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Minister Ongeri,
Dr Gatere,
Dr Njenga,
Deputy Mayor,
Colleagues,
It is a great pleasure to be able to attend the
opening of this conference, especially since I understand that you
have adjusted the timing and venue to allow me to be here with you.
Earlier this afternoon, we were all witnesses to
something extraordinary. The mental institution as a transparent and
open place. Large mental institutions have for so long contributed to
fear and stigma. This was the case in my own country, Norway, and I am
sure it holds true also in your home countries. To bring people into
these institutions as we did today, is a first step on the way to take
mental illness out of the shadows and bring these diseases where they
belong: among other health problems we all are at risk of or suffer
from. It is also a first step on the way to reduce the reliance on
these institutions.
Let us be frank: one of the functions of the
central mental institutions were to hide those suffering from mental
illness away from society, so they don’t scare us, or trouble us.
Now, if we can reduce the fear, we will also reduce the stigma
associated with mental illnesses.
Colleagues,
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.
During my time at WHO, I have been greatly
encouraged by what I have seen and heard. I sense that mental health
is increasingly being treated as a part of the whole health agenda –
not as a low-priority side-show.
I believe one of the reasons for this is the
understanding of the dominating place mental illness and brain
disorders have in the global burden of disease. I mentioned some
figures earlier today. I would like to repeat them now:
More than 400 million people world-wide are
estimated to be suffering at any given time from some kind of mental
and neurological disorder, including alcohol and substance abuse
disorders.
Mental disorders account for more than 10% of the
burden of all disease in 1999. It is one of the dominating causes of
years lost to disease, something too few people realize. The overall
figure is expected to increase to 15% over the next 20 years.
Five of the ten leading causes of disability are
mental problems such as depression, schizophrenia, bipolar disorders,
alcohol dependence, and obsessive-compulsive disorders.
We cannot ignore these figures anymore.
What is spurring new action around the world,
however, is the realization that we also have new and effective ways
of treating and preventing mental illness and brain disorders. New
methods of care which are focusing on the family and the local
community; effective and relatively cheap drugs; and data showing the
cost-effectiveness of prevention and early detection – this new
knowledge is spurring reforms in many countries.
Often, the reforms spring from the doctors and
other health workers on the ground while governments can be slower to
see the benefits of change. This is natural. But it is important that
the national governments endorse and support these experiments and use
experience gained to spread the reforms throughout the health system.
I have been struck by what I have heard about new
initiatives in this region. Most of these outreach, community and
counselling services are driven by dedicated and innovative
psychiatrists, psychologists and nurses, who have not waited for
formal reorganization, but have worked to improve the system from
within, both through the national health services and through NGOs.
The burden of mental ill health and brain disorders
in Africa is a serious challenge. Not because it is any larger here
than anywhere else – suicide rates, for example are considerably
lower in Africa than in most other continents, while epilepsy
incidents are higher in Africa than in the industrialized part of the
world – but I say it because the resources and the manpower to deal
with mental ill health are so sparse to deal not only with the
ordinary burden of mental disease, but also an extraordinary burden.
I am talking about the burden that comes from the
continent’s many man-made disasters. Over the past few years, we
have seen a number of large armed conflicts in Africa, and some of
them affect the region in which you work. These conflicts have led to
displacement and terror among large population groups.
Displacement and exile are in themselves causes of
stress and trauma. The survivors of today’s conflicts carry, in
addition, the burden of sexual abuse and often of having lost close
relatives and friends – sometimes even having watched their
execution. Considered one by one, these are experiences that need much
attention and care for those affected, if they are to have the
possibility of surviving. But we are not talking about isolated cases
here. We are talking about tens of thousands, hundreds of thousands
– and, in instances such as in Rwanda, millions of cases.
Add to this the severe limitations of extreme
poverty in large parts of Africa, and the fact that most of the
refugees and displaced people in these conflicts do not even receive
basic assistance or protection – and we are all humbled by the task
facing us.
To address the mental health needs of such large
populations, we need definite strategies and plans. Given the
magnitude of the problem, the limited funding, the fact that the
majority of the refugees’ reactions are the expected reactions to an
extraordinarily abnormal situation, individual psychiatric care has a
limited impact and is not realistic.
Even more than in ordinary settings, a community
health care approach must be the way forward. Projects must be
holistic, seek multisectoral cooperation, be sensitive to gender,
culture and context; they have to take into account the aggravated
poverty, the deepened dependency of people and the feeling of loss of
dignity due to the ongoing human rights violations.
Colleagues,
There is a phenomenal treatment gap in Africa. In
Ethiopia, for example, 90% of those suffering from epilepsy do not
receive any treatment. Treatment rates for depression are not much
better.
The reason for this is clear: lack of money and
lack of manpower.
In many countries, also in Africa, mental health
receives far too small a share of the total health budgets. This is understandable in light of the many
pressing needs and the crippling low health budgets these countries
are limited by – but it is not acceptable. It means that spending is
out of synchrony with the disease-burden, and such priority setting
leads to inefficiencies. Mental health care is cost-effective. When it
is integrated into the primary health care, spending on early
detection and treatment is a highly efficient investment in secondary
prevention.
I need not tell you about the acute lack of
specialists in mental health. A few figures make clear what you
experience every day: In the African Region, there are a total of
1,200 psychiatrists and 12,000 psychiatric nurses serving a population
of 620 million people.
In contrast, in the European Region, which includes
the countries of the former Soviet Union, there are 86,000
psychiatrists and 280,000 nurses serving a population of 870 million.
Of course, Africa must educate more specialists.
But such a task will take decades to fully accomplish.
This puts an added responsibility on your
shoulders. You must not only practice. You must also disseminate your
knowledge. General practitioners and nurses must be taught how to
recognize the symptoms of mental illness and brain disorders and how
to provide basic treatment to those showing up at health centres.
You must build up strong networks of
primary-contact mental health prevention and treatment. Information
and experience must be shared. Additional training must be provided. I
understand how many of you, who already work impossibly long hours to
deal with an overload of patients, can feel overwhelmed by the demands
of your profession and would not welcome such additional tasks. But we
all share the conviction that we need to integrate physical and mental
health care, and there is no way of doing that other than spreading
your knowledge as far and as wide as possible.
That also means going beyond the formal health
sector. We all know that for many if not most of those suffering from
mental health problems or brain disorders, it is the traditional
healer who is the first port of call – not the health centre. In
many African communities, the traditional healers have a very
important position which should not be ignored. With guidance and
training they can do good. Your challenge is to seek collaboration
with the traditional healers and forge a synergy between your
professional knowledge and their credibility in the community and
direct contact with patients.
Colleagues,
Our message is one of concern and hope. The road
ahead is long and difficult. It is littered with myths, secrecy and
shame. But this new century is nothing if not a time of opportunity
and challenge. Let us use this day as an inspiration to go back to our
work places and our local communities and make a change.
Let us stop Exclusion! Let us Dare to Care!
Thank you. |
