WHO/NMH/MSD/MPS/02.

02

Nations for
Mental Health
Final Report

World Health Organization

Mental Health Policy and Service Development
Department of Mental Health and Substance Dependence
2 Acknowledgements

WHO/NMH/MSD/MPS/02.02 WHO gratefully acknowledges the financial support of Nations for Mental Health by the Eli Lilly and
Distribution: General Company Foundation, the Johnson and Johnson Corporate Contributions Europe Committee, the
Original: English Government of Italy, the Government of Japan, the Government of Norway, the Government of
Australia and the Brocher Foundation.

Concept and design: Tushita Graphic Vision, Tushita Bosonet and Valérie Rossier, Geneva

© Copyright 2002 World Health Organization

This document is not a formal publication of the World Health Organization (WHO), and all rights are reserved
by the Organization. The document may, however, be freely reviewed, abstracted, reproduced or translated, in
part or in whole, but not for sale or for use in conjunction with commercial purposes. The views expressed in
the document by named authors are solely the responsibility of those authors.

ACKNOWLEDGEMENTS
Introduction 3

The 20th century has witnessed significant improvements in somatic health in most countries.
However, the mental component of health has reached a plateau and, in many instances, has
deteriorated seriously. Increased life expectancy has been made possible by improved physical
health. However, this has meant that a larger proportion of the population now reaches the age
that carries higher risks of morbidity attributable to mental disorders.

WHO estimates that at any one time, as many as one in four of the world's population suffer from
different forms of mental, behavioural and neurological disorders, including affective disorders,
alcohol and drug abuse, epilepsy, dementias, mental retardation, schizophrenia and stress-related
disorders.

Unfortunately, in spite of this striking figure, concern with and commitment to mental health
largely remains a very remote and often obscure component of policy-makers’ agendas, which are
chiefly dealing with population mortality.

Beyond the figures, which are exclusively related to the mental and neurological disorders, we
recognize that far too many people, many of whom belong to vulnerable groups such as women,
children, the elderly, refugees, indigenous populations suffer from the effect of violence, disloca-
tion, poverty, isolation, stress and deprivation.

These people and those suffering from acute or chronic mental illnesses that are inadequately man-
aged, form a broad NATION living dispersed within the many NATIONS of the world.

The answer to each specific condition has to be specific, but there are some elements common to
all affected: the stigma, the frequent exposure to human rights violations, the need for a strong
family and community support, the need of more accessible and appropriate technical interventions
provided by services which should be local, flexible and comprehensive.

In 1996, WHO took up this challenge. It devised a vehicle to promote collaboration between gov-
ernments, the United Nations and its Specialized Agencies (such as UNICEF, UNDP, UNHCR, ILO,
UNDCP, UNESCO), and comparable entities such as The World Bank and Nongovernmental

INTRODUCTION
4

Organizations, with a view to improving the mental health and psychological well-being of the
world's underserved populations in all six WHO regions of the world.

Nations for Mental Health, as it was called, was designed to be an Initiative within the UN system
for mental health in underserved populations. WHO initiated this programme following the publica-
tion, in May 1995, of a report on world mental health by a team at Harvard Medical School.

Nations for Mental Health was to pursue the following goals:

1. To raise awareness of the people and governments of the world to the effects of mental
health problems and substance abuse on the psychosocial well–being of the world's under-
served populations.

2. To stimulate innovative approaches to the promotion of mental health and the prevention and
control of mental disorders.

3. To generate the human capital able to lead innovation in the mental health promotion and
care provision.

4. To promote service development at country level through technical demonstration projects.

A three-step approach was envisaged to create a process leading to put mental health in the
political agenda. The first step was to increase the general awareness of the importance of mental
health through a series of key high profile events to focus public attention. Second, it was planned
that efforts would be devoted to building the will of the key political authorities to participate.
Third, and finally, efforts were directed towards securing political commitments by decision-makers
(e.g., legislative measures, policy undertakings, and performance of specific initiatives in favour of
mental health, such as a campaign to destigmatize mental disorders). Alliances with the scientific
community and policy–makers were seen as achievable in the context of demonstration projects
and through the effects of awareness-raising efforts.

INTRODUCTION
 5

Nations for Mental Health had many achievements, which are detailed in this short report. And,
when Dr Gro Harlem Brundtland became WHO’s Director-General in 1998, Nations became one of
the key experiences from which she established the new WHO agenda for mental health. As she
said in 1999 during her address at the meeting “Setting the Agenda for Mental Health”, “There
can be no doubt: mental health has to be given renewed and increased attention from WHO. That
means a strengthened organizational emphasis and that we are doing. Our contribution has to look
beyond what WHO funds can buy – it is a question of how we as the lead agency in health can
help mobilize resources, attention and new knowledge and better advise governments on how to
adapt and develop their policies.”

Thanks to Dr Brundtland’s leadership and support, the vision of Nations for Mental Health came to
full fruition during 2001. Through the 2001 World Health Day, World Health Assembly, and World
Health Report, WHO and its Member States pledged their full and unrestricted commitment to this
public health area.

Countries are beginning to act: a large number of countries have established policies and legislation
in the past five years. NGOs and consumer and family organizations are starting to become active
in all regions.

In many ways, Nations for Mental Health was the beginning. However, it is far from the conclusion.
Continued efforts by governments and international agencies such as WHO can catalyse this new
energy to further improve the mental health situation around the world.

Dr Benedetto Saraceno
Director
Department of Mental Health and Substance Dependence
World Health Organization

INTRODUCTION
6

A decade of progress for mental health...

1991 UN calls for the improvement

of mental health care

The United Nations General Assembly adopts the Principles for the
Protection of Persons with Mental Illness and for the Improvement of
Mental Health Care. These twenty-five principles define fundamental
freedoms and basic rights. They deal with the right to life in the com-
munity, the determination of mental illness, provisions for admission to
treatment facilities, and the conditions of mental health facilities. They
serve as a guide to Governments, specialized agencies and regional
and international organizations, helping them facilitate investigation
into problems affecting the application of fundamental freedoms and
basic human rights for persons with mental illness.

1991 1992 1993 1994 1995 1996 1997 1998 1999 2000
 7

World Bank exposes the alarming burden of

mental health problems

1993
The World Bank’s World Development Report 1993 publishes startling
statistics on the global burden on mental disorders. It is estimated that
8 percent of the global burden of disability and morbidity in the world
is due to mental and neurological disorders. Adding behaviour-related
illnesses, the figure rises to 42 percent.

1991 1992 1993 1994 1995 1996 1997 1998 1999 2000
8

1995
Harvard University raises awareness
about the complexity of mental disorders
in low-income countries
World Mental Health: Problems and Priorities in Low-Income Countries
is published. This book is the result of several years of collaboration
among experts from 19 countries and researchers in the Department
of Social Medicine at Harvard University. It outlines the range of mental
and behavioural problems, the major social challenges of violence and
displacement, and the problems of special populations.

