SAMHSA Addresses Global Burden of Mental Illness

The burden of mental illness on health and productivity in the United States and throughout the world has long been underestimated.

According to a Global Burden of Disease study by the World Health Organization (WHO), Harvard University, and the World Bank, mental illness—including suicide—accounts for more than 15 percent of the burden of disease in countries with established market economies. This is more than the disease burden caused by all cancers.

To help address this public health challenge, SAMHSA is working at home and abroad to identify what needs to be done to effect change.

Around the world, the goal is to investigate and explore all available methods to create flexible, accessible, and sustainable mental health care systems. SAMHSA has met with public health officials from many countries—including England, Afghanistan, Iraq, Russia, New Zealand, Australia, Italy, and countries affected by the tsunami in South Asia—to share information and gain insight on how to address the global mental health crisis.

The Agency is working to find common ground and partner with the international community to move initiatives forward, map out plans for advanced training for care providers, strategize funding possibilities, and prepare to respond to natural disasters and to terrorism as well as to the needs of countries in post-conflict recovery.

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SAMHSA’s international efforts include:

Work with Post-Conflict Countries

Project 1 Billion is an effort that convenes meetings with post-conflict countries to enable them to work together to address the mental health needs of their peoples. In December 2004, SAMHSA Administrator Charles G. Curie, M.A., A.C.S.W., addressed attendees in Rome, Italy, at Project 1 Billion: International Congress of Ministers of Health for Mental Health and Post-Conflict Recovery.

Calling the project “an excellent roadmap for our work on global mental health issues,” Mr. Curie emphasized how collaboration “will help to define our roles as leaders who have a genuine desire to work together to help recovery around the globe.”

At this 2004 meeting, participants endorsed a mental health action plan and distributed Project 1 Billion Book of Best Practices: Trauma and the Role of Mental Health in Post-Conflict Recovery.

In Rome, Italy, SAMHSA Administrator Charles G. Curie and James Lavelle, LICSW, of the Harvard Program in Refugee Trauma joined with other leaders from around the world at the 2004 Project 1 Billion conference.

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Mental Health Leadership

SAMHSA is actively supporting Afghanistan and Iraq to re-establish mental health services in their countries, where decades of conflict have destroyed most of the mental health care system and deeply affected the populations.

Currently, SAMHSA chairs the Planning Group on Iraq Mental Health. At a meeting in December 2004 (see SAMHSA News, January/February 2005), the Planning Group—including Dr. Sabah Sadik, Iraq’s National Mental Health Advisor—developed plans for the Action Planning Conference on Iraq Mental Health. That conference convened March 14 to 18, 2005, in Amman, Jordan, as part of an ongoing effort to help rebuild Iraq’s mental health care system. (SAMHSA News will report on this conference in an upcoming issue.)

Other Agency efforts include the International Initiative for Mental Health Leadership (IIMHL), a joint endeavor of SAMHSA, the National Institute for Mental Health in England, and the Ministry of Health New Zealand. Mr. Curie serves as a founding member.

The IIMHL developed from a worldwide effort to share best practices and provide support and collaborative opportunities for global leaders in mental health services from developed countries. The group holds annual conferences and leadership exchanges hosted by member countries on a rotating basis.

When the United States hosted the Second IIMHL conference in 2004, SAMHSA played a key role in the preparations. The agenda focused on consumer involvement in the mental health system, reducing the use of seclusion and restraint, and on the transformation of mental health services from institutional services to community-based, consumer-driven services.

SAMHSA also participated in the 2005 conference in Wellington, New Zealand.

SAMHSA has joined in collaborations with the World Health Organization, the World Federation for Mental Health, the Clifford Beers Foundation, the Carter Center, and others. The focus of these efforts is to promote mental health and decrease the incidence and disease burden of mental and behavioral disorders worldwide, principally through establishing the Global Consortium for the Worldwide Advancement of Promotion and Prevention in Mental Health (GCAPP) as an international resource.

While in New Zealand in September 2004 at a meeting of the GCAPP, Mr. Curie participated in the International Alliance for Child and Adolescent Mental Health and Schools (Intercamhs). SAMHSA has provided the seed money to launch Intercamhs, which advances the idea that schools have a part to play in promoting and protecting the mental health of the community.

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Training and Support

Functional mental health care systems require trained mental health care providers. SAMHSA is helping to plan programs for mental health professionals from developing nations to receive training in the United States and elsewhere.

For example, SAMHSA provided support for Afghan representatives to attend a pilot meeting of Ministers of Health of post-conflict countries, held in Sarajevo.

SAMHSA also supported representatives from mental health systems in Afghanistan and Iraq to attend Masterclasses in Refugee Trauma and Treatment provided by the Harvard Project on Refugee Trauma.

Other efforts to strengthen mental health systems abroad have included a collaboration with the State Department to develop a two-part project on substance abuse prevention for use in Russia. The project provided support for a substance abuse prevention curriculum based on the evidence-based Life Skills model in every grade in Russian schools. In addition, the project offered a training curriculum for all health care workers on prevention screening for substance abuse, based on SAMHSA’s Treatment Improvement Protocol 24, A Guide to Substance Abuse Services for Primary Care Clinicians.

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International Resources For more information about international relief efforts by the U.S. Department of Health and Human Services (HHS), visit www.globalhealth.gov. Other international initiatives and programs for mental health include: Project 1 Billion: International Congress of Ministers of Health for Mental Health and Post-Conflict Recovery at www.project1billion.org. International Initiative for Mental Health Leadership (IIMHL) at www.iimhl.com. Global Consortium for the Advancement of Promotion and Prevention in Mental Health (GCAPP) at www.gcappmentalhealth.org. International Alliance for Child and Adolescent Mental Health and Schools (Intercamhs) at www.intercamhs.org.

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Tsunami Disaster Relief

SAMHSA is supporting U.S. Department of Health and Human Services (HHS) efforts to help countries in South Asia devastated by the December 26, 2004, tsunami. The HHS Mental Health Team, which includes SAMHSA staff, is supporting efforts of the United Nations and non-governmental organizations to address mental health issues in the communities along the west coast of Sumatra, Indonesia.

For example, 50 HHS staff (including staff from SAMHSA) traveled on the USNS Mercy to the Indian Ocean in January to provide assistance.

In addition, SAMHSA’s National Center on Child Traumatic Stress prepared information on children and trauma for distribution to humanitarian aid workers and victims of the tsunami.

Also, in a partnership with the Centers for Disease Control and Prevention (CDC), SAMHSA enhanced the mental health and substance abuse elements of CDC’s disaster response, and the two agencies are collaborating to make more online information available on the psychological impact of disasters.

SAMHSA is currently exploring other ways to provide specific support to the area.

For more information, visit www.samhsa.gov. 

In January, the USNS Mercy set sail for the Indian Ocean to provide support and assistance to those affected by the Asian tsunami. The HHS Mental Health Team included SAMHSA staff. (Official US Navy photo)

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