Contemporary issues for delivery of mental health services in Commonwealth countries.

Abstract

Byline: Rajen. Prasad, Anand. Satyanand Mr President, chief guest of the day, chairman, distinguished delegates, ladies and gentlemen, at the outset we extend the warm greetings to you all from the people of New Zealand, a fellow Commonwealth country with who India has very many close links in terms of diaspora, education, sport and tourism. May we offer congratulations to the new President for his insightful and inspirational comments just delivered. His comments would be apt in any Commonwealth country and is a reflection of his enormous grasp of what needs to happen in the mental health space globally. It is a matter of considerable regret that my colleague and friend, Sir Anand Satyanand, has been prevented from being with you today to deliver this plenary address. This has been occasioned by a temporary illness resulting in medical advice not to travel for a few weeks. The address I shall now deliver can be described as a joint production of Sir Anand Satyanand's work with some input from myself based on my own background in social policy and social work, human rights, public policy, as a parliamentarian, and most recently as a Commonwealth Special Envoy to Lesotho in Southern Africa. Since Sir Anand Satyanand and I are not medical doctors, we are intrigued, humbled, and very appreciative of the fact that you would include us in your deliberations at this conference. You administer in an arena that is vast in its geography, extensive in its historical time frame, populous, diverse, and with a very large diaspora of which Sir Anand and I are but two. We trust that the perspective we bring satisfies our brief and provides some challenge to your thinking. The brief in this address is to identify some contemporary issues for the delivery of mental health services in Commonwealth countries. As a peak organization of psychiatrists, your interest is in change, change to the way in which mental health is perceived and in the range of services that are offered to your patients. What this address advances is a broad framework for considering contemporary issues in the delivery of mental health services that may be useful as you individually and collectively review your priorities for advocacy and take on new challenges for the future. We start with a description of the contemporary international context of mental health. We then follow a simple organizing framework for our discussion. First, we address overarching issues (macro dimensions of mental health). They are the place in medical and community consciousness of mental health and second, the ever-present threat of corruption of systems and practices which thwart efforts of improvement. We then discuss the policy context of the delivery of mental health services, the community context, and finally the family context. While we focus primarily on the macro challenges we have included the other challenges for the sake of completeness and to acknowledge that practitioners and organizations like yours have the ability to take effective action at many levels concurrently. We want to begin by setting out the broad context in which mental health is practiced. The world's population today is more than 7 billion. In the year 2005, it was 6.5 billion and in 10 years' time in 2025, it will have reached 8 billion. All of you as medical practitioners in the psychiatric field will know that in all countries, people with mental disabilities represent a significant proportion of this number. It will be accepted that mental health conditions apply worldwide and that one in four people will experience a mental health condition in their lifetime. Globally, the World Health Organization estimates 450 million people suffer from mental disorders. Dementia, schizophrenia, depression, and addiction make up the bulk of this. One million people die due to suicide each year. Suicide is the third leading cause of death among young people. …