Guillermo Rivera, MD, PhD.

Associate Professor of Psychiatry University of Santa Cruz

WHO, 2007.

WHO, 2007.

2030 rankings: The leading causes of DALYs lost

World 1 2 3 1 2 3 HIV/AIDS Depression Ischaemic heart dis. Depression Ischaemic heart disease Alzheimer

High-income countries

Middle-income countries

1 2 3 1 2 3

HIV/AIDS Depression Cerebrovascular HIV/AIDS Perinatal Depression WHO, 2010.

Low-income countries

Scarcity
Human Resources
(N=157 to 183 countries)

7|

Human resources for Mental Health per 100,000 population WHO, Mental Health Atlas, 2005.

Mental health resources in the USA

300 million people 50,000 psychiatrists

Mental health resources in India

1.1 billion people 3000 psychiatrists
WHO Mental Health Atlas 2005

Gap in treatment:
Serious cases receiving no treatment during the last 12 months
90 80

85% 76%

70

60

50

50%
40

30

35%

20

10

0 Lower range Upper range Lower range Upper range

Developed countries

Developing countries

WHO World Mental Health Consortium, JAMA, June 2nd 2004

100% 90% 80% 70% 60% 50% 40% 30% 20%

Treatment Gap 69%

Treatment Gap 98%

COVERAGE
10% 0%

COVERAGE
Schizophrenia n =50 COVERAGE Mood disorders n=28 TREATMENT GAP

 Most

resources concentrated in urban areas resources in private sector with high out-of-pocket costs

Many

100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0%

20%

17% 63%
Other facilities Mental hospitals

80%

83% 37%

Proportion of expenditures

Proportion of beds

Proportion of human resources

Mental Health Services (WHO, 2003)

HIGH LOW

Specialist Services

FREQUENCY OF NEED

COST

Psychiatric Services in General Hospitals

Community Mental Health Services

Mental Health Services through PHC

LOW

INFORMAL COMMUNITY CARE

HIGH

SELF CARE

Scaling up services for people with mental disorders based on evidence and human rights protection
increasing the coverage of services based on the evidence derived from experimental research, leading to improve health outcomes in the target population
17

18

Building capacity in stakeholders

Supporting community and primary care intervention programs Implementing priority mental health research Advocacy to raise mental health literacy

19

In many low-income countries, mental illness has traditionally been seen as a low priority area, both in terms of clinical resources and emphasis in the training of healthcare professionals. The psychiatrist are essential part of every health care system, but their training should response to the needs of the community.