Mental Neurological And Substance Use Disorders In Sub Saharan Africa

Millions of people in sub-Saharan Africa suffer from mental, neurological, and substance use (MNS) disorders, and most do not have the resources to obtain treatment. The Uganda National Academy of Sciences and the Institute of Medicine hosted a workshop to discuss the state of care for MNS disorders in sub-Saharan Africa.

Mental, neurological, and substance use disorders are common, highly disabling, and associated with significant premature mortality. The impact of these disorders on the social and economic well-being of individuals, families, and societies is large, growing, and underestimated. Despite this burden, these disorders have been systematically neglected, particularly in low- and middle-income countries, with pitifully small contributions to scaling up cost-effective prevention and treatment strategies. Systematically compiling the substantial existing knowledge to address this inequity is the central goal of this volume. This evidence-base can help policy makers in resource-constrained settings as they prioritize programs and interventions to address these disorders.

In 2011 the Grand Challenges in Global Mental Health initiative identified priorities that have the potential to make a significant impact on the lives of people with mental, neurological, and substance use disorders. Reduction of the cost and improvement of the supply of effective medicines was highlighted as one of the top five challenges. For low- and middle-income countries, improving access to appropriate essential medicines can be a tremendous challenge and a critical barrier to scaling up quality care for mental, neurological, and substance use disorders. Reduction of cost and improvement of the supply of effective medicines has the potential to significantly impact the lives of patients with these disorders. Improving Access to Essential Medicines for Mental, Neurological, and Substance Use Disorders in Sub-Saharan Africa is the summary of a workshop convened by the Institute of Medicine Neuroscience Forum in January 2014 in Addis Ababa, Ethiopia to discuss opportunities for achieving long-term affordable access to medicines for these disorders. This report examines challenges and opportunities for improving access to essential medicines in four critical areas: demand, selection, supply chains, and financing and pricing. The report also discusses successful activities that increase access to essential medicines both within Sub-Saharan Africa and in other developing countries, and considers the role of governments, nongovernmental organizations, and private groups in procurement of essential medicines for mental, neurological, and substance use disorders.

Seventy percent of the global burden of mental disorders is located in low and middle income countries (LMIC),including sub-Saharan Africa (SSA). However, in Africa,only 0.62% of the national health budget is allocated to mental health compared to a global median of 2.8% and 5% in Europe. The government is the source of funding in 62%of patients with severe mental disorder in the World Health Organisation (WHO), Africa Region, the lowest of all the WHO regions, and lower compared to a global median of 79%. This is compounded by poor resources, with mental health outpatient facilities in WHO Africa Region being less that 10% of the global median. To address these problems, the WHO launched its Mental Health Action Gap Programme (mhGAP) in 2008, to scale-up mental health services in low and middle income countries (LMIC). The book is directed to all policy makers in sub-Saharan Africa to aid decision making about the urgent need for sustainable and relevant mental health care strategies, and the important areas that need priority. The book should be helpful to local and international researchers in formulating research questions relevant to the African continent and it will be of interest to medical practitioners and students in the region as adjunct to standard text books.

Mental, neurological, and substance use (MNS) disorders have a substantial impact on global health and well-being. Disorders such as depression, alcohol abuse, and schizophrenia constitute about 13 percent of the total burden of disease. Worldwide, MNS disorders are the leading cause of disability, and the 10th leading cause of death. Despite this high burden, there is a significant shortage of resources available to prevent, diagnose, and treat MNS disorders. Approximately four out of five people with serious MNS disorders living in low- and middle-income countries do not receive needed health services. This treatment gap is particularly high in Sub-Saharan Africa (SSA). Challenges to MNS care in SSA countries include a lack of trained mental health professionals, few mental health facilities, and low prioritization for MNS disorders in budget allocations. African countries, on average, have one psychiatrist for every 2 million people, whereas European countries have one psychiatrist per 12,000 people. Expanding on previous efforts to address the development and improvement of sustainable mental health systems in SSA, the Institute of Medicine convened this 2015 workshop series, bringing together key stakeholders to examine country-specific opportunities to improve the health care infrastructure in order to better prevent, diagnose, and treat MNS disorders. Providing Sustainable Mental and Neurological Health Care in Ghana and Kenya summarizes the presentations and discussions from these workshops.

Current data and trends in morbidity and mortality for the sub-Saharan Region as presented in this new edition reflect the heavy toll that HIV/AIDS has had on health indicators, leading to either a stalling or reversal of the gains made, not just for communicable disorders, but for cancers, as well as mental and neurological disorders.

One of the largest treatment gaps for mental, neurological, and substance use (MNS) disorders in the world can be seen in Sub-Saharan Africa (SSA). According to the World Health Organization (WHO), about 80% of people with serious MNS disorders living in low- and middle-income countries do not receive needed health services. A critical barrier to bridge this treatment gap is the ability to provide adequate human resources for the delivery of essential interventions for MNS disorders. An international workshop was convened in 2009, by the .S. Institute of Medicine (IOM) Forum on Neuroscience and Nervous Systems Disorders and the Uganda National Academy of Sciences (UNAS) Forum on Health and Nutrition, to bring together stakeholders from across SSA and to foster discussions about improving care for people suffering from MNS disorders and what steps, with potential for the greatest impact, might be considered to bridge the treatment gap. Due to the broad interest to further examine the treatment gap, the IOM forum organized a second workshop in Kampala, Uganda on September 4 and 5, 2012. The workshop\'s purpose was to discuss candidate core competencies that providers might need to help ensure the effective delivery of services for MNS disorders. The workshop focused specifically on depression, psychosis, epilepsy, and alcohol use disorders. Strengthening Human Resources Through Development of Candidate Core Competencies for Mental, Neurological, and Substance Use Disorders in Sub-Saharan Africa: Workshop Summary outlines the presentations and discussions by expert panelists and participants of the plenary sessions of the workshop. This summary includes an overview of challenges faced by MNS providers in the SSA, perspectives on the next steps, the 2009 workshop, and more.