Module 1: Introduction to Global Mental Health and the Global Burden of Mental

Welcome to Module 1.

“There is no health without mental health,” yet around the world we fail to provide effective preventive and treatment services for mental health to the vast majority of people who need them. Mental health impacts all aspects of society, and improving population mental health will be critical to achieving global targets for human progress.

This module will give you a brief overview of the field of global mental health. You will learn about different philosophies underlying the concepts we’ll talk about in this course, the global burden of mental disorder, and how mental health changes over the human life course. I will also talk about mental health and its place on the global development agenda, and introduce the social determinants of mental health.
Note: If you have trouble watching the lectures due to a slow Internet connection, try downloading the lecture or the transcript listed below each video. Right click the link and select "Save Link as" to download.

Learning Objectives

After completing this module, you will be able to:

  • Describe the field of global mental health
  • Describe the global burden of mental disorder;
  • Explain the life course perspective on mental health;
  • Describe the gap in child mental health services globally;
  • Explain the difference between the biological, psychological, and social factors that contribute to mental disorder; and
  • Describe the social determinants of mental disorder at the demographic, economic, neighborhood, environmental, and social/cultural levels.

Video: Global Mental Health and Global Burden of Mental Disorder (9 minutes)

In this lecture, Dr. Christopher Kemp will provide an introduction to the field of global mental health and the global burden of mental disorder.



Download: Video (11 MB) | Audio (4 MB) | Transcript

Assignment: Burden of Mental Illness in Your Country (60 minutes)

In the lecture on Global Mental Health and the Global Burden of Mental Disorder, you learned about the global burden of mental illness. As you learn about the topics covered in this course, it will be helpful for you to understand what the burden of mental disorder is in your country.

Research the questions below to learn more about your country. Some useful resources include the Global Burden of Disease visualization tool, the Global Burden of Disease data tool, and the WHO Mental Health Atlas. You can also use sources from within your own country, including national household surveys.

Answer these questions in your Individual Reflection Guide (IRG).

  1. How many people in your country are living with a mental disorder?
  2. What are the leading causes of mental disorder in your country (which disorders have the highest prevalence, and cause the most disability)?
  3. How has the prevalence of mental disorders changed over the past ten years in your country?
  4. What is the suicide rate for males? For females?
  5. What is the prevalence of depression? Which age group has the highest prevalence?
  6. How many trained mental health professionals (psychiatrists, mental health nurses, psychologists) are in your country for every 100,000 people?
  7. Does your country have a national mental health policy? Does it have a national mental health plan?
  8. Are you surprised by these findings? Why or why not?

Although you will not turn this in until your IRG part 1 is due (Sunday, July 30, at 11:59 pm), we encourage you to keep up with the weekly IRG assignments. 

Video: Mental Health Over the Life Course (4 minutes)

Watch this lecture by Dr. Christopher Kemp about how mental health changes over the life course, including how the brain develops over time. He will also describe the gap in child mental health services.


Download: Video (6 MB) | Audio (2 MB) | Transcript

Video: Mental Health & Sustainable Development (9 minutes)

In this lecture, Dr. Christopher Kemp discusses the Sustainable Development Goals, the WHO Mental Health Action Plan (2013-2020), and the Lancet Commission on Global Mental Health and Sustainable Development.


 Download: Video (15 MB) | Audio (4 MB) | Transcript

Video: Social Determinants of Mental Health (11 minutes)

Dr. Christopher Kemp introduces the social determinants of mental health in this lecture.


Download: Video (14 MB) | Audio (5 MB) | Transcript

Video: Violence and Mental Health (8 minutes)

In this lecture, Dr. Christopher Kemp will provide an introduction to the field of global mental health and the global burden of mental disorder.


Download: Video (11 MB) |Audio (4 MB) | Transcript

Optional Reading

Patel, V. The Lancet Commission on global mental health and sustainable development. The Lancet. Vol 392. October 27, 2018.

Discussion (20 minutes)

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*Please note that there is no access to the discussion in this sample course

Reading: Module Summary (5 minutes)

We started out the module by defining mental health. In 1948, the WHO defined health as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.” This definition means that overall health requires positive mental health.

The field of global mental health can be traced back to the 1970s and the field of transcultural psychiatry. Today, mental health care is no longer just the domain of psychiatrists, but is now a responsibility of primary care providers, community health workers, educators, law enforcement, and other diverse stakeholders.

