The World Health Organization defines health as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.” Mental health, by this definition, is an essential building block of health. Good mental health enables people to cope with the normal stresses of life, work productively, and fulfill their potential by contributing to their communities.
In the Region of the Americas, mental, neurological, and substance use disorders are among the principal contributors to morbidity, disability, injuries, and premature mortality, and they increase the risk of other health problems. During 2013, between 18.7% and 24.2% of the Region's population had a mental disorder (1). Although mental health is an essential component of overall health, there exist critical treatment gaps: that is, significant proportions of people with serious mental illness do not receive treatment, up to 73.5% among adults and 82.2% among children and adolescents.
In 2014, the Pan American Health Organization and its Member States adopted the Plan of Action on Mental Health to guide mental health interventions in the Region of the Americas between 2015 and 2020 (2). The Plan identifies four strategic lines: 1) Develop and implement policies, plans, and laws in the field of mental health in order to achieve appropriate and effective governance; 2) Improve the response capacity of mental health systems and services in order to provide comprehensive, quality care in community-based settings; 3) Prepare and implement programs for promotion and prevention in the area of mental health systems and services, with particular attention to the life course; and 4) Strengthen information systems, scientific evidence, and research.
Research provides an indispensable basis for appropriate policy making, planning, and evaluation in the field of mental health. The acquisition of new knowledge through research can help to ensure that every policy or decision is based on hard data and best practices. Furthermore, the availability of relevant, up-to-date data allows us to closely monitor the measures implemented and identify services that can be improved. Currently, most mental health research is carried out in high-income countries and under their control, an imbalance that should be remedied so that low- and middle-income countries can develop cost-effective, culturally appropriate strategies for addressing their needs and priorities in relation to mental health.
This issue of the Pan American Journal of Public Health, focusing on mental health, highlights research initiatives taking place in diverse contexts and cultures across the Region. The articles in this issue relate to the implementation of the Plan of Action on Mental Health and include culturally validated research that assesses the burden of disease and evaluates progress in strengthening policies and the organization of services in the field of mental health. Eight of the articles present original research. They include in-depth analyses of the impact of governance on the development of models of care in Chile and Ecuador. Other articles document progress and obstacles with respect to psychiatric reform in Brazil and decentralization of services in Jamaica and El Salvador. Also described are an interesting experiment with “protected homes” in Peru, as well as the use of primary care consultation liaison to reduce the rate of hospitalization in Chile. Finally, there is a thorough review of the treatment gap in the Region and its various consequences, including suicide, a phenomenon that is analyzed in Ecuador and Colombia.
The array of excellent research initiatives described in this issue demonstrates the enormous capacity of the Region. However, important tasks remain pending. We need to improve the quality and quantity of regional research projects, promote greater cooperation among institutions, conduct research in different cultural contexts, and develop a better understanding of the mental health disparities affecting population groups that are in situations of vulnerability or are minorities in their countries.
The articles in this issue make clear that while mental health is of great importance to the Region, we still have a long way to go to ensure that it is treated as a priority by the governments. Our vision is one of a Region in which mental health is valued, promoted, and protected, mental and substance-related disorders are prevented, and persons with these disorders are able to exercise their human rights and to access both health and social care that is timely and high-quality. We hope that the scientific evidence presented in this issue will encourage regional actors to seek solutions in their local contexts and to support the further development of research.
- Suggested citation Etienne CF. Mental health as a component of universal health. Rev Panam Salud Publica. 2018;42:e140. https://doi.org/10.26633/RPSP.2018.140
- 1Organización Panamericana de la Salud. Salud en las Américas+, Edición 2017. Resumen: Panorama regional y perfiles de país. Washington, D.C.: OPS; 2017.
- 2Organización Panamericana de la Salud. Plan de acción sobre salud mental 2015-2020. 53 Consejo Directivo, 66 Sesión del Comité Regional de la OMS para las Américas. Washington, DC: OPS; 2014. Disponible en: https://www.paho.org/hq/dmdocuments/2015/plan-of-action-on-MH-2014.pdf Acceso el 21 de agosto de 2018.