A mental health component

petual stalemate , with every group invoking the higher interests of the health of the people , while giving priority to its own sectional inter- ests. Only occasionally do those sets of interest coincide. Then there are times in the life of a society when the community is open to the spirit of innovation. This may be encouraged by revolu- tionary political situations-not a very frequent occurrence-or by some major global crisis that per- suades people of the need to clear away old structures and promote new attitudes. This felt need for change is contagious, spreading throughout the social fabric. And that is just when the political lead- ers should include health slogans in their innovative platforms. Let us not forget that , in normal circumstances, health is not a very paying proposition for the political leader. It is almost impossible to keep both the popular majority and the power interests satisfied. More- over, reforms in depth tend to pro- voke too many conflicts in the early stages , whereas their benefits are only felt in the longer term. In short , health's hour strikes when the political clock shows that W ORLD HEALTH, April 1988 society is ready for global change, to the degree and in the direction that each national culture and cir- cumstance determine. And in that context the best health leadership, at whatever level , will be the lead- ership that is most consistently im- bued with the spirit of political change which is motivating society at that moment in history. We must bear in mind that Latin America is going through a period of severe crisis. What is more , owing to the widespread failure of authoritarian solutions, a majority of countries are now looking to the democratic system as the key to their future. Their social ineffec- tiveness, and the inefficiency of many of their economic, social and political institutions, cry to heaven for reform. Many countries have embarked on that reform or are about to. The debate on reform of the health system must be conduct- ed in the conclaves of the political parties as well as in the usual corpo- rate and academic circles, since it is largely from the political parties that will emerge the dynamic lead- ership we need if we are to succeed in promoting the health of our peoples. • A mental_ health component l?articularly in countries with a more devolved type of goverpment, responsi- bility for a health serviceJi.es at different points on the pe g Even with more 1 centralised systems 'many decisions concerning local functioning are taken at the local level. lt follows that, for action to improve health, leadership develop- ment has to occur at all levels of the system, WHO has not the resources to take responsibility for organizing development workshops for all such personnel. But it can take the lead incc;Jeveloping a format for such activities wnic n be replicated by the relevant he 9rities in other, member countri . ; 11· Several countrie ave included men- tal health within therr primary health care programme, in line with the recommen- dations of the .Aima-Ata Conference in 1978. The implications of this have to be made plain to all those responsible for health care_ At the moment there are many mental health· professionals (usu- ally psychiatric nurses) working at district and other provincial levels of the health system, Their tr · · · has usually en- couraged them . ·provide a treat~ ment service for tho e patiemts who turn up at clinics. They are 'seldom aware that they could also be taking a leadership role in ensuring that the health service within their district contains a mental health component throughout. As a step towards overcoming this problem in one area of Africa, a WHO workshop on Leadership Development in Mental Health.w(;ls held last year in · Arusha, United R ublic of Tanzania, ·· with finangil:ll '~u ' om the Danish :• Agency for lnt I 'D.evelopmentl' (DANIDA). lt was attended by 22 participants drawn from East and Central African countries of the African Mental Health Action Group. They came from regional or district levels within countries and were invited as teams consisting of a mental health worker and a more general health worker from the same administra- tive unit. The National Mental Health Co- ordinators from :t pia .{whi<:;h helped to arrange the . co' d from , Uganda. also attended. · The workshop .starte with an account of the Tanzanian 1mental health pro- gramme, which puts emphasis on including a mental health component within primary health care. lt then dealt with ways in which .. local projects could be planned, and underscored the need for community involvement in both plan- ning and carrying P.l!t projects. Finally, the teams preparecFproppsals for spe- , cific projects ~ Riph1 th~Y themselves 'could try to 1undertak~ Q,ver ~he next1 12 months. SimHar~1courses are planned in the future, esp~ciall{one for the more southern countries of the African Mental Health Action Group. John Orley 11