This week The Lancet is beginning a major new series devoted to mental health. We have invited an internationally respected group of clinical scientists and public-health leaders to review the evidence about mental health services, critique existing efforts to improve mental health, and devise new policies to advance mental health as an important global issue. Their findings are published in 6 papers ([Ссылки доступны только зарегистрированным пользователям ] we are releasing together today.
We are also publishing research articles and editorials ([Ссылки доступны только зарегистрированным пользователям ]) to support the main messages of their report. Following this note, you will find an opening comment to launch the series. Please take a moment, if you can, to look at this initiative and also please give me your feedback. Most importantly of all, please join our campaign.
My best,
Richard Horton
Editor, The Lancet
Comment
Launching a new movement for mental health
by Richard Horton
Despite the great attention western countries pay to the mind and human consciousness in philosophy and the arts, disturbances of mental health remain not only neglected but also deeply stigmatised across our societies. Viewed through a global lens, this marginalisation is only amplified still further. Yet the fragile-and utterly fragmented for the most disadvantaged-state of mental health services in many countries is not for the want of trying.
In 2001, for example, WHO devoted its World Health Report to mental health, with the optimistic message "new understanding, new hope". Gro Harlem Brundtland wrote: "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."1 As Director-General, she set a deservedly high standard for WHO and others to follow and be judged by.
Since then, WHO has continued to publish reports on mental health.2 But somehow the agency, through its leadership and partnerships, has been unable to convert fine words into tangible actions at country level. Partly this is because WHO has not backed its words with resources. And partly it is because WHO's leadership has failed to build a sustainable mechanism across global and country institutions to hold itself and others accountable for its recommendations. This paralysis is surprising. Many low-income countries and civil society groups are crying out for help.
WHO is not the only institution with a responsibility to strengthen mental health services. The World Bank, country donors (such as the USA, UK, and European Union), foundations (such as the Gates and Rockefeller Foundations), research funding bodies (eg, the US National Institutes of Health), and professional associations all share a duty to make mental health a central theme of their strategies and financial flows. For the most part, these organisations have done far too little, if anything at all. In the past, The Lancet has tried to draw attention to mental health services in particular countries.3,4 With a Series of papers launched today from an internationally diverse Lancet Global Mental Health Group, to whom we owe a deep debt of thanks, together with a call to action and a commitment to track and monitor progress across a range of mental health indicators in the run up to a global summit on mental health in 2009, we aim to change this culture of lost opportunity.
The key messages from our Series are clear. First, mental health is a neglected aspect of human well-being, which is intimately connected with many other conditions of global health importance. Second, resources for mental health are inadequate, insufficient, and inequitably distributed. Third, there is already a strong evidence base on which to scale up mental health services. Fourth, most low-income and middle-income countries currently devote far too few resources to mental health. Fifth, there are critical lessons to learn from past successes and failures-for political leadership and priority setting, for increasing financial support, for decentralising mental health services, for integrating mental health into primary care, for increasing health workers trained in mental health, and for strengthening public health perspectives in mental health. Finally, any call to action demands a clear set of indicators to measure progress at country level.
During the next 2 years, The Lancet will make mental health one of its campaign focal points. We urge partners to join the broad new social movement we are launching to strengthen mental health.
References
1. WHO. World health report. Mental health: new understanding, new hope. 2001: [Ссылки доступны только зарегистрированным пользователям ] (accessed Aug 20, 2007)
2. In: . Herrman, H, Saxena, S, Moodie, R (Eds.), Promoting mental health: concepts, emerging evidence, practice. 2005: [Ссылки доступны только зарегистрированным пользователям ] (accessed Aug 20, 2007)
3. The Lancet. Mental health: neglected in the UK. Lancet 2007; 370: 104.
4. Butcher J, Samarasekera U, Wilkinson E, Shetty P. Special report. Lancet 2007; 370: 117-124.