Before I took office as Director-General of the World Health Organization, I was determined to address mental health as a priority. I had seen how hard it had been to strengthen mental health policies in my own country, Norway. I had started to see some of the vast neglect that people with mental health problems faced in developed and developing countries alike. It was very clear to me: Mental health must rise to a more prominent place if we are to live up to our mandate of promoting health and human rights.

This conference is a clear contribution towards this goal. I would like to thank the World Federation of Mental Health and the Clifford Beers Foundation to have taken the initiative to organize this Conference and also to The Carter Centre to have cosponsored it.

We have a long way to go. Recently, I looked through an old issue of WHO World Health Magazine which said the following:

"Great numbers of mentally ill still live, shut away behind hopeless walls by the prejudices and incomprehension of society. The efforts (…) to have the mentally ill treated as other sick people who can be cured, are likely to remain fruitless as long as irrational fear of ‘madness’ is not conquered, as long as all the influential members of the social hierarchy do not understand that mental health is not only the business of specialists but must concern the whole community."

Sadly, it is as true today, as when it was written – in 1959. Yet, the fact that we forty years later still have to struggle to place mental health on an equal footing with other aspects of public health should not discourage us.

This past century has seen spectacular changes in the way we live and think. Human brilliance and technology have come together to propose solutions we dared not imagine forty years ago. We have conquered diseases that once seemed insurmountable. We have saved millions of people from premature death and disability. And our search for better solutions to health is, as it should be, ceaseless. The solutions to mental health problems are not difficult to find; many of them are already with us. What we need is to focus on this as a basic necessity, in our systematic search for a better life for all.

This is a conference of mental health promotion and prevention. Much time and energy have been spent in the past on delineating these two concepts and evaluating the relative merits. Let me say clearly that for WHO, there is a continuum that stretches from general promotion on the one hand through primary prevention to specific therapeutic interventions that have preventive effects on the other. Our task must be to use the whole of this spectrum to achieve results.

To do so, we need more evidence and more knowledge.

Let me start with the framework.

Health promotion is a question of empowerment. All people want to lead healthy lives. Society’s task is to empower them to do so.

Let us agree on the key points: for people to have the power to be healthy, they first need knowledge. Accurate, reliable knowledge about how to achieve good health, and about the risks to health that they face in their daily lives. They need knowledge that helps them to make the best choices and to implement them.

Knowledge is necessary, but it is not sufficient. For people to have the power to be healthy, they must be in a position to choose better health. This means making the right choices, and putting them into practice. If people are not able to do so, the new knowledge leads to frustration.

Yet, the combination of knowledge and a healthy environment may not be enough. Many people will still not feel that the power to be healthy is in their hands. The third element is their being empowered to make the healthy choices for themselves - and stick to them. This means local, national - and even international - policies that give them the freedom to do what they want, and need, to do.

Families need to know the importance of early childhood development and what this means in practice for parents and other care-takers. Early support to young mothers can both promote good physical and mental health and reduce child abuse. Families need to know how early identification and treatment of psychotic illness is highly effective for a better outcome Families and doctors in general practice need to know the early signs of depression and the basic steps that can be taken to arrest or alleviate the condition. Teachers need to know how to notice vulnerable and unhappy children and how best to support children. We need to give increased attention to prevention of depression, and we now see promising programmes developed to reduce depression in adolescents and adults.

Better environments. We must ensure that the social and natural environments are such that they prevent mental disorders. It is unacceptable to continue seeing high incidence rates of disorders with lifelong impact which could have been easily avoided at very little cost.

For example, cognitive and social stimulation of children of mentally retarded mothers early in life can reduce the incidence of mental retardation in these children.

Or, take the case of mental retardation due to iodine deficiency.

It is estimated that more than 1.5 billion people around the world are at risk of iodine deficiency disorders. Each year about 18 million women suffering from asymptomatic deficiency become pregnant, sixty thousand of these pregnancies end in miscarriage or still birth, 120,000 result in the birth of children with overt cretinism, a million children develop deafness, speech disorder, or other neuromuscular disorder and five million will have significant intellectual disabilities.

Yet, with only 5 US cents per person per year iodine deficiency disease can be prevented by iodizing salt for all consumption. In this particular case, governments must be held responsible for not developing and implementing national plans for safeguarding public health and nutrition through salt or water iodization.

Then there is epilepsy. This neurological disorder affects more than one per cent of the population and more than half of these cases are preventable with relatively simple measures, such as adequate prenatal care, safe childbirth, prevention of brain injuries and control of infectious diseases affecting the brain. What is needed is a comprehensive primary health care.

Enabling policies. The responsibility for good mental health prevention sits with the family, the school, the work place, and the local community. But above all it sits with the government and the political institutions. Only if the government provides enabling policies can these other entities make the decisions they need to promote good mental health and prevent disorders.

Governments and parliaments need to be in the forefront for reducing stigma through the way it treats mental disorders and how it promotes integration and care for those with temporary or permanent conditions of mental ill health.