In response, the Secretary-General of the United Nations affirms the

need for mental health to be a United Nations priority in its second
half century:
“Mental health must be regarded as a
foremost challenge… an international
campaign is needed… to secure mental
health for the people of the world must
be one of the objectives of the United
Nations in its second half century” .
UN Secretary-General,
Boutros Boutros-Ghali

1991 1992 1993 1994 1995 1996 1997 1998 1999 2000
 9

Nations for Mental Health Steering Committee

1996: A nation is formed... Nations for Mental Health is guided by a

distinguished group of professionals, including:

Dr Antonio Andreoli, Switzerland

Mr John Bowis, United Kingdom
Dr Alex Cohen, USA
Dr Gaston Harnois, Canada
Dr Mohan Isaac, India
The World Health Organization launches a global programme,
Professor Lars Jacobson, Sweden
Nations for Mental Health. The programme is dedicated
Dr Rachel Jenkins, United Kingdom
towards improving the mental health and psychosocial well-
Professor Arthur Kleinman, USA
being of the world’s underserved populations. This “Nation” is
Dr V.N. Krasnov, Russia
comprised both of people with defined mental disorders, and
Professor Lourdes Ladrido-Ignacio, Philippines
those suffering from behavioural and social problems. Nations

1996
Professor Driss Moussaoui, Morocco
sets an ambitious goal for itself: to create a world wide move-
Dr Malik Hussain Mubbashar, Pakistan
ment for mental health.
Nations for Mental Health is managed
To accomplish this goal, Nations adopts a tripartite approach: at WHO Headquarters by:
• Organizing high-profile awareness-raising and commit- Dr Benedetto Saraceno (Programme Manager)
ment-building events; Dr Michelle Funk
Ms Adeline Loo
• Providing technical and monetary assistance to developing
Mr Sylvain Poitras
countries in developing and implementing mental health
policies and services; Nations for Mental Health also received
substantial input from the following WHO
• Creating and disseminating a Nations for Mental Health Regional Advisers for Mental Health:
publication series, covering a wide-range of mental health
Dr Itzhak Levav, AMRO
topics.
Dr Custodia Mandlhate, AFRO
Dr Ahmad Mohit, EMRO

1991 1992 1993 1994 1995 1996 1997 1998 1999 2000
 11

Building political will and commitment

Sensitization of governments and policy

makers to the public health importance of
mental problems will be required to
stimulate political awareness, political
commitment and the political will to address
mental problems in our underserved
populations.

Nations for Mental Health: an overview of a strategy to

improve the mental health of underserved populations

WHO/MSA/NAM/97.3

1991 1992 1993 1994 1995 1996 1997 1998 1999 2000
12 First ladies, women leaders pledge unprecedented efforts
for mental health in the Western Hemisphere
September

1996
In September 1996, First Ladies, Ministers of Health, and mental health experts from more than 20
countries of the Americas gather in Washington, DC, USA to make an unprecedented pledge to
support efforts to improve the mental health of women and children in the Western Hemisphere,
through programmes directed to foster, protect and restore mental health and well-being. The
meeting is organized in collaboration with WHO’s Regional Office for the Americas (AMRO) and the
USA Harvard University Department of Social Medicine, and through the co-sponsorship of the World
Federation for Mental Health and the Carter Center. Seventeen women leaders, 13 of whom wives
of Heads of States, and mental health experts from more than 20 countries of the Americas, gather
for a one-day working session on mental health, focusing in particular on domestic violence and
neglected or underserved populations.

The Nations for Mental Health meeting of International Women Leaders for Mental Health includes
First Ladies and former First Ladies and designated representatives from Antigua and Barbuda,
Belize, Bolivia, Colombia, Costa Rica, Panama, Trinidad, Tobago, Turks, Caicos and the United States
of America.

“The Conference is an important first step in raising awareness of the mental health con-
cerns and issues affecting women today.” says former USA First Lady, Rosalynn Carter,
Chairwoman of the International Committee of Women Leaders for Mental Health.

Bolivian First Lady, Ximena Iturialde de Sánchez de Losada notes that drugs, alcohol, and family vio-
lence are causing serious increases in mental health problems, adding: “Mental health must be
identified with quality of life and must be dealt with in the home, at work, in schools and
on the street, where people can either lose their mental equilibrium or can learn to pre-
serve it and live in harmony with their social groups and environment.”

Participants formally pledge, through a signed Joint Statement, to firmly support national mental
health programmes, to promote at least one activity in each of their countries to help improve men-
tal health, to assist in the establishment of international mental health programmes, to assist NGOs
involved in the development of mental health and to support awareness-raising initiatives.

BUILDING POLITICAL WILL AND COMMITMENT

A joint statement of international women leaders for mental health 13
in the Western Hemisphere

We, First Ladies and Wives of Heads of State or their designated personal representatives, have con-
vened at the International Meeting of Women Leaders for Mental Health to address concerns over
mental health in the Western Hemisphere.

We have taken note of the platforms for action contained in the “Declaration of the Rights of
Mental Patients” of the United Nations; the report presented to the United Nations by Harvard
University entitled, “World Mental Health Report”; the initiative, “Nations for Mental Health”
coordinated by the World Health Organization; and the strategic orientations of the Programs on
Mental Health and on Women, Health and Development of the Pan American Health Organization.

In order to initiate proactive steps toward improving mental health and well-being of the peoples
of the Americas, we pledge to:

• Firmly support existing national mental health programs, work to forge a coordinated effort in
conjunction with ongoing initiatives being implemented in other social sectors, and promote at
least one activity in each of our countries that will help to improve the mental health of citizens.

• Assist in the establishment of international programs directed to foster, protect and restore
mental health and well-being.

• Assist nongovernmental organizations and institutions involved in the fostering and develop-
ment of mental well-being.

• Support ongoing initiatives that raise awareness of mental health issues in our countries and
across the Americas, and promote the inclusion of mental health as an item on the agenda at
the Seventh Conference of First Ladies and Wives of Heads of State to be held in Panama in
1997.

• Call upon governments that have not yet done so, to ratify the Inter-American Convention for
the Prevention, Punishment and Eradication of Violence against Women. To signatory coun-
tries, request the implementation and enforcement of this Convention.

1991 1992 1993 1994 1995 1996 1997 1998 1999 2000
14

• Support policies, programs and activities that promote an integrated approach to mental
health which incorporates a gender perspective.

• Call upon international organizations responsible for technical and financial support to assist
efforts to enhance mental health and well-being in the Western Hemisphere.

Signed at the Headquarters of the

Pan American Health Organization in Washington,
Mrs Zelmira Regazzoli, Ambassador of Argentina D.C., on this twenty-eighth day of September,
Mrs Patricia Bird, First Lady of Antigua and Barbuda Nineteen hundred and Ninety-six.
Mrs Ximena Iturialde de Sánchez de Losada, First Lady of Bolivia
Mrs Kathy Esquivel, First Lady of Belize
Mrs Ruth Cardoso, First Lady of Brazil
Mrs Jacquin Strouss de Samper, First Lady of Colombia
Mrs Josette Altman de Figueres, First Lady of Costa Rica
Mrs Patricia Arzu, First Lady of Guatemala
Mrs Bessie Watson de Reina, First Lady of Honduras
Mrs Margaret Bernal, representing the Prime Minister of Jamaica
Mrs Dora Boyd de Pérez Balladares, First Lady of Panama
Mrs Lolita Taylor, First Lady of Turks and Caicos
Mrs Zalayhar Hassanali, First Lady of Trinidad and Tobago
Mrs Alicia de Caldera, First Lady of Venezuela
The Honorable Yvonne Francis-Gibson, Minister of Health and the Environment, Saint Vincent and the Grenadines
Mrs Eugenie Condor, Wife of the Deputy Prime Minister of Saint Kitts and Nevis

BUILDING POLITICAL WILL AND COMMITMENT

International women leaders pledge to improve the mental 15
health of families and youth in Europe
July

1997
The International Committee of Women Leaders for Mental Health participates in a Nations for
Mental Health co-sponsored meeting on mental health in Helsinki, Finland in July 1997. The
meeting is organized in collaboration with WHO’s Regional Office for Europe (EURO) and through
the co-sponsorship of the World Federation of Mental Health and the Carter Center in the USA.
Ten women leaders of their countries, the personal designees of leaders in seven additional
countries, and participants representing a total of 34 countries of Europe gather for a one-day Finland
working session on the improvement of mental health for families and youth.

