specific points about what we should be doing, but most importantly what is the progress towards these goals? The 2009 Global Assessment Report on Disaster Risk Reduction (7) summarises thus:

“Progress towards reducing disaster risk is still mixed. In general terms, countries are making significant progress in strengthening capacities, institutional systems and legislation to address deficiencies in disaster preparedness and response. Good progress is also being made in other areas, such as the enhancement of early warning. In contrast, countries report little progress in mainstreaming disaster risk reduction considerations into social, economic, urban, environmental and infrastructural planning and development.”

* I haven’t quoted directly from this document because it costs US$18.95 just to download the PDF!!

References

  1. Tschoegl, L. (2006) An Analytical Review of Selected Data Sets on Natural Disasters and Impacts. Brussels: CRED; 2006. (ID 218) http://www.cred.be/publications
  2. Vos F, Rodriguez J, Below R, Guha-Sapir D. Annual Disaster Statistical Review 2009: The Numbers and Trends. Brussels: CRED; 2010. (ID 269) http://www.cred.be/publications
  3. World Disasters Report 2009. Geneva: IFRC; 2009. http://www.ifrc.org/publicat/wdr2009/summaries.asp
  4. Hoyois P, Scheuren J-M, Below R, Guha-Sapir D. Annual Disaster Statistical Review 2006: The Numbers and Trends. Brussels: CRED; 2007. (ID 231) http://www.cred.be/publications
  5. http://www.ausaid.gov.au/keyaid/drrfacts.cfm
  6. Hyogo Framework for Action 2005-2015: Building the resilience of nations and communities to disasters. Geneva: UNISDR; 2005. http://www.unisdr.org/eng/hfa/hfa.htm
  7. Global Assessment Report on Disaster Risk Reduction Geneva: UNISDR; 2009. http://www.preventionweb.net/english/hyogo/gar/report/index.php?id=1130&pid:34&pih:2
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Rupert McFly and The Real Thing have appeared from out of nowhere to provide you with the evidence behind events around the world. Check out the “About” section for more info.

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