Integrating mental health into primary healthcare.

Abstract

Health is now widely acknowledged as having both a physical and mental health dimension. Indeed, as far back as 1948, WHO's constitution recognised health as ‘a state of complete physical, mental and social well-being, and not merely the absence of disease or infirmity’.1 Despite this, many primary healthcare systems in countries around the world focus on physical care, failing to provide mental healthcare to their populations. Mental disorders are extremely prevalent in all countries and are responsible for immense suffering, poor quality of life, increased mortality and staggering economic and social costs. As such they cannot continue to be ignored. Today, 30 years on from the adoption of the Alma Ata Declaration, as the world prepares to re-affirm primary healthcare as essential healthcare, universally accessible to individuals, an important opportunity presents itself to change this state of affairs.2 Indeed, a fundamental shift needs to occur in healthcare paradigm, from one of human rights violations and poor health outcomes associated with care delivered through psychiatric institutions, to one which respects human rights and promotes good health outcomes and recovery through the delivery of mental healthcare in the primary health-care system. While this editorial focuses on primary health-care, it is important to emphasise that mental healthcare delivered in this setting is much more likely to be effective and sustainable if complimented by a strong secondary level of care to which primary healthcare workers can turn to for referrals, as well as for support and supervision. Having in place strong informal community mental health services and support groups, run by NGOs and faith-based organisations can also compliment and strengthen the services provided through primary healthcare services.