The meeting seeks to increase public awareness within each country and throughout each region
of mental health and illness; and to stimulate local activities within each country that will advance
the mental health agenda.

In a signed Joint Statement, participants formally pledge to support awareness-raising efforts in

their own countries, to assist in the establishment of international efforts, to firmly support national
mental health policies, to promote at least one mental health activity in each of their countries and
to assist nongovernmental organizations involved in the development of mental health.

1991 1992 1993 1994 1995 1996 1997 1998 1999 2000
16 A joint statement of International Women Leaders for
Mental Health in Europe

We, First Ladies and Wives of Heads of State or their designated personal representatives, have con-
vened at the Meeting of the Committee of the International Women Leaders for Mental Health to
address concerns regarding mental health in Europe.
Mrs Ludmilla Ter-Pettrossian, Armenia
In order to initiate proactive steps toward improving mental health and well-being of the peoples of
Martha Kyrle, MD, Austria
Europe, we pledge to:
Hubert Ronse De Craene, MD, Belgium
• Support ongoing initiatives that raise awareness of mental health issues in our countries.
Ms Kaja Neumann, Denmark
• Assist in the establishment of international programs directed to foster, protect and restore
Mrs Eeva Ahtisaari, Finland mental health and well-being.
Lali Rukhaia, MD, Georgia
• Firmly support existing national mental health policies, work to forge a coordinated effort in
Kinga Göncz, MD, Hungary conjunction with ongoing initiatives being implemented in other social sectors, and promote at
Mrs Reuma Weizman, Israel
least one activity in each of our countries that will help to improve the mental health of citizens.

Mrs Mairam Akayeva, Kyrgyz Republic • Assist nongovernmental organizations and institutions involved in the fostering and develop-
ment of mental well-being.
Mrs Nada Gligorova, Macedonia
• Call upon intergovernmental organizations in Europe responsible for technical and financial sup-
Mrs Antonina Lucinschi, Moldova
port to assist efforts to enhance mental health and well-being in our countries.
Mrs Margarita L. Kok-Roukema, Netherlands

Mrs Jolanta Kwásniewska, Poland

Signed on the eleventh day of July,
Mrs Maria José Ritta, Portugal
nineteen hundred and ninety-seven in Helsinki, Finland.
Ms Margarita Aleksandrova Kachaeva, Russia

Mrs Emilia Kovácová, Slovakia

Professor Belma Aksit, Turkey

BUILDING POLITICAL WILL AND COMMITMENT

Eastern Mediterranean Health Ministers pledge 17
to support mental health
October

1997
As part of its awareness raising strategy, Nations for Mental Health holds a special working session
on mental health in Tehran, Iran in October 1997. The half-day session is organized in conjunction
with the Regional Committee of WHO’s Eastern Mediterranean Region. Representatives of twenty
countries of the region, of whom 17 were Ministers of Health, attended.

A number of the Health Ministers, Dr H. Nakajima, WHO Director–General, Dr H. A. Gezairy, Iran

WHO Regional Director and several mental health experts at WHO’s Headquarters and the
Eastern Mediterranean Regional Office address the meeting. Papers presented to the committee
highlighted the extent of the burden related to mental health problems in the region and
described the resources available to manage these problems. There is considerable discussion
about the need to strengthen services without placing additional pressure on existing human and
material resources.

A joint statement and a pledge made by Health Ministers herald a new era for mental health in
the Eastern Mediterranean region, and signal the potential for the reduction of suffering of mil-
lions of people.

1991 1992 1993 1994 1995 1996 1997 1998 1999 2000
18 Joint Statement on Mental Health by the Ministers of Health
of the Eastern Mediterranean Region

We, the Ministers of Health (or designated representatives) of the countries of the Eastern
Mediterranean Region of the World Health Organization, desiring to improve the mental health and
well-being of the people of the Region, pledge ourselves to:

• Support our national mental health policies and programmes, and review them as necessary to
identify factors that hinder these policies and programmes from having the optimal outcome;

• Coordinate activities with other concerned social sectors in all areas that impinge on the
mental health and well-being of the people;

• Raise awareness of mental health issues among the public, professionals and policy-makers;

• Encourage and work with nongovernmental organizations and institutions involved in the fos-
tering and development of mental well-being.

Signed by 20 countries’ representatives, of whom 17 were Ministers of Health

BUILDING POLITICAL WILL AND COMMITMENT

Chinese Government commits itself to improve mental health 19

November

1999
A high-profile Nations for Mental Health awareness-raising meeting takes place in Beijing, China, in
November 1999, and is attended by the WHO Director–General, Dr Gro Harlem Brundtland. This is
an historic occasion because, for the first time, Chinese senior government officials voice their
recognition of the problem of mental disorders in China, and their support for improving mental
health care in their country. During the meeting, the Chinese Vice-Premier calls upon government
at various levels and departments to raise their awareness of mental health and attach more China
importance to mental health. A direct and important output of the meeting is a joint declaration,
endorsed by a wide cross-section of Ministries that called for social support and initiatives for
achieving mental health for all. Identified areas for attention include prioritizing rural mental health;
putting prevention first; giving equal importance to Western medicine and traditional Chinese
medicine; relying on science and education; and, mobilizing social participation. The Chinese gov-
ernment also announces its intention to cooperate with WHO as well as national governments and
nongovernmental organizations.

The Conference in Beijing opens the way for further and larger-scale cooperation and technical
assistance on mental health issues in China. As a follow up to the above conference, there are
three further awareness raising conferences funded by Nations for Mental Health at the Provincial
level in 2000 in Shanghai, Qinghai and Shandong.

Excerpt from the declaration of China/WHO Mental Health

Awareness Raising Conference
The China/WHO Mental Health Awareness Raising Conference is an important one that gives
impetus to the development of China’s mental health services. Responding favourably to the UN’s
resolution of “the Protection of Persons with Mental Illness and the Improvement of Mental Health
Care” and WHO’s proposed Global Strategy of “Nations for Mental Health”, China has committed
itself to improving its mental health services.

Endorsed by a wide cross-section of Chinese Government Ministries, 13 November 1999

1991 1992 1993 1994 1995 1996 1997 1998 1999 2000
 21

Creating collaborative strategies

Nations for Mental Health is conceived

as a vehicle for multidisciplinary
and interorganizational work.

Nations for Mental Health:

an overview of a strategy to improve
the mental health of
underserved populations

WHO/MSA/NAM/97.3

1991 1992 1993 1994 1995 1996 1997 1998 1999 2000
22 WHO sets its agenda for mental health

April

1999
A Nations for Mental Health meeting on “Setting the WHO agenda for mental health” is held at
WHO headquarters in Geneva, bringing together experts from many parts of the world on 28 and
29 April 1999 to advise the Organization on the future directions of its work on mental health.

As the Director-General of WHO, Dr Gro Harlem Brundtland, says in her opening address, mental
WHO disorders are one of the most significant contributors to the global burden of disease. And,
she underlines, “All predictions are that the future will bring an exponential increase in mental
Headquarters problems. The most important reasons include the ageing of the population, exacerbating social
problems and unrest, including the rising number of persons affected by violent conflicts, civil wars
and disasters and the growing number of displaced persons.”

