The Lancet Commission on global mental health and sustainable development

The Sustainable Development Goals (SDGs) represent an exponential advance from the Millennium Development Goals, with a substantially broader agenda affecting all nations and requiring coordinated global actions. The specific references to mental health and substance use as targets within the health SDG reflect this transformative vision. In 2007, a series of papers in The Lancet synthesised decades of interdisciplinary research and practice in diverse contexts and called the global community to action to scale up services for people affected by mental disorders (including substance use disorders, self-harm, and dementia), in particular in low-income and middle-income countries in which the attainment of human rights to care and dignity were most seriously compromised. 10 years on, this Commission reassesses the global mental health agenda in the context of the SDGs. Mental health for all: a global goalIn 2007, The Lancet published a Series on global mental health that sought to transform the way policy makers thought about global health. The Series papers argued that a growing and worldwide burden of mental disorders was a global health crisis. The authors issued an urgent call for action to scale up services for people living with mental health problems and to close a substantial treatment gap, especially in low-income and middle-income countries, where the proportions of people receiving treatment are lowest. Full-Text PDF Prevention, detection, intervention: the big wins for mental healthAround the world, media news bulletins and headlines are dominated by the health scourges of our time: cancer, diabetes, obesity, malaria, and heart disease. Governments rightly focus our international efforts on improving prevention, diagnosis, and treatment, and all are in the sights of clinical experts, scientists, and researchers who, with enough time, resources, and manpower, might just find a cure for them all. Full-Text PDF Towards a new era for mental healthThe new Lancet Commission on global mental health and sustainable development1 raises important issues at a time when many countries in the Global South are re-examining their national priorities in mental health. With its broad vision, the Commission shows why mental health is a public good that is a crucial part of the Sustainable Development Goals (SDGs). The Commission's report emphasises the need to take a dimensional approach to mental health problems and their treatment; to allocate resources where they will be most cost-effective; to consider a life-course approach; and to build on existing research that will pave the way for better understanding of the causes, prevention, and treatment of mental health problems. Full-Text PDF Implementing sustainable global mental health in a fragmenting worldThe Lancet Commission on global mental health and sustainable development1 sets out ambitious recommendations for the transformation of global mental health according to the UN's wide-ranging Sustainable Development Goals (SDGs) for 2030. The depth of the Commission's report capture the complex, diverse, and sometimes contradictory positions and perspectives of mental health stakeholders, including the ultimate beneficiaries of the proposed reforms—people with lived experience of mental health problems who may use mental health services, along with their carers and communities. Full-Text PDF Shekhar Saxena: making mental health a development prioritySoftly spoken Shekhar Saxena is a giant in the world of mental health. As Director of the Department of Mental Health and Substance Abuse at WHO for the past 8 years—a role from which he stepped down in June, 2018—he has seen a shift in attitudes to mental health. "The seriousness with which mental health is taken at a political and societal level has certainly increased", says Saxena. However, there is a chasm between commitments made by governments and what happens on the front line, he says: "When it comes to mental health, all countries are developing countries. Full-Text PDF Department of ErrorPatel V, Saxena S, Lund C, et al. The Lancet Commission on global mental health and sustainable development. Lancet 2018, 392: 1553–98—In this Commission, grant numbers have been added to the details of funding for Ilina Singh in the Acknowledgments section. This correction has been made to the online version as of Oct 25, 2018 Full-Text PDF Global mental healthAs UK trainee psychiatrists sharing an interest in global mental health, we welcome the Lancet Commission on global mental health and sustainable development1 with enthusiasm. We concur that task sharing, as a central factor to scaling up global mental health care, requires engagement from multidisciplinary mental health specialists. We also agree that in addition to optimising clinical care at a distance, digital technologies can enhance the training and supervision of non-specialist health workers. Full-Text PDF Global mental healthThe Lancet Commission on global mental health and sustainable development1 was excellent and necessary. We were especially pleased to see recognition of the role of legislation in promoting the global mental health agenda. Historically, mental health has been the branch of medicine most closely aligned with the law, although mental health legislation often came to perpetuate violations of human rights rather than prevent them. The response of mental health professionals to this historical relationship, however, should not be to distance mental health from legislation, but to reimagine the partnership to protect people's liberty and improve services. Full-Text PDF Global mental healthTo enhance the commitment of the Lancet Commission on global mental health and sustaintable development set out by Vikram Patel and colleagues1—to reframe the global mental health agenda within the broader conceptualisation of mental health, envisioned in the Sustainable Development Goals—we offer some suggestions for further reform. Full-Text PDF Mental health care in Pakistan boosted by the highest officePakistan's President Arif Alvi launched the President's Programme to Promote Mental Health of Pakistanis on Oct 10, 2019, World Mental Health Day. Mental health, a long-neglected global priority—stigmatised, under-resourced, and under-researched in most low-income and middle-income countries—is finally drawing attention. For Pakistan, which faces major health concerns, such as polio and dengue outbreaks, humanitarian disasters, and a struggling economy, this prioritisation of mental health by the government is a testament to how far the field has come in the past decade. Full-Text PDF Global mental health – Authors' replyWe thank the correspondents for their comments and suggestions on the Lancet Commission on global mental health and sustainable development.1 They highlight several aspects regarding the implementation of the key recommendations made in the Commission. Full-Text PDF Task sharing: stopgap or end goal?The disparity between the burden of mental ill health and the resources available to address it is well known. One solution is task sharing—a process developed in global health fields such as HIV management that involves training community health workers to do specific jobs. On Oct 26, 2018, WHO launched its guideline on health policy and system support to optimise community health worker programmes. The guideline aims to improve the selection, training, and payment of community health workers. Competency-based certification forms the basis for the recognition of community health workers as a respected part of the workforce, with their own career structure. Full-Text PDF Diversity and inclusion: from priority setting to publicationWorld Mental Health Day saw the publication of the Lancet Commission on global mental health and sustainable development. Acknowledging the central principle of the Sustainable Development Goals that no one be left behind, the Commission aims to broaden the global mental health agenda. Its strategy includes the mobilisation of the voices of people with lived experience of mental disorders. Although it refers to "the demand for meaningful participation by patients and family members in all aspects of shaping mental health policies", the Commission mainly addresses service user involvement in treatment and care planning. Full-Text PDF