Mental Illness Finally in Focus at World Health Organization

The United Nations General Assembly discussed noncommunicable diseases last fall for the first time.

“It was a huge accomplishment, but it was incomplete,” said Eliot Sorel, M.D., a professor of global health and of psychiatry and behavioral sciences at George Washington University School of Medicine and School of Public Health.

Incomplete, because the organizers of the discussion talked about heart disease, cancer, and diabetes, among others, but left out schizophrenia, bipolar disorder, posttraumatic stress disorder, depression, and other mental health diagnoses, he said. Despite last-minute efforts by the international psychiatric community, the U.N. event went on without formal inclusion of mental health.

Afterward, when Sorel asked the United States representatives on the World Health Organization (WHO) Executive Board to act on the matter, they said the organization would do something “separate.”

“But separate is not equal,” Sorel told them. Furthermore, “separate” is the opposite of global trends to bind mental health more closely to general health by connecting primary care to psychiatry.

Sorel organized a letter-writing campaign to the WHO Executive Board asking that mental health and mental illness be included in all health systems. Other signers included former U.S. Surgeon General David Satcher, M.D., Ph.D., a professor at Morehouse School of Medicine; former APA President Pedro Ruiz, M.D., now president of the World Psychiatric Association; Jeffrey Lieberman, M.D., APA president-elect; and Patricia Newton, M.D., Ph.D., president of the Black Psychiatrists of America.

Their action resulted in a proposal to be discussed and voted upon at the WHO’s World Health Assembly in Geneva in May.

That’s a move in the right direction, said Sorel.

“Integration of mental health is a matter of quality, economics, and access,” he said. “It will be interesting to see if they tack mental health onto the noncommunicable diseases or keep it a separate issue.”

These steps follow efforts by APA, such as its Integrating Psychiatry and Primary Care action paper that originated in the Assembly in May 2008 and initiatives by APA task forces and work groups, Sorel noted. They also mirrored the theme of this year’s APA annual meeting, which was “Integrated Care.”