Meeting participants conclude that WHO should work with a range of partners – countries, other
international organizations, mental health professionals, scientists, NGOs, the media, etc., and
should provide an information base indicating how effective interventions can be generalized
successfully at the community or population level. It is further recommended that WHO should
advise governments and communities on how to set up policies and programmes and how to
mobilize funds from other sectors (e.g. labour, education) and external funding bodies, but also
on how to make better use of community resources, including family members. Finally, WHO is
urged to target key areas where it can make a difference such as rehabilitation in schizophrenia,
treatment of depression and epilepsy in the primary care setting, and suicide prevention, and
vulnerable populations, such as poor women, victims of violence, displaced persons and persons
living in extreme poverty.

CREATING COLLABORATIVE STRATEGIES

A first-ever joint World Health Organization/European 23
Commission meeting on mental health
April

1999
In April 1999, Nations for Mental Health convenes a joint meeting between WHO and the
European Commission in Brussels. Notably, it is the first-ever joint collaboration between the two
bodies in the area of mental health. The main objective of the meeting is to develop an agenda
defining priorities for the promotion of mental health that WHO and the European Commission can
incorporate into their respective work programmes and which can serve as a basis for joint action
between the organizations. Belgium
Sixty-four mental health professionals, managers, and policy-makers from 34 European countries,
including 14 EU Member States and most countries of Central and Eastern Europe, attend this
meeting. Other key participants included representatives of nongovernmental organizations and
foundations. The meeting establishes a consensus on what balance between mental health care
and mental health promotion activities in Europe would be appropriate and what policy should be
developed in the future to meet the needs of the population.

As part of the closing statement, a set of nine key principles is endorsed. They include the need to
develop explicit mental health policies; the importance of tackling traditional inequities by giving
particular attention to mental health promotion and care; and, the need for continuing professional
education to mental health care providers.

Following – and as a direct result of – this meeting, an European Council resolution on the promotion
of mental health is passed in November 1999. Among other points, this resolution calls on Member
States to give due attention to mental health and to strengthen its promotion in their policies.

1991 1992 1993 1994 1995

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24 Closing Statement of WHO/European Commission meeting
on mental health
Mental health promotion and mental health care are complementary parts of the spectrum of nec-
essary interventions to achieve good mental health outcomes for the population. Both approaches
are essential elements of a comprehensive mental health strategy and a balance should be realized
between them, stressing an intersectoral and a multi-disciplinary approach. This balance will be
based on historical, cultural, structural [including availability of health and social services] and ethi-
cal factors and conditions, and made at the appropriate level in each context. Actions should be
based on the best available knowledge or evidence, and continuously evaluated.

The following nine key principles are central to mental health promotion and to mental health care:
personal autonomy, sustainability, effectiveness, accessibility, comprehensiveness, equity, account-
ability, coordination, and efficiency.

Common goals and strategies to advance mental health promotion and care include:

• Enhancing the visibility and improving recognition of the value of mental health, including
at the political level.

• Increasing the interchange of knowledge and experience on mental health and the transmis-
sion of mental health information.

• Developing innovative and comprehensive, explicit mental health policies in consultation with
all stakeholders, including users and carers, and respecting NGO and citizen contributions.

• Defining priorities regarding settings, target groups and target conditions for activities and
interventions in mental health promotion, primary, secondary and tertiary prevention, and
prevention of mortality (e.g. families, schools, workplaces, prisons, neighbourhoods, social
services, primary and specialist care).

• Development of primary care and specialized mental health services focusing on quality of care
and the development of new non-stigmatizing and self-help approaches.

CREATING COLLABORATIVE STRATEGIES

 25

• Tackling inequity in health by giving special attention to the mental health promotion and care
needs of marginalized, deprived and socially excluded groups, taking account of the serious
social changes and upheavals currently occurring in many countries of the European region of
WHO, in particular in the newly emerging democracies.

• Developing evidence-based guidelines for mental health promotion, primary and secondary
care, including rehabilitation and community-based interventions.

• Developing a human resource strategy and emphasizing continuing professional development

(life long learning and training).

• Highlighting research and development, establishing mental health information and monitor-
ing systems, including systems to assess the prevalence, cost and needs of mental health, and
outcomes of intervention.

• Development of mental health legislation based on human rights, emphasizing freedom

of choice, and the importance of appropriate confidentiality.

Endorsed by European representatives from over 30 countries

1991 1992 1993 1994 1995

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26 International workshop places mental health
on the international agenda
April

2000
Nations for Mental Health collaborates in the development of a Harvard University Department of
Social Medicine workshop entitled “Placing Mental Health on the International Agenda”, which is
held in Boston, USA in April 2000. This effort is led by Professor Arthur Kleinman, Nations for
Mental Health steering committee member.

USA The following areas are covered:

• The burden of mental disorders

• Ethical, scientific and empirical bases for mental health policy

• The economics and financing of mental health programs

• Key policy issues and research questions

• The Role of the World Bank and Private Foundations

Delegates present a wide spectrum of views and information from a range of

developing countries, namely Brazil, India, Mexico, Tanzania, and China.

CREATING COLLABORATIVE STRATEGIES

 27

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 29

Strengthening mental health

policies and services
Governments will be assisted to formulate,
implement, monitor and evaluate mental
health policies. Improving accountability,
organization, quality, appropriateness, and
delivery of services and treatments … are
important areas which will be addressed by
Nations for Mental Health.

Nations for Mental Health: an overview of a strategy to improve the

mental health of underserved populations

WHO/MSA/NAM/97.3

1991 1992 1993 1994 1995 1996 1997 1998 1999 2000
30
Belize
Project goal
To strengthen community-based mental health services and networks.

Implementing institutions
• The Ministry of Health

• The Pan American Health Organization/WHO

Key results
• A mental health advisory board with its own terms of reference was established.

• Community mental health training workshops were implemented.

• Mobile psychiatric units were set up in the villages most in need.

• A community education committee for mental health was established.

• A media strategy for mental health was implemented.

• The referral system for mental health problems was reorganized.

• Forms for reporting mental health problems, and admission and discharge to and from hospitals
were updated.

• A plan was developed to reorganize the psychiatric and mental health services with emphasis on
deinstitutionalization.

Belize
SI N
T TR RE O
NGDH
UTCE
TNI OI N
NG M E N TA L H E A LT H P O L I C I E S A N D S E R V I C E S
Egypt 31

Project goal
To improve mental health care by giving training to primary care providers.

Project objectives
• To develop mental health resource materials for trainers and primary care providers.

• To conduct training.

• To integrate mental health care into primary health care in the Eastern Medical district.

Key results
• 134 physicians and 75 nurses were trained in mental health issues.

• A baseline and a post-training questionnaire were developed and used as evaluative tools.
Evaluations showed that there was a marked increase in knowledge of those physicians and nurs-
es who underwent training.

• An evaluation protocol was developed for the training of supervisors/psychiatrists.

• Mental Health training materials were developed in six areas – mental health, brain and
behaviour, mental health prevention and promotion, signs of mental illness, major psychiatric ill-
ness, psychiatric emergencies, drug abuse, psychopharmacology, communication skills, referral
and recording (record keeping).

Egypt
1991 1992 1993 1994 1995 S 1996
TRENGH
1997
T E N I N1998
G M E N 1999
T A L H E2000
ALTH POLICIESIN
ATN RD O SDEURCVTI ICOE N
S
32
China-Zhejiang Province
Project goal
• To strengthen the coordination and management of mental health services in the province of
Zhejiang.
• To develop a detailed, three-year mental health plan.

