The U.N.'s Unfortunate Exclusion

For the first time in the United Nations' history, noncommunicable diseases were on the United Nations General Assembly agenda in September. Regrettably, mental disorders were not included in this historic dialogue.

Mental health is essential to overall health and well-being. Without mental health, we cannot be considered healthy. Mental health affects the individual's ability to function, to be productive, to establish and maintain positive relationships, and to experience a state of well-being.

Mental disorders, a highly prevalent group of noncommunicable diseases, affect the lives of 1 out of every 4 to 5 people each year; they represent between 20 percent and 45 percent of the burden of disability. Factors related to mental illness can interfere with the treatment of other illnesses and frequently co-occur with cardiovascular disorders, diabetes, cancer, and other noncommunicable diseases. It is no surprise that in the face of this evidence, the Organization for Economic Cooperation and Development in Paris started a study on mental health and mental illness in 2010, seeking solutions to this growing challenge affecting not only the nations' and populations' health but also the economies of member countries.

The United Nations General Assembly debated and adopted in 2007 and 2008 the human-rights document known as the "Convention on the Rights of Persons With Disabilities," which included those suffering from mental disorders. To date the convention has been signed by 147 countries, including the United States. In October 2008, the U.S. president signed the Domenici/Wellstone parity law, the goal of which was to end discrimination in insurance coverage of treatment for mental disorders. Passage of the U.N. convention and the U.S. parity law was preceded in 2007 and 2008 by articles in the Lancet, as part of its "Global Mental Health" series, that addressed the need for all countries to pay far more attention to mental illness and mental health care and described the dimensions of the disease burden attributable to mental illness, including substance abuse.

The good news is that mental disorders are diagnosable and treatable—we have the ability to return people to productive lives and positive relationships in the majority of cases. The main barriers to successful treatment are the stigma and discrimination that still prevent individuals in all countries from seeking treatment on a timely basis and the lack of access to basic mental health services, especially in low- and middle-income countries.

Given the high prevalence of mental disorders and the burden of disease and disability related to these illnesses, the inclusion of mental disorders in the human-rights accord signed by a majority of the United Nations member states, and the documented effectiveness of combined treatments for mental disorders and comorbid conditions, it is imperative that mental disorders be included on the United Nations' agenda in the very near future.

Moreover, mental disorders must be included on the United Nations' noncommunicable diseases agenda on a par with the other noncommunicable diseases and any projects that may emerge from United Nations' health-related discussions and debates this autumn. Including mental health and mental disorders will be in faithful observance of the "Convention on the Rights of Persons With Disabilities," will diminish stigma and discrimination, and enhance the ability of health systems worldwide to improve people's health.