Showing papers by "Benedetto Saraceno published in 2006"

Beyond evidence: the moral case for international mental health.

Abstract: The global burden of disease attributable to mental, neurological, and substance use disorders is expected to rise from 12.3% in 2000 to 14.7% in 2020 (1). This rise will be particularly sharp in developing countries. Research has documented the socioeconomic determinants of many disorders, the profound impact on the lives of those affected and their families, and the lack of appropriate care in developing countries. The enormous gap between mental health needs and the services in developing countries has been documented in international reports, culminating in the World Health Report 2001 (2). This evidence has increased the profile of international mental health, but action still remains limited. With every new public health challenge, mental health is once more relegated to the background. We argue that moral arguments are just as important as evidence to make the case for mental health intervention. At the center of these moral arguments is the need to reclaim the place of mental health at the heart of international public health. We consider some moral arguments for international mental health and an example from another area of public health in which the moral case was an important enough argument for making policy changes and implementing interventions.

Advocacy for mental health: roles for consumer and family organizations and governments

Abstract: The World Health Organization urges countries to become more active in advocacy efforts to put mental health on governments' agendas. Health policy makers, planners and managers, advocacy groups, consumer and family organizations, through their different roles and actions, can move the mental health agenda forward. This paper outlines the importance of the advocacy movement, describes some of the roles and functions of the different groups and identifies some specific actions that can be adopted by Ministries of Health. The mental health advocacy movement has developed over the last 30 years as a means of combating stigma and prejudice against people with mental disorders and improving services. Consumer and family organizations and related NGOs have been able to influence governments on mental health policies and laws and educating the public on social integration of people with mental disorders. Governments can promote the development of a strong mental health advocacy sector without compromising this sector's independence. For instance, they can publish and distribute a directory of mental health advocacy groups, include them in their mental health activities and help fledgling groups become more established. There are also some advocacy functions that government officials can, and indeed, should perform themselves. Officials in the ministry of health can persuade officials in other branches of government to make mental health more of a priority, support advocacy activities with both general health workers and mental health workers and carry out public information campaigns about mental disorders and how to maintain good mental health. In conclusion, the World Health Organization believes mental health advocacy is one of the pillars to improve mental health care and the human rights of people with mental disorders. It is hoped that the recommendations in this article will help government officials and activists to strengthen national advocacy movements.

Seven criteria for improving effectiveness trials in psychiatry.

Abstract: Background There are no published criteria for improving the quality of effectiveness of randomized controlled trials (RCTs) in psychiatry. Method The authors review and systematize the relevant literature on effectiveness trials, with particular reference to psychiatry. Results In planning effectiveness RCTs in psychiatry, seven sets of issues need to be carefully considered: (i) study question (i.e. is the study question expressed in an answerable way?); (ii) reference population (i.e. what is the reference group or subgroup to which the trial results should be generalized?); (iii) patient sample (i.e. how far does the sample reflect the target population?); (iv) study settings (i.e. how representative are the study settings of routine clinical sites?); (v) study interventions (i.e. is the study intervention manualized, acceptable to patients and suitable for widespread use?); (vi) control condition (i.e. are the key characteristics of the control condition well described, and do they vary within and between sites?); and (vii) bias (e.g. attrition, blinding, concealment, consent and contamination). Conclusions More effectiveness trials are needed which have sufficient statistical power to provide precise answers to assist clinicians in making treatment decisions. The development of effectiveness trials in psychiatry, both for studies of individual treatments and for service evaluations, may be enhanced by carefully considering and justifying decisions in relation to each of the seven key headings proposed here.

Monitoring of mental health systems and services: comparison of four existing indicator schemes.

Abstract: Background A public mental health indicator scheme may be defined as a systematic collection of brief proxy measures that represent summary information on variables that are potentially influenced by or relevant to mental health systems, programmes and services. Existing public mental health indicator schemes have been developed in or for high-income countries.

Mental health assistance to populations affected by disasters: World Health Organization's role.

Abstract: In this article, the authors describe the role of the World Health Organization (WHO) in mental health post-disaster recovery. The article covers the mandate and structure of WHO, mental health activities by the WHO Department of Mental Health and Substance Abuse, WHO-supported principles and strategies in mental health post-disaster recovery, and available WHO technical assistance. The paper outlines a public mental health approach to make very basic mental health services broadly available in post-disaster countries. Using examples based on the Asian tsunami experience, suggestions for delivering mental health assistance are made. The response to mental health of disaster victims should be seen in the context of national health priorities.