Key results to date

• The establishment of a Mental Health Leadership Group that has collaborated regularly with the
Working Group in identifying and resolving difficulties in the implementation of the project and
in developing the three-year mental health development plan.
• The establishment of a Working Group responsible for the day-to-day implementation of the project.
• The organization of a provincial Mental Health Awareness Conference to inform the public and
government officials about the project, increase awareness about the importance of mental
illnesses in public health, and to solicit support for the project.
• The development and testing of instruments used in the study, as well as the training of staff in the
use of these instruments. For instance, the instruments for the epidemiological study to be con-
ducted among 15 000 respondents have been developed and tested in a pilot study of 600 sub-
jects.
• The staff of the Working group have collaborated with the focal points in a number of depart-
ments to develop assessment tools that meet their own goals and, thus have increased the likelihood
that these departments will be active partners in the subsequent provincial mental health plan.
• The collection and analysis of data have begun to gather detailed information for inclusion in
a database on (i) the mental health burden; (ii) the state of hospital mental health care; (iii) the

China-Zhejiang
SI N
T TR RE O
NGDH
UTCE
TNI OI N
state of community mental health care.
• The establishment of a Mental Health Consultant Group by the Leadership Group to advise
the latter and assist the secretariat in implementing and monitoring the plan.

NG M E N TA L H E A LT H P O L I C I E S A N D S E R V I C E S
Ghana 33

Project goal
To improve the detection and treatment of people suffering from psychosis and epilepsy.

Project objectives
• To sensitize opinion leaders to the issue of mental illness in their communities.
• To give support to community psychiatric nurses to extend care within the community.
• To support districts with the aim of integrating mental health in primary care and creating a
network of support systems for care providers.

Implementing institutions
• Ministry of Health, Ghana

Key results
• Raised awareness and information among opinion leaders in District Assemblies and senior health
authorities about the programme, and their involvement in effective planning and implementation.
• An Expert Core Group was established to develop training manuals. The main areas covered
were: common symptoms of mental illness; identification of major and minor psychiatric
conditions; epilepsy; alcohol and substance abuse.
• Training was provided to coalition teams, general health care providers, and community
psychiatric nurses to assist them in carrying out their functions.
• An integrated community-based mental health programme was formed with the help of coalition

Ghana
team members and general health workers in the district.
• There was an extension of community-based services over a wider geographical area in both districts.
• More people suffering from psychosis and epilepsy began to receive help.

1991 1992 1993 1994 1995 S 1996

TRENGH
1997
T E N I N1998
G M E N 1999
T A L H E2000
ALTH POLICIESIN
ATN RD O SDEURCVTI ICOE N
S
34
Marshall Islands
Project goal
To improve care provided to individuals who have attempted suicide and to prevent suicide
attempts.

Project objectives
• To increase public knowledge about and exposure to suicide and related issues.
• To organize and implement education and training of relevant staff.

Key results
• Public awareness was increased through training of community groups and high school students
on Majuro Atoll and Ebeye on suicide prevention.
• Two videotapes on suicide and suicide prevention were developed and completed for use
in schools and communities.
• Comprehensive use of the media helped to increase public knowledge and education about suicide.
• The WHO-RMI National Suicide Prevention Training was developed, organized, and held
in September 1998, sparking nation-wide interest in the suicide project.
• Mental health professionals from Ebeye, Majuro and Outer Islands participated in the planning
and evaluation of workshops and met the objectives of educating and training health workers.
• An NGO was funded to train staff in techniques for developing community self-help and support
groups.

Marshall Islands
• Further systematic staff training was developed and an informal poll of Human Services staff was
conducted to guide the training.
• Community mental health services were advocated through incorporation of the project in
the National Mental Health Plan.

SI N
T TR RE O
NGDH
UTCE
TNI OI N
NG M E N TA L H E A LT H P O L I C I E S A N D S E R V I C E S
Mongolia 35

Project goal
To reorient the mental health service from one that is specialist and hospital-based to one providing
community-based services focusing on the promotion of mental health and the prevention of men-
tal illness.

Key results
• All 91 psychiatrists were trained in community-based mental health treatment and care, as well
as to teach family doctors in three aimags.

• Psychiatrists from the Centre for Mental Health and Drug Abuse began regular visits to family
doctors in order to assist them with the identification and management of patients with mental
health problems.

• Over 1,000 family doctors were trained in the identification and management of persons
suffering from mental and behavioural disorders.

• For the first time a system was introduced for collection of data specific to mental health for
family doctors.

• The first mental health NGO – the Mongolian Mental Health Association – was established.

• The first psychosocial rehabilitation centre was opened and two others were also established.

• Eight gers were established for rehabilitation activities and for housing and de-institutionalization.

• Quality Assurance training on psychosocial rehabilitation for psychiatrists, doctors and feldshers
was provided.

1992 1993 1994 1995 S 1996

TRENGH
Mongolia
• An expert review committee was established for the inclusion of mental health in national health
law and for the implementation of the national mental health programme.

1991 1997
T E N I N1998
G M E N 1999
T A L H E2000
ALTH POLICIESIN
ATN RD O SDEURCVTI ICOE N
S
36
Mozambique-Cuamba
Project goal
To integrate mental health into general health care at the primary care level, in particular through
the enhancement of psychosocial support.

Implementing institutions
• Ministry of Health, Maputo/Mozambique
• Provincial Authorities – Lichinga/Niassa
• District Health Authorities, Cuamba

Key results to date

• People who have received training are capable of identifying patients with mental disorders.
These include community workers, NGO representatives, traditional healers, nursing personnel
(including midwives) and workers at health posts.

• Health posts are beginning to organize informal discussions on mental health and drugs and alco-
hol. At least nine informal sessions have taken place.

• Posts have been established to offer consultation and integrated community care (screening
patients and psychosocial support) at the Cuamba rural hospital, and in four of the 10 health
posts in the district.

• Improvements have been made to the referral system to make it function more efficiently.

• Monitoring and evaluation of the programme has led to successful problem solving in a number

Mozambique
of areas such as: regular registration of patients at the hospital; identifying measures to address
mental health problems in the district by project focal points; the need for regular timely supervi-
sion of workers involved, particularly at the health posts; ensuring a regular supply of psychotrop-
ic drugs to the relevant health posts.

SI N
T TR RE O
NGDH
UTCE
TNI OI N
NG M E N TA L H E A LT H P O L I C I E S A N D S E R V I C E S
Mozambique-Policy 37

Project objectives
• To increase the technical capacity of Mozambique in mental health policy-making and planning.

• To assist the Ministry of Health of Mozambique to draft a mental health policy and update and
improve its mental health programme.

• To build the capacity of mental health professionals to provide community-based care.

Implementing institutions
• Ministry of Health, Maputo

• Provincial Health Authorities

Key results to date

• Training has taken place of mental health professionals in the area of community mental health.

• An initial situational analysis has been made of mental health issues and problems.

• A clear and costed plan-of-action has been drawn up, it will result in the drafting of a policy by
June 2002.

• Discussions on the way forward have advanced with the Deputy Minister of Health and senior
personnel in the Ministry.

• Discussions have taken place and initial recommendations have been made on training, therapeu-
tic interventions, the supply of psychotropic drugs at all levels of the system, and on intersectoral

Mozambique
collaboration.

• Plans have been finalized for a pilot epidemiological study to support the promulgation of the
mental health policy.

1991 1992 1993 1994 1995 1996

S T R E N G1997
H T E N I 1998
N G M E 1999
N T A L H2000
E A L T H P O L I C I E ISN A
TRNO
D DSUECRTVI IOC NE S
38
Romania
Project goal
To improve the quality of life of the mentally ill through their reintegration in the community.

