Global Mental Health: Optimizing Uniformed Services Roles

By Flynn, Brian W.; Morganstein, Joshua C. et al. | Joint Force Quarterly, October 2016 | Go to article overview

Global Mental Health: Optimizing Uniformed Services Roles


Flynn, Brian W., Morganstein, Joshua C., Ursano, Robert J., Regier, Darrel A., West, James C., Wynn, Gary H., Benedek, David M., Fullerton, Carol S., Joint Force Quarterly


Mental health considerations in the context of global health include an extensive variety of elements and constitute complex and wide-ranging topics. Three perspectives are important to consider. First, in the field of global mental health, direct patient care is not the only role that should be considered important. Second, this article is inclusive of not only military Services, but uniformed services as well. A true uniformed services approach, one that includes the Commissioned Corps of the U.S. Public Health Service (USPHS), is essential to tackle global health challenges. Third, global health activities in the mental health field have been taking place for decades. Therefore, examples that represent important historic landmarks as well as current activities are included. These examples demonstrate important lessons as well as the diversity of mental health contributions to global health.

Mental Health Around the World

"There is no health without mental health." In making this bold statement as the foundation for its groundbreaking Mental Health Action Plan 20132020, the World Health Organization (WHO) reminds us that mental health is a fundamental global health issue. (1) Consider the following excerpts from that report:

* "Depending on local context, certain individuals and groups in society may be placed at higher risk of experiencing mental health problems." The report mentions such factors as poverty, chronic health conditions, child and elderly maltreatment and neglect, and human rights violations.

* "Mental disorders often affect, and are affected by, other diseases such as cancer, cardiovascular disease, and HIV infection/AIDS. Taken together, mental, neurological, and substance abuse disorders exact a high toll, accounting for 13 percent of the total global burden of disease in the year 2004."

How have we come to such dramatic and global conclusions? In 1996, the WHO and World Bank published the landmark study The Global Burden of Disseise (GBD).2 It quantified for the first time the mortality and disability from diseases, injuries, and risk factors in 1990 with projections to 2020. Among the most striking findings were that mental and addictive disorders occupied five of the leading causes of disability in the world, including unipolar major depression, alcohol use, bipolar disorder, schizophrenia, and obsessive-compulsive disorder--with unipolar major depression constituting the leading cause of disability worldwide.

The levels of disability associated with mental disorders in the United States have shown that one-third of all the disability days "out-of-role" associated with chronic-recurrent health problems are due to mental disorders. (3) The societal costs of anxiety disorders alone in the United States throughout the 1990s exceeded $42 billion. (4)

After the GBD report, the WHO recognized the importance of mental disorders for public health and economic development by devoting an entire annual report to mental health, The World Health Report 2001--Mental Health: New Understanding, New Hope. (5) The conclusions of this historic report were that there can be no health without mental health, and recommendations were provided for initiating more treatment in primary care and community settings, involving families and consumers, and linking with other sectors including education, labor, welfare, and the criminal-justice system. With support from the National Institutes of Health (NIH) and many international organizations, the WHO has followed up with a program of international surveys of mental disorders in over 30 countries to document in greater detail the types of disorders and levels of severity and disability associated with these conditions. In 2014, the WHO updated its findings and recommendations, adding to and emphasizing the multitude of evidence for increased attention to mental health issues worldwide.

In his foreword to the GBD report, William Foege, former director of the Centers for Disease Control and Prevention (CDC), noted:

If knowledge is power, the field of public health has remained incredibly weak. …

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