Mental health and the global agenda: core conceptual issues.

Abstract

This is the first in a series of four papers examining mental health and the global agenda. The series as a whole addresses three broad themes. First, there are significant opportunities to be gained through public policies that promote mental health and prevent mental disorders to the greatest extent possible. Better mental health contributes to the promotion of healthy development and achievement of educational, social and economic goals, as well as the avoidance of both communicable and noncommunicable health problems and the consequent premature mortality. Second, there are also potential significant social and economic gains to be made through public policies that recognise and address the burden of mental disorders. Third, public policies need to prepare for the fact that in many countries mental disorders are likely to rise through a range of different factors including population growth and ageing, marital and family breakdown, an increasing number of orphans and child-headed households, migration both from rural to urban areas within a country and across international borders, changing patterns of work, climate change, the risk of debt and increased income disparity and alcohol and substance abuse. Poor mental health will further impact disadvantageously on physical health, and on broader social and economic goals. In addressing these themes policy makers face many challenges. Intersectoral responses are needed to look at the links between mental health, poverty and economic performance and to help provide opportunities to draw more people into education, employment, entrepreneurship and other economic activity. As populations grow and age, healthcare systems will need to be able to adapt to more efficiently address mental disorders and counter the increased risk of co-morbid physical health problems. Policy makers may also wish to pay particular attention to specific ‘at-risk groups’, such as children. The social and educational impacts of poor mental health can be substantial, persisting into adulthood; policy makers may wish to look at different ways of preventing and tackling these long-term impacts. In order to consider these issues in more detail, it is first of all important to clarify key concepts and linkages in the field. This first paper addresses core conceptual issues, with subsequent papers in the series addressing social, political and economic challenges,1 international and national policy challenges2 and health system challenges.3