Project objectives
• To set up a psychosocial rehabilitation center.
• To provide patients in the centre with adequate mental health care in keeping with internationally
accepted standards.
• To implement rehabilitation programmes, and assist the reintegration of people with mental dis-
orders back into society and in their families.

Key results
• A promotional plan was developed to engage the media, who publicized the centre.
• The first psychosocial centre of this type was established by assessing the needs of adults with
psychosocial handicaps, identifying the centre’s target group, recruiting and hiring staff, and
planning services and activities.
• A programme of activities was implemented for people suffering from mental health problems
and their families.
• The creation and development of partnerships between the institutions involved in the project
(Armonia Association, Timisoara Psychiatric Clinic, the Timisoara Mental Health Centre, Pro
Mente Association in Austria, the Romanian League for Mental Health, the Romanian Health
Ministry and WHO), with the subsequent establishment of significant professional relationships.
• National health authorities were involved in the project through the integration of the Armonia

Romania
Psychosocial Centre in Timisoara (PSC) into the national social health insurance system, and by
lobbying the government in order to secure increased social protection.
• A heightening of awareness, and activities to promote the need for mental health reform, includ-
ing the establishment of a mental health law and the drafting of a mental health plan.

SI N
T TR RE O
NGDH
UTCE
TNI OI N
NG M E N TA L H E A LT H P O L I C I E S A N D S E R V I C E S
Sri Lanka 39

Project goal
To encourage a process of deinstitutionalization of psychiatric patients and promote reintegration
in the community.

Implementing institutions
• Ministry of Health, Colombo
• Angoda (Teaching) Mental Hospital, Colombo, Western province
• Nivahana Society of Kandy (NGO), Central province

Key results to date

• A strengthening of the network of psychiatric services in the Central and Western provinces by
the establishment of new clinics and by the extension of the range of community-based care
and support.
• Training of primary health care workers, medical health officers and divisional directors of health
services to provide community-based care thus strengthening the integration of mental health in
primary health care.
• Raising the level of awareness in the community and among policy-makers and securing their
support.
• Decreasing the number of readmissions to psychiatric hospitals (approximately 70% of patients
in the Gampaha district).

Sri Lanka
• Establishing forums for carer groups to express their needs and concerns.
• Establishing rehabilitation facilities in the community.

1991 1992 1993 1994 1995 1996

S T R E N G1997
H T E N I 1998
N G M E 1999
N T A L H2000
E A L T H P O L I C I E ISN A
TRNO
D DSUECRTVI IOC NE S
40
Yemen
Project goal
To improve the mental health of the community by integrating mental health within the primary
health care system in Dhola’a Centre near Sana’a.

Project objectives
• To enhance the performance of mental health facilities (outpatient and inpatient units).

• To provide training to general practitioners and primary health care workers.

• To enhance the efficiency of the mental health referral and record-keeping systems (including the
development of a mental health information system).

• To provide mental health education to the community.

Key results
• Mental health facilities were enhanced through the training of health workers by a team of
mental health professionals and general practitioners; by the referral of mentally ill patients to the
inpatient psychiatric unit at Al-Thowra General Hospital; and through the regular provision of
essential drugs to the mental health services.

• Training and retraining courses were provided to health workers, general practitioners, and
specialists.

• The efficiency of the mental health referral and record-keeping systems was improved to better
identify persons suffering from mental illness.

Yemen
SI N
T TR RE O
NGDH
UTCE
TNI OI N
• Health workers provided mental health education to members of the community.

NG M E N TA L H E A LT H P O L I C I E S A N D S E R V I C E S
Eastern Mediterranean countries promise to work towards 41
a new mental health strategy
November

1998
In November 1998, Nations for Mental Health organized the first-ever meeting of Eastern
Mediterranean countries concerning mental health. This was an inter-regional meeting, in that it
included representatives from countries in the African, Eastern Mediterranean, and European WHO
regions: Cyprus, Egypt, Greece, Israel, Italy, Lebanon and the Palestinian Authority.

During the meeting, participants shared information concerning mental health reforms in different Cyprus
countries, and discussed the role of primary health care in reforms.

The meeting resulted in a Declaration that called for more resources for mental health care; recog-
nition of the burden of mental health problems; promotion of concrete initiatives to fight stigma
and respond to the needs of disadvantaged groups such as refugees and displaced persons; ade-
quate legislation; and, adequate mental health care systems.

Another important outcome of the meeting was the creation of a permanent Forum on Mental
Health of Eastern Mediterranean countries (EMHF). The Forum was structured to disseminate inno-
vative experiences of mental health policy reforms, to create common training activities, and to
develop common policies. Under this Forum structure, both Israel and Greece hosted all participat-
ing countries to visit their mental health programmes. To this day, Forum members continue to sup-
port one another in improving their mental health policies and services.

1991 1992 1993 1994 1995 1996

S T R E N G1997
H T E N I 1998
N G M E 1999
N T A L H2000
E A L T H P O L I C I E ISN A
TRNO
D DSUECRTVI IOC NE S
42 Excerpt from declaration of the meeting of Eastern
Mediterranean countries
In order to facilitate exchanges and international collaboration, the participants have created a
permanent Forum on Mental Health for the Eastern Mediterranean countries (EMHF). The Forum
will include all Eastern Mediterranean countries willing to establish mutual cooperation on a bilater-
al or multilateral basis. This collaboration should be under the auspices of the WHO initiative
Nations for Mental Health and the WHO Regional Offices of Eastern Mediterranean and Europe.

Signed by representatives from Cyprus, Egypt, Greece, Israel, Italy, Lebanon,

and the Palestinian Authority

STRENGHTENING MENTAL HEALTH POLICIES AND SERVICES

Supporting Governments and 43
Policy-Makers

“This document is aimed at government minis-

ters, civil servants. government advisers and other
policy–makers who are concerned with national
health strategy. It summarizes the public health
significance of mental health and the main social
and economic arguments for tackling mental dis-
orders in a planned strategic way. It sets out the Schizophrenia and Public Health
key elements of a strategy, together with a
framework for mental health legislation.” “This document addresses important public
health issues related to schizophrenia… It is
Nations for Mental Health Document WHO/MSA/NAM/97.5
hoped that this important document will help
support health ministers, ministry officials, and
regional health planners whose task is to deliver
and improve mental health policy and services
within a strategic context.”
Nations for Mental Health Document WHO/MSA/NAM/97.6

1991 STRE
1992 N G H T 1994
1993 E N I N G 1995
M E N T 1996
AL HEA L T H P1998
1997 O L I C I E1999
S A N D 2000
SERVICES
44

The Effectiveness of Mental Health

Services in Primary Care: The View
from the Developing World

“This document reviews and evaluates the effec-

tiveness of mental health programmes in prima-
ry health care in developing countries… This
document includes a detailed discussion of pro-
grammes in developing countries and an histori-
cal review of what has been achieved, which will
be of great help to policy-makers, planners and
practitioners in the health and mental health
fields, who are considering implementation of
such programmes.”
Nations for Mental Health Document WHO/MSD/MPS/01.1

STRENGHTENING MENTAL HEALTH POLICIES AND SERVICES

Community care of schizophrenia in developing countries 45

February

1999
In February 1999, Nations for Mental Health held an international symposium in Bangalore, India
on community care of schizophrenia in developing countries, in collaboration with the National
Institute of Mental Health and Neurosciences (NIMHANS). The symposium convened experts and
mental health nongovernmental organizations from several countries to discuss interventions for
schizophrenia that are integrated at the individual, family and community levels. Participants from
Bangladesh, Bhutan, India, Maldives, Myanmar, Nepal, and Sri Lanka presented information on India
their countries’ innovations in community-based care for schizophrenia.

