Academic journal article Bulletin of the World Health Organization

Evaluating the WHO Assessment Instrument for Mental Health Systems by Comparing Mental Health Policies in Four Countries/ Evaluation De L'instrument D'evaluation Des Systemes De Sante Mentale De l'OMS Par Comparaison Des Politiques De Sante Mentale De Quatre pays/Analisis del Instrumento OMS De Evaluacion De Los Sistemas De Salud Mental Mediante la Comparacion De Las Politicas De Salud Mental En Cuatro Paises

Academic journal article Bulletin of the World Health Organization

Evaluating the WHO Assessment Instrument for Mental Health Systems by Comparing Mental Health Policies in Four Countries/ Evaluation De L'instrument D'evaluation Des Systemes De Sante Mentale De l'OMS Par Comparaison Des Politiques De Sante Mentale De Quatre pays/Analisis del Instrumento OMS De Evaluacion De Los Sistemas De Salud Mental Mediante la Comparacion De Las Politicas De Salud Mental En Cuatro Paises

Article excerpt

Introduction

Countries across the globe have long overlooked the issue of mental health and mental illness. Countries spend little on mental health, especially developing countries that allocate less than 1% of their gross domestic product (GDP), while developed countries only spend about 5% of their GDP. (1) These figures are remarkable given that one single mental illness, unipolar major depression, is today one of the top five leading causes of disability worldwide and is expected to be the second leading cause of disability worldwide by 2020. (2)

In 2003, almost half (40-50%) of low- to middle-income countries did not have mental health policies. (3) In response, WHO developed the Assessment Instrument for Mental Health Systems (WHO-AIMS), designed to gather information on specific components of a country's mental health system and its infrastructure, in order to promote the development of mental health policies. (4)

WHO-AIMS may have a significant influence on how developing countries view the "model" mental health system. The WHO-AIMS tool provides a template for regional mental health care experts to enter essential data regarding six domains of mental health care systems: policy and legislative framework; mental health services; mental health in primary care; human resources; education of the public at large; and monitoring and research.

The initial instrument was piloted in several countries. While the overall conclusion of the pilot test was that WHO-AIMS was useful, the initial length of the instrument precluded several countries from completing it. Currently, 50 countries have agreed to use WHO-AIMS as an instrument to assess their mental healthcare systems. However, although WHO-AIMS has been used in many countries, its utility has never been evaluated. This paper examines the utility of the WHO-AIMS instrument in developing and developed countries by applying it to the mental health systems of Iraq, Japan, the Philippines and The former Yugoslav Republic of Macedonia. These four countries have distinct cultural and historical circumstances, which make it especially interesting to use the WHO-AIMS model to compare their mental health systems and policies. These comparisons allow us to demonstrate how WHO-AIMS may be used in countries with different political and cultural situations, and to assess its possible limitations given these differences.

Mental health systems in four countries

Iraq, the Philippines and The former Yugoslav Republic of Macedonia, are three low- to middle-income countries that are currently in the process of evaluating their mental health systems through the application of the WHO-AIMS instrument (Table 1).

Policy and legislative framework

WHO-AIMS provides a useful model for evaluating the mental health policy of each country. As reported in Table 1, The former Yugoslav Republic of Macedonia is the only country without any policy on mental health; however, it does have provision for coverage of mental health under primary care. (5) In the last two years, with the establishment of policy institutes such as the Center for Research and Policy Making, its health-care services are being utilized in mental healthcare. (6)

The Philippines has a mental health policy that is hampered by a miniscule budget and limited legislative authority. (7,8) No mental health law has been established. (9) Its mental health budget is only 0.02% of its total health budget, the latter being 3% of its GDP. (7)

Like the Philippines and The former Yugoslav Republic of Macedonia, Iraq is also in the early stage of developing a mental health system. With the help of the Substance Abuse and Mental Health Services Administration (SAMHSA) in the United States of America, the United Kingdom's National Health Service and WHO, Iraqi mental health policy-makers have started to develop a detailed plan for implementing a policy on mental health. …

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