1. Asia Maselko and Kristen Shirey 01 October 2013 1

2. Mortality DALYs YLD Prevalence Foot-print Cost of care Loss of productivity Loss of income Family, community, and country costs 2

3. Disease% Ischemic heart disease13.4 Cerebrovascular disease9.5 Lower respiratory infections6.4 HIV/AIDS4.2 COPD4.2 Diarrhoeal diseases4.1 Perinatal conditions4.0 Tuberculosis2.8 Lung cancer2.3 Road traffic accidents2.2 WHO, 2002 3

4. Disease% Lower respiratory infections6.7 HIV/AIDS6.2 Perinatal conditions6.2 Diarrhoeal diseases5.0 Depression4.1 Ischaemic heart disease4.1 Cerebrovascular disease3.5 Malaria3.1 Road traffic accidents2.8 COPD2.7 WHO, 2002 4

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6. BMJ 2002;325:947 Disease% Depression10.7 Iron-deficiency anaemia4.7 Falls4.6 Alcohol use3.3 Chronic Obstructive Pulmonary Disease 3.1 Bipolar disorder3.0 Congenital anomalies2.9 Osteoarthritis2.8 Schizophrenia2.6 Obsessive-compulsive disorder 2.2 6

7. WHO Mental Health Survey Initiative 26 countries (6 are classified as less-developed*) 100,000+ respondents Results 12-month prevalence of any disorder 4.3-26.4% 12-month prevalence of moderate-severe disorder 1-16% Leading spectrum disorders Anxiety (2.4-18.2%) Mood (0.8-9.6%) Substance use (0.1-6.4%) Challenges? * Mexico, Colombia, Nigeria, Lebanon, China, Ukraine 7

8. 15% of those with mental illness in low-income countries receive the treatment they need 54% of those with mental illness in high-income countries receive the treatment they need The gap is large, but is treatment good anywhere? 8

9. Mental Health Gap Action Programme (mhGAP) Aims at scaling up services for mental, neurological and substance use disorders for countries especially with low- and middle-income. The programme asserts that with proper care, psychosocial assistance and medication, tens of millions could be treated for depression, schizophrenia, and epilepsy, prevented from suicide and begin to lead normal lives– even where resources are scarce. 9

10. In addition to recommendations for policy, infrastructure development, and financing, published implementation/treatment guide for primary care providers in resource-limited settings Guide is 121 pages, includes modules on treatment of the eight priority conditions as well as bipolar disorder and other significant emotional or medically unexplained complaints Each module provides basic algorithms for feasible assessment and treatment of the conditions… example: 10

11. WHO identified 8 priority mental, neurological, and substance use conditions: Depression Schizophrenia and other psychotic disorders Suicide Epilepsy Dementia Disorders due to alcohol use Disorders due to illicit drug use Mental disorders in children 11

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14. Kenya 14