Global mental health really broke through as a field, however, starting in the 1990s, largely as an indirect result of a new approach to measuring and comparing the global burden of all diseases. Mental and neurological disorders are the world’s leading cause of disability and are responsible for around 9% of all disease burden, or almost a quarter of all disability. However, it is important when thinking about these estimates, to acknowledge that we actually have very limited data on the distribution of mental health problems across much of our world.

Then, you learned about the life course perspective on mental health. In early childhood, the brain is highly plastic and prone to change. This is a critical period for healthy development and highly predictive of good mental health later. Pruning is when the brain reduces and focuses its synaptic connections: this peaks during adolescence. And finally, senescence is when the brain function starts to diminish. This starts during adulthood and progresses through the end of life. Given that stress caused by adversity in early life can lead to mental disorder later in life in later life, it is crucial that resources be focused on mental health in children. Yet most of the attention in our field gets placed on meeting the needs of adults with mental disorders, leaving the needs of children significantly under-addressed.

Next, I talked about how mental health fits in the global agenda. Mental health is explicitly mentioned in two United National Sustainable Development Goals targets, both under Goal 3, which is to ensure healthy lives and promote well-being for all at all ages. However, mental health cross-cuts most of the rest of the SDGs as well. Unfortunately, global expenditure on mental health care is very small.

In 2013, 194 ministers of health signed the World Health Organization Mental Health Action Plan as an agreement on what needs to be done to support public mental health globally. It describes what needs to happen in order for nations to more effectively invest in population mental health. How to achieve this plan is outlined by the Lancet Commission on Global Mental Health and Sustainable Development’s recommendations. These are:

  • To reframe mental health as a global public good
  • To make mental health an essential component of universal health coverage
  • To protect mental health with action on social determinant
  • To strengthening public engagement
  • To promote innovation in the use of technology and non-specialist providers
  • To make more and better investments in mental health
  • To strengthen monitoring and accountability

Then I discussed social determinants of disease. The World Health Organization’s argued that mental disorders emerge as a product of biological, psychological, and social factors. Biological factors include things like neural processes in the brain and our genetic predisposition to different disorders. Psychological factors refer to things like the shaping of our thought processes, our resilience and ability to cope. Social factors include the range of social and economic determinants that protect us from or drive our exposure to environmental stressors, that affect our thought processes, and that interact to change our risk of developing a mental disorder.

Social determinants of mental health, as defined by the Lancet Commission on Global Mental Health, include demographic factors, such as age, ethnicity, and sex; economic factors, such as income, food security, employment, income inequality, and financial strain; neighborhood factors, such as the built environment, water and sanitation, housing, and community infrastructure; environmental factors, such as exposure to violence, natural disasters and climate change, war, and migration; and social and cultural factors, such as social capital, social stability, culture, social support, and education. All these social determinants frequently cluster and interact to give rise to mental disorders and other mental health problems.

This module wrapped up by looking at the effects of violence on mental health. I debunked the myth that people with mental illness are more likely to be violent than the general population. There is little evidence that people with mental illness in general are at any increased risk of perpetrating violence compared with the general population. In fact, people with mental illness are far more likely to be the victims of violence rather than the perpetrators. And exposure to violence, whether direct or indirect, can have negative physical and mental effects. Finally, I mentioned that we should think about addressing exposure to violence as a public health issue.

Quiz (15 minutes)

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*Please note that there is no access to the quiz in this sample course

Resources

Mental Health Action Plan. WHO
Four major objectives are set forth: more effective leadership and governance for mental health; the provision of comprehensive, integrated mental health and social care services in community-based settings; implementation of strategies for promotion and prevention; and strengthened information systems, evidence and research.

Mental Health. Our World in Data.

Website that presents the latest estimates of mental health disorder prevalence and the associated disease burden. Also contains a blog with entries on Mental Health and Substance Use.

Mental Health Atlas 2017

WHO country profiles on various mental health metrics.

World Mental Health Day

The goal is to raise awareness of mental health issues around the world and mobilizing efforts in support of mental health. This site has resources from past World Mental Health Days.

Mental Health for All webinar series

A webinar series by The Lancet Psychiatry, Mental Health Innovation Network, MHPSS.net, and United for Global Mental Health to provide policy makers and the wider health community with the latest evidence on the impact of COVID-19 on mental health and how to address it. It has recently expanded to include topics beyond just COVID-19.

UN Resolution WHA65.4

A resolution on the global burden of mental disorders and the need for a comprehensive coordinated response from health and social sectors at the country level.