A person's mental health and many common mental disorders are shaped by various social, economic, and physical environments operating at different stages of life. Risk factors for many common mental disorders are heavily associated with social inequalities, whereby the greater the inequality the higher the inequality in risk. The poor and disadvantaged suffer disproportionately, but those in the middle of the social gradient are also affected. It is of major importance that action is taken to improve the conditions of everyday life, beginning before birth and progressing into early childhood, older childhood and adolescence, during family building and working ages, and through to older age. Action throughout these life stages would provide opportunities for both improving population mental health, and for reducing risk of those mental disorders that are associated with social inequalities. As mental disorders are fundamentally linked to a number of other physical health conditions, these actions would also reduce inequalities in physical health and improve health overall. Action needs to be universal: across the whole of society and proportionate to need. Policy-making at all levels of governance and across sectors can make a positive difference.

Social determinants of mental health

https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(16)00683-8.pdf

Transgender people: health at the margins of society

https://ora.ox.ac.uk/objects/uuid:e0b5ae23-d562-4348-94b8-84f70b7812c5/download_file?safe_filename=Cipriani%2520et%2520al%2C%2520Comparative%2520efficacy%2520and%2520tolerability%2520of%2520antidepressants%2520for%2520major%2520depression%2520in%2520ch.pdf&file_format=application%2Fpdf&type_of_work=Journal+article

Comparative efficacy and tolerability of antidepressants for major depressive disorder in children and adolescents: a network meta-analysis.

Ninety percent of the determinants of our health derive from our lifetime social and physical environment-not from the provision of health care. The author describes behaviors, such as poor eating, excessive drinking and abuse of drugs, smoking, and physical inactivity, and social factors, such as adverse childhood experiences, poor education, food insecurity, poor housing quality, unemployment, and discrimination, that contribute to ill health and early demise. Better health and mental health can be achieved by understanding and responding to these determinants of health.

/pdf/the-social-determinants-of-mental-health-29lm9ruv8y.pdf

The social determinants of mental health

Crick Lund and colleagues describe their plans for the PRogramme for Improving Mental health carE (PRIME), which aims to generate evidence on implementing and scaling up integrated packages of care for priority mental disorders in primary and maternal health care contexts in Ethiopia, India, Nepal, South Africa, and Uganda.

/pdf/prime-a-programme-to-reduce-the-treatment-gap-for-mental-27s5is8med.pdf

PRIME: A Programme to Reduce the Treatment Gap for Mental Disorders in Five Low- and Middle-Income Countries

https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(11)61093-3.pdf

Human resources for mental health care: current situation and strategies for action

https://www.who.int/workforcealliance/knowledge/resources/lancet_hrmentalhealth_oct2011.pdf

Global Mental Health 5 Human resources for mental health care: current situation and strategies for action

A challenge faced by many countries is to provide adequate human resources for delivery of essential mental health interventions. The overwhelming worldwide shortage of human resources for mental health, particularly in low-income and middle-income countries, is well established. Here, we review the current state of human resources for mental health, needs, and strategies for action. At present, human resources for mental health in countries of low and middle income show a serious shortfall that is likely to grow unless effective steps are taken. Evidence suggests that mental health care can be delivered effectively in primary health-care settings, through community-based programmes and task-shifting approaches. Non-specialist health professionals, lay workers, affected individuals, and caregivers with brief training and appropriate supervision by mental health specialists are able to detect, diagnose, treat, and monitor individuals with mental disorders and reduce caregiver burden. We also discuss scale-up costs, human resources management, and leadership for mental health, particularly within the context of low-income and middle-income countries.

Keshav Desiraju

Papers

Human resources for mental health care: current situation and strategies for action

Global Mental Health 5 Human resources for mental health care: current situation and strategies for action

PRIME Policy Brief 3. Human resources for mental health care: current situation and strategies for action