Mental health as indicator for burden of disease

Mental disorders are rarely seen as a priority when it comes to health in  fragile states. However, like many other non-communicable or chronic diseases, they combine high prevalence with low mortality and are characterized by a high degree of ‘disability’. The concept of Disability Adjusted Life Year (DALY) was introduced to measure this burden of disease. DALYs indicate the numbers of years of healthy life lost due to a disorder, by premature death or years lived with disability.

The World Bank and WHO indicated in 2001 that 12% of the global burden of disease should be attributed to mental problems. This percentage is expected to increase significantly in the next decade, also in developing countries. On a global scale depressive disorders causes health consequences that are equal to that of heart diseases. Disability related to mental disorders has negative effects on productivity and financial consequences for the individual and their family. When the context is a fragile state, a war-torn society, one does not really need high-level epidemiology to understand that psychological problems are not only important as determinants of health, but also as barriers to rebuild both individual and family life, as well as rebuilding communities and society as a whole.

Although most of our programmes address mental health as well as psychosocial problems in a combined approach, there is a difference to be made between the two:

• Psychosocial issues are often related to the consequences of years of violence which are felt in almost all domains of people’s livess: poverty, insecurity, strained family relations, poor education and poor health. Psychosocial problems may lead to the expression of mental disorders, such as depression and anxiety disorders. Reduction of psychosocial problems and stressors is therefore a focus in our programmes, to prevent the expression of mental disorders. Read more about psychosocial support
  
• Mental health programmes usually focus on decentralisation of psychiatric services from specialized hospitals into integration in primary health care, linked with awareness building in the community. Read more about mental health