Governments and parliaments need to mandate - and equip schools and work places to carry out activities that prevent mental ill health. This must include addressing the goals of primary and secondary schooling with education leaders and devising ways to make schools child friendly.

The teaching of "life skills" is one such way of addressing these needs. WHO has developed a programme to promote the teaching of such "life skills" in schools. These are personal and interpersonal, psychological skills that can help the children in their everyday life.

This includes skills to cope with stress, decision making skills, problem solving, creative and critical thinking, as well as communication and empathic skills. Assertiveness skills, if used appropriately can prevent people suffering by being pushed about and humiliated unjustly. These skills can also help in resisting pressure from peers to join activities which the child might not otherwise wish to.

Some years ago, a US first lady promoted the slogan "Just say no!" as a tool against the rising wave of drug abuse among the country’s youth. It was a good slogan, but one that depended on young people being taught how to say no to drugs.

In general, to say no is a useful skill throughout life, starting at an early age of saying no to a cigarette at the age of 10, saying no to sex at the age of 14 or saying no to another drink as an adult, when you will be driving.

We don’t want ten different programmes of how to say no, but one where communities, schools and parents take responsibility to reduce aggression and the risk of conduct disorder and youth delinquency, and instead educate children to pro-social behaviour.

Colleagues,

There is no clear frontier where prevention ends and treatment begins. Working to ensure access to early and effective treatment is an integral part of the effort to reduce the burden of disease caused by mental disorders and to reduce suffering for patients and their families.

We have effective and cheap treatments for most mental disorders. Yet, they do not reach more than a fraction of those who need them. The figures are disturbing:

• Of the 37 million people suffering from schizophrenia in developing countries, only a quarter receive treatment.

• Major depression affects 5% of the global adult population, yet less than a quarter of those affected receive treatment.

• More than 50 million people suffer from epilepsy, nearly 40 million of them are in developing countries. Between 60% and 90% of these do not get treatment.

There is no single reason why so few get access to treatment. But they can be summed up under a few headings:

Stigma. It prevents those who suffer from making use of available treatment.

General poverty. In the many developing countries that spend less than $10 per person on health, mental health needs often come far down on the priority list and there is very little treatment available.

Lack of skills at primary health sector level. Too few doctors and nurses know enough to recognize the need for treatment.

Lack of drugs. Many psychotropic drugs are included in the list of essential drugs that 140 of the world’s countries use as basis for their procurements. Still, one third of the global population has no access to these essential drugs. In Africa the figure is half of the population. The situation is particularly serious in rural areas, where antidepressants, anticonvulsants and antipsychotic drugs are rarely available.

Imbalances in health insurance. In many countries, mental disorders are not covered by health insurance schemes, which means that a number of people cannot afford treatment.

Wrong priorities. A number of countries still spend most of their resources on a few large mental asylums which focus on a small fraction of those who need treatment and care – and often does so badly – while the majority of those who need treatment go without.

Only when a comprehensive strategy for mental health which incorporates both prevention and care elements is adopted, will we see substantial and sustainable progress.

Colleagues,

We know a fair amount about secondary prevention, about how to discover and treat mental and neurological disorders early so that we can prevent more serious or chronic conditions.

We know considerably less about the range and effectiveness of primary prevention.

How do we best prepare children for the challenges and hardships of life? How can we best prevent disorders such as schizophrenia, depression, Alzheimer’s disease and alcohol dependence? What are the preventive interventions that can work well in resource-poor settings? What actions and policies are needed to take effective prevention up to scale?

We need to find answers to these questions. I would therefore urge more research dedicated to mental health – and in particular to the area of primary prevention of mental disorders.

For this to happen we need an increased awareness. Among the general population. Among the medical profession. But above all, among the decision makers – the political leaders of all countries in the world.

WHO is contributing to such an awareness campaign through dedicating the coming year to mental health.

By focusing next year’s World Health Day to mental health, we are starting a global campaign to end the taboos surrounding mental health. We are inviting non-governmental organizations, patient and family associations, mental health professionals and governments the world over to spread the message. In short, we want the world to "Stop Exclusion" and "Dare to Care".

The next year’s World Health Report will be on mental health. It will provide a solid review of the status of science in the field of mental health and use existing and new evidence to underpin a global strategy for mental health. It is our hope that this World Health Report will serve as a catalyst and inspiration for further work in mental health and mental health research.

Colleagues,

Our message is one of concern and hope.

The road ahead is long and difficult. It is littered with myths, secrecy and shame. By accident or design, we are all responsible for this situation today.

But this new century is nothing if not a time of opportunity and challenge. Let us use the outcome of this conference as an inspiration to go back to our work places and our local communities and make a change.I hope that the governmental institutions and the nongovernmental organizations that are here together will maintain the momentum for mental health prevention that this successful conference clearly has created.

Let us stop Exclusion!

Let us Dare to Care!