title: Addressing the burden of mental, neurological, and substance use disorders: key messages from Disease Control Priorities, 3rd edition.
abstract: The burden of mental, neurological, and substance use (MNS) disorders increased by 41% between 1990 and 2010 and now accounts for one in every 10 lost years of health globally. This sobering statistic does not take into account the substantial excess mortality associated with these disorders or the social and economic consequences of MNS disorders on affected persons, their caregivers, and society. A wide variety of effective interventions, including drugs, psychological treatments, and social interventions, can prevent and treat MNS disorders. At the population-level platform of service delivery, best practices include legislative measures to restrict access to means of self-harm or suicide and to reduce the availability of and demand for alcohol. At the community-level platform, best practices include life-skills training in schools to build social and emotional competencies. At the health-care-level platform, we identify three delivery channels. Two of these delivery channels are especially relevant from a public health perspective: self-management (eg, web-based psychological therapy for depression and anxiety disorders) and primary care and community outreach (eg, non-specialist health worker delivering psychological and pharmacological management of selected disorders). The third delivery channel, hospital care, which includes specialist services for MNS disorders and first-level hospitals providing other types of services (such as general medicine, HIV, or paediatric care), play an important part for a smaller proportion of cases with severe, refractory, or emergency presentations and for the integration of mental health care in other health-care channels, respectively. The costs of providing a significantly scaled up package of specified cost-effective interventions for prioritised MNS disorders in low-income and lower-middle-income countries is estimated at US$3-4 per head of population per year. Since a substantial proportion of MNS disorders run a chronic and disabling course and adversely affect household welfare, intervention costs should largely be met by government through increased resource allocation and financial protection measures (rather than leaving households to pay out-of-pocket). Moreover, a policy of moving towards universal public finance can also be expected to lead to a far more equitable allocation of public health resources across income groups. Despite this evidence, less than 1% of development assistance for health and government spending on health in low-income and middle-income countries is allocated to the care of people with these disorders. Achieving the health gains associated with prioritised interventions will require not just financial resources, but committed and sustained efforts to address a range of other barriers (such as paucity of human resources, weak governance, and stigma). Ultimately, the goal is to massively increase opportunities for people with MNS disorders to access services without the prospect of discrimination or impoverishment and with the hope of attaining optimal health and social outcomes.
authors.affiliation: London School of Hygiene & Tropical Medicine, London, UK; Public Health Foundation of India, New Delhi, India; Sangath, Goa, India. Electronic address: vikram.patel@lshtm.ac.uk.
authors.forename: Vikram
authors.initials: V
authors.lastname: Patel
authors.affiliation: Department of Mental Health and Substance Abuse, World Health Organization, Geneva, Switzerland.
authors.forename: Dan
authors.initials: D
authors.lastname: Chisholm
authors.affiliation: Public Health Foundation of India, New Delhi, India.
authors.forename: Rachana
authors.initials: R
authors.lastname: Parikh
authors.affiliation: School of Public Health, University of Queensland, Herston, QLD, Australia; Queensland Centre of Mental Health Research, Wacol, QLD, Australia; Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA.
authors.forename: Fiona J
authors.initials: FJ
authors.lastname: Charlson
authors.affiliation: Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA; National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia; Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia.
authors.forename: Louisa
authors.initials: L
authors.lastname: Degenhardt
authors.affiliation: Department of Mental Health and Substance Abuse, World Health Organization, Geneva, Switzerland.
authors.forename: Tarun
authors.initials: T
authors.lastname: Dua
authors.affiliation: School of Public Health, University of Queensland, Herston, QLD, Australia; Queensland Centre of Mental Health Research, Wacol, QLD, Australia; Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA.
authors.forename: Alize J
authors.initials: AJ
authors.lastname: Ferrari
authors.affiliation: Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard and Department of Stem Cell and Regenerative Biology, Harvard University, Cambridge, MA, USA.
authors.forename: Steve
authors.initials: S
authors.lastname: Hyman
authors.affiliation: Center for Disease Dynamics, Economics and Policy, Washington DC, USA; Princeton Environmental Institute, Princeton University, Princeton, NJ, USA; Public Health Foundation of India, New Delhi, India.
authors.forename: Ramanan
authors.initials: R
authors.lastname: Laxminarayan
authors.affiliation: Department of Global Health, University of Washington, Seattle, WA, USA.
authors.forename: Carol
authors.initials: C
authors.lastname: Levin
authors.affiliation: Department of Psychiatry and Mental Health, Alan J Flisher Centre for Public Mental Health, University of Cape Town, Cape Town, South Africa; Centre for Global Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
authors.forename: Crick
authors.initials: C
authors.lastname: Lund
authors.affiliation: National Institute on Psychiatry de la Fuente Muniz, Mexico City, Mexico.
authors.forename: María Elena
authors.initials: ME
authors.lastname: Medina Mora
authors.affiliation: School of Applied Human Sciences, University of KwaZulu-Natal, Durban, South Africa.
authors.forename: Inge
authors.initials: I
authors.lastname: Petersen
authors.affiliation: The University of Queensland Centre for Clinical Research, Brisbane, QLD, Australia; Metro North Mental Health, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia.
authors.forename: James
authors.initials: J
authors.lastname: Scott
authors.affiliation: Public Health Foundation of India, New Delhi, India; CAPHRI School for Public Health and Primary Care, Maastricht University, Netherlands.
authors.forename: Rahul
authors.initials: R
authors.lastname: Shidhaye
authors.affiliation: Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia; SNEHA, Volunatary Health Services, Chennai, India.
authors.forename: Lakshmi
authors.initials: L
authors.lastname: Vijayakumar
authors.affiliation: Centre for Global Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
authors.forename: Graham
authors.initials: G
authors.lastname: Thornicroft
authors.affiliation: School of Public Health, University of Queensland, Herston, QLD, Australia; Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA.
authors.forename: Harvey
authors.initials: H
authors.lastname: Whiteford
mesh_terms: D017281:Cost of Illness; D003695:Delivery of Health Care / Q000458:organization & administration; D014943:Global Health; D017048:Health Care Costs / Q000706:statistics & numerical data; D006801:Humans; D001523:Mental Disorders / Q000191:economics / Q000453:epidemiology* / Q000628:therapy; D009422:Nervous System Diseases / Q000191:economics / Q000453:epidemiology* / Q000628:therapy; D019966:Substance-Related Disorders / Q000191:economics / Q000453:epidemiology / Q000628:therapy; D019472:Universal Health Insurance / Q000191:economics