Symposium participants identified schizophrenia as a prime cause of disability and a public health
priority, particularly because it can be treated effectively. To tackle schizophrenia, participants rec-
ommended the integration of mental health into general health care; a focus on the family as a
valuable resource in planning and implementation of care programmes; the promotion of advocacy
through self-help groups; changing public awareness about mental health by reviewing the current
portrayal in the media.

To achieve these recommendations, participants agreed to discuss with media personnel guidelines
and measures to present mental health problems in a more positive manner; to develop a consen-
sus statement about the treatment of schizophrenia in particular; to organize professional training
programmes to influence practice; and, to give special attention to vulnerable groups such as
women, the elderly, persons without the support of families, and the homeless.

1991 1992
STRE
1993
N G H T 1994
E N I N G 1995
M E N T 1996
AL HEA
1997
L T H P1998
O L I C I E1999
S A N D 2000
SERVICES
 47

Empowering consumers and families

Interventions that incorporate consumers’

and families’ perspectives, and that support
the action of consumer and family groups
with regard to mental health care, will be
encouraged and supported.

Nations for Mental Health: an overview of a strategy to

improve the mental health of underserved populations

WHO/MSA/NAM/97.3

1991 1992 1993 1994 1995 1996 1997 1998 1999 2000
48
Argentina
Project goal
To consolidate and extend community mental health services in the Río Negro Province in order to
assist with the recovery, treatment, and rehabilitation of people with mental health problems.

Project description
The overall goal of this project was to assist people to earn a living and achieve the kind of rehabili-
tation that can only be accomplished when one’s work has been recognized by society. There were
seven businesses run by users of mental health services in Río Negro in 1999. Almost all of the
employees of these companies were beneficiaries of mental health services. The project aimed to
develop work plans, staff training and education, and to implement evaluation processes to consoli-
date the work being undertaken by these companies.

Various associations of users, family members and friends were incorporated in community mental
health policies. The aim of the project was to strengthen five existing associations and set up five
new ones through the organization of training workshops for the associations and awareness train-
ing sessions for the community.

Twenty mental health teams, as well as several associations of relatives, took part in the ongoing
education provided at provincial working meetings. These meetings were held three times a year
and provided specific training on subjects such as: legal aspects of the application of law 2440;
principles of community mental health; agreements on diagnostic categories; establishment of a
register of activities; and basic gathering and analysis of statistics.

EMPOWERING CONSUMERS AND FAMILIES

 49

Key results
• The businesses run by mental health service users were confirmed as a valid and effective way of
assisting the recovery and rehabilitation of people with mental health problems.

• A number of user and family organizations were reactivated.

• The training and education of health professionals were undertaken.

1991 1992 1993 1994 1995

E M P O1996
W E R I N1997
G C O N1998
S U M E R1999
S A N D 2000
FAMILIES
 51

Promoting mental health

The implementation of strategies to modify

or to reduce the impact of risk factors will
be encouraged…

WHO/MSA/NAM/97.3

1991 1992 1993 1994 1995 1996 1997 1998 1999 2000
52
South Africa
Project goal
To implement a mother-infant interaction programme in Khayelitsha, an informal settlement in
South Africa, to prevent adverse effects of maternal mood disorder and socio-economic deprivation
on children.

Key results
• It was shown that lay community workers could be successfully trained to deliver a mother-infant
counselling programme.

• It was also shown, by making a comparison with the control group from an adjacent area, that
delivery of these sessions by the community workers was both appreciated by the mothers and of
significant benefit to the mother-infant relationship.

• All community workers showed improvement in the manner in which they implemented the
intervention protocol.

• Mothers were unanimously positive in their perceptions of the programme. Many requested that
the sessions continue for longer, and expressed gratitude to the programme for their increased
knowledge about their baby, but also for the fact that their husbands and other children had also
become involved with the baby as a result of the visits.

• In comparison to the mothers in the control group, the mothers participating in the sessions as
part of this project showed significantly more sensitivity, and the infants were somewhat more
responsive. The overall quality of the interaction was more harmonious.

• Early intervention by community workers was shown to be beneficial to mother-infant interaction

as demonstrated by and assessed in the videotaped play and feeding sessions. There was also
improved physical development, particularly weight-for-age and length-for-age growth.

PROMOTING MENTAL HEALTH

 53

Mental Health and Work: Impact,

Issues and Good Practices

“The document examines the importance

of mental health in the workplace in gener-
al, and suggests appropriate management
for workers with mental health problems. In
addition, it takes a practical look at strate-
gies to promote and sustain good mental
health while highlighting examples of good
practices.”

Document WHO/MSD/MPS/00.2

1991 1992 1993 1994 1995 1996 1997

PROMO
1998
T I N G 1999
M E N T A 2000
L HEALTH
 55

Focusing on underserved populations

Nations for Mental health is an initiative

primarily for underserved populations and
therefore includes disadvantaged persons,
in addition to those people suffering from
mental disorders. Both groups have much in
common, including the need to common
solutions that address specific situations.

Nations for Mental Health: an overview of a strategy to

improve the mental health of underserved populations

WHO/MSA/NAM/97.3

1991 1992 1993 1994 1995 1996 1997 1998 1999 2000
56 Latin American conference on the mental health
of indigenous populations
July

1997
To raise awareness about the mental health of indigenous people, a working group meeting of
senior health leaders was held in Bolivia in July 1997. Nations for Mental Health, in conjunction
with PAHO and with the cooperation of the Bolivian government, organized this event. Some 30
people participated, not only from Bolivia, but also from other countries such as Brazil, Chile,
Ecuador, the United States of America, Guatemala, Mexico, Nicaragua and Peru. Participants includ-
Bolivia ed mental health professionals, social scientists, and leaders of indigenous peoples. They presented
the national programmes of their respective countries, and they met in subgroups to develop pro-
posals for raising awareness on the mental health of indigenous populations.

One important outcome of this conference was a formal publication by Nations for Mental Health,
entitled “The Mental Health of Indigenous Peoples: an International Overview.”. This publication
outlines modern challenges to the mental health of indigenous peoples, and reviews specific cases
in the Americas, Australia, New Zealand, the Pacific Islands, Russia and Asia.

FOCUSING ON UNDERSERVED POPULATIONS

 57

1991 1992 1993 1994 F 1995

O C U S I 1996
N G O N1997
U N D E 1998
R S E R V E1999
D POPU
2000
LATIONS
58
A Focus on Women

“This document describes the

background, rationale, and
implementation procedures for
a range of potential demonstra- Gender Differences in
tion projects addressing women’s the Epidemiology of
mental health. The purpose of Affective Disorders and
the document is to stimulate
Schizophrenia
discussion and action…”
Document WHO/MSA/NAM/97.4
The Mental Health of “The incorporation of a gender-
Indigenous Populations: related perspective into psychi-
an International atric research may have impor-
Overview tant implications for clinical
practice, public health policy
“Dr Cohen’s overview of the and theory… The aim of this
Mental Health of Indigenous work is to report the main epi-
Peoples inscribes itself in the demiological findings on gender
World Health Organization’s differencies in affective disor-
overall thrust to promote mental ders and schizophrenia.”
health, prevent major mental Document WHO/MSA/NAM/97.1

and neurological disorders and

ensure the provision of appropri-
ate care, particularly to the vul-
nerable and underserved.”
Document WHO/MNH/NAM/99.1

FOCUSING ON UNDERSERVED POPULATIONS

 59

Nations for Mental Health model becomes

new vision of mental health department

1999
Following the historic meeting, “Setting the Agenda for Mental
Health,” WHO designs a new strategy for its Department of Mental
Health. This strategy is approved by WHO’s Cabinet. Dr Benedetto
Saraceno, Programme Manager of Nations for Mental Health, is
appointed as the Director of the Department of Mental Health.

