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May 19, 2010

Global Mental Health: A New Global Health Field Comes of Age

Author Affiliations

Author Affiliations: Centre for Global Mental Health, London School of Hygiene and Tropical Medicine, and King's Health Partners, London, England.

JAMA. 2010;303(19):1976-1977. doi:10.1001/jama.2010.616

Global health is “an area for study, research and practice that places a priority on improving health and achieving equity in health for all people worldwide.”1 Global mental health is the application of these principles to the domain of mental ill health. The most striking inequity concerns the disparities in provision of care and respect for human rights of persons living with mental disorders between rich and poor countries. Low- and middle-income countries are home to more than 80% of the global population but command less than 20% of the share of the mental health resources.2 The consequent “treatment gap” is a contravention of basic human rights—more than 75% of those identified with serious anxiety, mood, impulse control, or substance use disorders in the World Mental Health surveys in low- and middle-income countries received no care at all, despite substantial role disability.3 In sub-Saharan Africa, the treatment gap for schizophrenia and other psychoses can exceed 90%.4 Even where treatment is provided, it often is far below minimum acceptable standards. Failure to provide basic necessities such as adequate nourishment, clothing, shelter, comfort, and privacy; unauthorized and unmonitored detention; and shackling and chaining are all well-documented abuses, described recently as a “failure of humanity.”5