Intercountry Workshop on Developing Country Specific Community-Based Strategies for Reduction of Treatment Gap in Common Neuropsychiatric Conditions, WHO/SEARO, New Delhi, 18-20 November 2004

Address by Dr Samlee Plianbangchang Regional Director, WHO/SEARO at the Intercountry Workshop on Developing Country Specific Community-Based Strategies for Reduction of Treatment Gap in Common Neuropsychiatric Conditions WHO/SEARO, New Delhi, India 18-20 November 2004 INTERCOUNTRY WORKSHOP ON DEVELOPING COUNTRY SPECIFIC COMMUNITY-BASED STRATEGIES FOR REDUCTION OF TREATMENT GAP IN COMMON NEUROPSYCHIATRIC CONDITIONS WHO/SEARO, New Delhi, India, 18-20 November 2004 Address by Dr Samlee Plianbangchang Regional Director, WHO South-East Asia Distinguished Participants, Colleagues, Ladies and Gentlemen, • With great pleasure, I welcome you all to the WHO Regional Office for South-East Asia to attend the subject workshop. • This workshop, I am sure, will be of great help as we embark on community-based mental health programme. • As you may recall, the World Health Report 2001 clearly pointed out that mental and neurological conditions cause a significant amount of morbidity and disability all over the world. • It is estimated that about 450 million people are affected by mental and neurological disorders and substance abuse. • A large proportion of these people live in developing countries, including South East Asia Region. • The projected estimate of disease burden from neuropsychiatric conditions measured by using DALYs method would increase from 9% in 1990 to 14% in 2020. 2 • Therefore, these conditions are clearly an issue of emerging importance in today public health. • It is also known that a substantial proportion of persons with these conditions, particularly in developing countries, do not get appropriate treatment. • This is the treatment gap that we will be reviewing and planning to tackle in the course of this workshop. • It is very unfortunate that this treatment gap in developing countries could be as high as 80-90% of the affected population. • This is the opportunity for us to discuss this vital issue, and develop appropriate community-based strategies to reduce the treatment gap in a phased manner. • Traditionally, neurological and psychiatric services have been concentrated in tertiary care hospitals. • Thus, large segments of the population, particularly those who live in rural and remote areas, have been deprived of such services. • This is despite the fact that both neurological and psychiatric conditions are also common in these communities. • WHO’s current priority in this area is to concentrate its attention on community-based activities. 3 • We are, therefore, making efforts to develop programmes suitable for delivering, at least the basic minimum level of services, to everyone who is suffering from neuropsychiatric conditions everywhere. • Ideally, such services should be provided within the community, integrated with the basic health care services; rather than expecting people to travel long distance to tertiary care hospitals. • Those who are delivering health care in the community should be trained to be able to identify and manage these conditions effectively at that level. • In addition, affordable and appropriate treatment should be made readily available in the community itself, through primary health care approach. • No less important, the programmes should also address psychosocial issues such as stigma and rehabilitation. • Taking into account feasibility and practicality, our strategies in this endeavour are to address the most common causes of morbidity. • The identification of such causes is guided by the following simple criteria: 1. There is a high prevalence of the condition in the community; 4 2. There is a high morbidity from the condition; 3. Identification is possible through the use of resources available in the community; 4. Effective and low cost treatment is available; and 5. Good outcome of such treatment can be expected. • Many mental health conditions are found to meet the above criteria, e.g. epilepsy, psychosis, depression, mental retardation, dementia, and alcohol and substance abuse. • Some communities may have their own unique conditions, but these conditions can be satisfied by the above criteria. • The WHO Regional Office for SEA with the cooperation of experts in the Region has developed community-based strategies to address most of these operational issues. • We will have to ensure that these strategies will be really useful for implementation in countries of our Region, taking into account the local specific socio-cultural situations. • Among other things regarding tools to be used, technical materials on community-base d rehabilitation has been developed, tested and ready for application. 5 • Training in the use of these materials is currently in progress for concerned health staff from three Member States. • There are a number of projects on adolescent mental health promotion, dealing with issues of specific relevance to this vulnerable group. • Also, there are projects to support Member Countries in their efforts to protect communities from harm due to alcohol and substance abuse. • In addition, there are many other activities being identified for the development of community mental health programmes. • Colleagues, looking at the agenda of the workshop, our attention will be paid to community-based strategies for closing the treatment gaps in the most common neuropsychiatric conditions; namely, epilepsy and psychosis. • WHO estimates that there are approximately 15 million people with epilepsy; and at least 20 million with psychosis in countries of our Region. • Both conditions are easily amenable to treatment with cheap and efficacious medications. • Yet, unfortunately, the treatment gap in these two conditions is very wide as mentioned earlier. 6 • However, in our Region, there are many prevailing positive and supportive socio-cultural aspects that can help promote the effectiveness of the treatment of mental health patients. • The deeply spiritual and religious traditions and strong family ties of populations help improve the prognosis of treatment of mentally ill persons. • We may specifically see the example of a community mental health programme in Thailand, where Buddhist monks in the community have taken a leading role in organizing mental health promotion activities. • The entire community then gets involved voluntarily, including community leaders, the police, businessmen and families of those affected. • Such grass-roots activities are normally supported by the country regional mental health hospital. • These community-based actions help very effectively in closing the treatment gap; this is clearly demonstrating that such successful initiatives can be valuable lessons for other countries to learn. 7 • I hope this workshop will further strengthen WHO’s work in supporting Member States in their efforts to deliver, at least the minimum services, for neuropsychiatric conditions, through the use of community-based health care providers and other community assets. • I thank all participants for sparing their valuable time to come to attend this important workshop. • This area of work still needs our special attention. • Let us work attentively together to improve the situation, so that the whole population in our Region will be mentally healthy. • Finally, I wish the workshop productive deliberations and successful conclusions; and I wish you all the best and a very pleasant stay in New Delhi. • Thank you. Q:\RD-OFFICE\Speeches\2004\for RD\IC wksp on devlpg cntry specific CB strat for red. trtmt gap in Neuro conditions, WHO-SEARO, 18-20 Nov 04.doc – 18 Nov. 04/10.30 am