Dr Saraceno identifies the mission of the newly-formed department: to

promote mental health of the population worldwide and to reduce the
burden associated with mental disorders. The cornerstones for achiev-
ing this goal overlap with those of Nations for Mental Health: focus on
underserved populations, promotion and protection of human rights,
policy and service development, and evidence-based treatment.

1991 1992 1993 1994 1995 1996 1997 1998 1999 2000
2001 and beyond...
WHO declares 2001 as
“The Year of Mental Health.”
In an unprecedented move, World Health Day, the Ministerial
Round Tables of the World Health Assembly, and the World Health
Report are devoted to the single theme of mental health during 2001.

April 2001
World Health Day 2001, with the slogan "Stop exclusion –
Dare to care," raises awareness among the general public
about mental health, increases knowledge, and changes
negative attitudes. Altogether, 155 countries respond posi-
tively to WHO’s call for action, and World Health Day events
are organized around the world. Millions of people declare
that they “dare to care.”
 61

a new decade begins

May 2001 October 2001
WHO puts mental health on the agenda of governments and WHO’s Director-General launches the World Health Report 2001,
decision makers at the annual gathering of 191 Member States Mental Health: New Understanding, New Hope. The report pre-
during the World Health Assembly (WHA). Four ministerial round sents the most up-to-date information on the prevalence of
tables discuss poverty, discrimination, gender, and human rights mental disorders, their determinants and treatments, the
aspects of mental health. The 132 participating Ministers of organization and financing of mental health programmes, and
Health generally agree that mental health deserves increased combating against stigma and discrimination.
attention in their health policies and plans.
Later in the month, WHO announces a new Mental Health
Global Action Programme (mhGAP). This programme provides a
clear and coherent strategy for closing the gap between what is

2001 urgently needed, and what is currently available to reduce the

burden of mental disorders, world wide.

This programme focuses upon forging strategic partnerships to

enhance countries’ capacity to comprehensively address the stig-
ma and burden of mental disorders. By concentrating on priority
conditions, the programme aims to increase governments’
awareness and responsiveness to mental health issues; enhance
the quality and effectiveness of mental health services; reduce
stigma and discrimination; and by doing so, take important steps
toward reducing the burden of a range of conditions and
enhancing the mental health of the population.

2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
62 WHO’s expanded “Mental Health Global Action Programme”

25 October “Our engagement does not end with the end of this year which we have dedicated to mental

2001
health. We have developed a new ‘Global Action Programme’ or ‘GAP’. The name is no
coincidence. This five–year programme will focus on helping countries closing the treatment gap.
It represents a comprehensive strategy for closing the gap between effective and available mental
health services.

The GAP has identified four core strategies: Information, Policy and Service Development,
Belgium Advocacy, and Research. These four strategies are fundamentally related to one another.
Information concerning the magnitude, burden, determinants and treatment of mental disorders
leads to enhanced awareness and advocacy against stigma and discrimination. This in turn creates
the necessary conditions for the formulation and implementation of integrated policy and services,
which in turn serves to generate more advocacy and information for better decisions. Countries’
research capacity drives this relationship.

In more ways than one, we make this simple point: we have the means and the scientific knowl-
edge to help people with mental and brain disorders. Governments have been remiss, as has been
the public health community. By accident or by design, we are all responsible for this situation. As
the world's leading public health agency, WHO has one, and only one option – to ensure that ours
will be the last generation that allows shame and stigma to rule over science and reason.”

Dr Gro Harlem Brundtland, announcing WHO’s new 5–year mental health programme
Brussels, Belgium, 25 October 2001

2001 AND BEYOND… A NEW DECADE BEGINS

 63

Collectively, the events of 2001 extend the programme

of Nations for Mental Health and reinforce an
international momentum for change. Through the
World Health Day, World Health Assembly, and World
Health Report, WHO and its Member States pledge
their full and unrestricted commitment to this public
health area.
The message is clear and unequivocal: mental health
– neglected for far too long – is crucial to the overall
well-being of individuals, societies and countries, and
must be universally regarded in a new light.

2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
64 Nations for Mental Health: Country Projects and
Awareness-Raising Events

Country project Awareness raising event

2001 AND BEYOND… A NEW DECADE BEGINS

Awareness and Commitment Raising Events 65
of Nations for Mental Health
Place/date

Meeting of international women leaders for mental health USA

September, 1996

Mental health of indigenous populations Bolivia

July, 1997

Meeting of the international committee of women leaders for mental health: hope for a brighter world Finland
July, 1997

Special meeting of the 44th session of the regional committee for the Eastern Mediterranean Islamic Republic of Iran
October, 1997

First meeting of the Eastern Mediterranean countries on psychiatric reform: Cyprus

towards a new mental health strategy November, 1998

WHO international symposium on community care of schizophrenia in developing countries India

February, 1999

Balancing mental health promotion and mental health care: a joint World Health Belgium
Organization/ European Commission meeting April, 1999

Setting the agenda for mental health Switzerland

April, 1999

China/WHO mental health awareness raising conference China

November, 1999

Placing mental health on the international health agenda USA

April, 2000

2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
66 Demonstration Projects of Nations for Mental Health

Country WHO Region Theme

Argentina AMRO • socio-economic enterprises for mentally-ill • training health care providers
• family and consumer associations

Belize AMRO • mental health plans • creation of services

• training of psychiatric nurses • sensitization of community

China WPRO • life skills education

Egypt EMRO • training of primary care providers

Ghana AFRO • mental health services • sensitization of the community

• involvement of community action group

Marshall Islands WPRO • suicide prevention • training of health care providers

Mongolia WPRO • psychosocial rehabilitation of long-term psychiatric patients

• training of health care providers

Mozambique AFRO • creation of services • outreach programmes

• training of health care providers, key community leaders, and traditional healers
• development of national mental health policy

Romania EURO • creation of a psychosocial rehabilitation centre

Sri Lanka SEARO • rehabilitation of long-stay psychiatric patients

South Africa AFRO • mother-infant interaction programme

Yemen EMRO • mental health services • primary care training

2001 AND BEYOND… A NEW DECADE BEGINS

Publications of Nations for Mental Health 67

Resource type

Gender differences in the epidemiology of affective disorders and schizophrenia Document WHO/MSA/NAM/97.1

An overview of a strategy to improve the mental health of underserved populations Document WHO/MSA/NAM/97.3

A focus on women Document WHO/MSA/NAM/97.4

Supporting governments and policy-makers Document WHO/MSA/NAM/97.5

Schizophrenia and public health Document WHO/MSA/NAM/97.6

Sriyawathie – rehabilitation of chronic psychiatric patients in Sri Lanka Video

Recommendations for evaluation Document WHO/MSA/NAM/98.1

The mental health of indigenous populations. An international overview Document WHO/MNH/NAM/99.1

Mental health and work: Impact, issues and good practices Document WHO/MSD/MPS/00.2

The effectiveness of mental health services in primary care: Document WHO/MSD/MPS/01.1

the view from the developing world

2001 2002 2003 2004 2005 2006 2007 2008 2009 2010