Mental Health Policy and Service Provision. (Chapter Four)
Governments, as the ultimate stewards of mental health, need to set policies -- within the context of general health systems and financing arrangements -- that will protect and improve the mental health of the population. In terms of financing, people should be protected from catastrophic financial risk; the healthy should subsidize the sick; and the well-off should subsidize the poor. Mental health policy should be reinforced by coherent alcohol and drug policies, as well as social welfare services such as housing. Policies should be drawn up with the involvement of all stakeholders and should be based on reliable information. Policies should ensure the respect of human rights and take account of the needs of vulnerable groups. Care should shift away from large psychiatric hospitals to community services that are integrated into general health services. Psychotropic drugs need to be available, and the required health workers need to be trained. The mass media and public awareness campaigns can be effective i n reducing stigma and discrimination. Nongovernmental organizations and consumer groups should also be supported, as they can be instrumental in improving service quality and public attitudes. Further research is needed to improve policy and services, in particular to take account of cultural differences.
To protect and improve the mental health of the population is a complex task involving multiple decisions. It requires priorities to be set among mental health needs, conditions, services, treatments, and prevention and promotion strategies, and choices to be made about their funding. Mental health services and strategies must be well coordinated among themselves and with other services, such as social security, education, employment and housing. Mental health outcomes must be monitored and analysed so that decisions can be continually adjusted to meet existing challenges.
Governments, as the ultimate stewards of mental health, need to assume the responsibility for ensuring that these complex activities are carried out. One critical role in stewardship is to develop and implement policy. Policy identifies the major issues and objectives, defines the respective roles of the public and private sectors in financing and provision, identifies policy instruments and organizational arrangements required in the public and possibly in the private sectors to meet mental health objectives, sets the agenda for capacity building and organizational development, and provides guidance for prioritizing expenditure, thus linking analysis of problems to decisions about resource allocation.
The stewardship function for mental health is poorly developed in many countries. The WHO Project Atlas (see Box 4.1) collected basic information on mental health resources from 181 countries. According to these data, which are used to illustrate the main points in this chapter, one-third of countries do not report a specific mental health budget, although they presumably devote some resources to mental health. Half the rest allocate less than 1% of their public health budget to mental health, even though neuropsychiatric problems represent 12% of the total global burden of disease. A non-existent or limited budget for mental health is a significant barrier to providing treatment and care.
Related to this budgetary problem is the fact that approximately four out of ten countries have no explicit mental health policy and approximately one-third have no drug and alcohol policy. The lack of policy related specifically to children and adolescents is even more dramatic (Graham & Orley 1998). It may be argued that a policy is neither necessary nor sufficient for good results, and that for those countries without a mental health policy it would suffice to have a defined mental health programme or plan. But one-third of countries have no programme and a quarter have neither a policy nor a programme. …