UN Includes Mental Health in Major Declaration

By Elizabeth K. Carll, Ph.D.
November 14, 2011



A historic Summit took place at the September 2011 meeting of the United Nations General Assembly (UNGA) focusing on the prevention and control of non-communicable diseases (NCDs). The NCDs are defined by the UNGA as consisting of four main global chronic diseases: cardiovascular disease, cancer, diabetes and respiratory illnesses.

These diseases are expected to become an increasingly enormous burden on society in the next 10 to 20 years and are rapidly evolving into an epidemic, particularly in lower income nations. The World Health Organization (WHO) estimated 36 million of the 57 million global deaths in 2008 were due primarily to the above NCDs.

In addition, according to WHO, depression is currently the third leading cause of the global burden of disease and expected to be the number two chronic disease burden worldwide by 2020 and number one by 2030. Depression is a co-morbid factor in the course of NCDs.

The UN Committee on Mental Health in New York, a consortium of non-governmental organizations (NGOs) partnered with the NGO Health Forum in Geneva, a network of NGOs, to focus advocacy efforts on the 193 countries of the UNGA for the inclusion of mental health in the Declaration of the UNGA Summit on NCDs.

Mental health was successfully included in the declaration as a risk factor for prevention and control of NCDs. This success would not have been possible without advocacy by mental health organizations and supporting groups.

The NGO Committee on Mental Health affiliated with the Conference of Non-Governmental Organizations (CoNGO) in consultative relationship with the United Nations, is chaired by Elizabeth Carll, Ph.D., and advocates for mental health awareness and access to services worldwide and the development of mental health policy. The monthly programs and conferences also organized by the Committee on Mental Health, inform UN staff, NGOs, government and the private sector as to the role of mental health in relationship to the various initiatives undertaken by the UN.

These initiatives focus on human rights, gender equality, violence against women and children, humanitarian emergency outreach, sustainable development and other global issues. The NGO Health Forum has a similar role in Geneva but focuses exclusively on physical health. Kelly O’Donnell, Psy.D., coordinator of the Mental Health and Psychosocial Working Group (MHPSWG) and Ann Lindsay, chair of the MHPSWG of the NGO Health Forum, spearheaded the advocacy effort via Geneva.

The Joint Statement of the NGO Forum on Health and the UN NGO Committee on Mental Health titled “Mental Health and the Scope of Non-Communicable Diseases,” including the list of the 94 endorsing NGOs, can be found online at (http://www.mentalhealthngo.org/content.html?page=10).

In addition to the four chronic diseases addressed by the UNGA, the joint statement advocated for inclusion of rapidly increasing neurological disorders, such as Alzheimer’s and dementia. As a result, the Declaration included “that mental and neurological disorders, including Alzheimer’s disease, are an important cause of morbidity and contribute to the global NCD burden for which there is a need to provide equitable access to effective programs and health care interventions.”

Implications:

1. The recognition of mental health as a risk factor for NCDs has been agreed to by 193 countries. This is an important outcome as previously mental health has not been recognized by many countries as a significant factor affecting health and social and economic development requiring action. WHO has become increasing cognizant and supportive of the role of mental health in health care and in social and economic development, and mental health has been mentioned in various documents and resolutions. However, the UNGA Declaration on NCDs is intended to be an action document with follow up in 2012 to establish implementation targets. As indicated by one of the supporting government health ministers, mental health is now at the table, even if it is at the edge.

2. It appeared to be the consensus of the UNGA that the first line of prevention and control of NCDs will be through primary care. There are references to primary care in the declaration and frequent references were made in the verbal statements of the representatives of the 193 countries throughout the summit. Therefore, mental health can be expected to be an integrated component of primary care health delivery groups and systems globally.

3. The reference to “for which there is a need to provide equitable access to effective programs and health care interventions” speaks to the allocation of equitable resources and the basis for future accountability for global accessibility of mental health resources.

However, the implementation of the terms of the declaration will be key in promoting global mental health. The declaration was a historic first step and did not include measurable performance targets. That will be the next step. As stated by Margaret Chan, WHO’s director-general, “What is not measured does not get done.” The NGO Committee on Mental Health and the NGO Health Forum and other organizations will focus advocacy on implementing steps to accomplish what was agreed to in the UNGA Declaration on Non-Communicable Diseases.

Elizabeth Carll, Ph.D., is the chair of the NGO Committee on Mental Health and a representative to the United Nations from the International Society for Traumatic Stress Studies. She is a New York psychologist in private practice. She may be reached by email at: ecarll@optonline.net

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