–    A closer look at an orphaned area of public health
IN the years since 2000 when the Millennium Development Goals (MDGs) were introduced, there has been a recognition that the Non-Communicable Diseases (NCDs) deserve more attention and that they should have never been excluded from the MDG targets – hence the call for the MGD+. Last Monday, world leaders kicked off a historic two-day high level meeting on the prevention and control of Non-Communicable Diseases (NCDs) at the United Nations (UN) 66th Session held in New York, by unanimously adopting a ‘Political Declaration’ meant to stem the rising tide of Non-Communicable Diseases.
The declaration is set to launch a global attack on NCDs such as diabetes, heart disease and stroke, chronic respiratory disease and cancer which cause the death of more than 36 million people every year. The forum agreed on the need for global targets to monitor these diseases and their risk factors which include harmful use of tobacco and alcohol, unhealthy diet and physical inactivity. The Political Declaration, which has the full support of the Caribbean Community, also called for Governments, industry and civil society to set up by 2013, the plans necessary to curb the risk factors behind the four groups of NCDs – cardiovascular diseases, cancers, chronic respiratory diseases and diabetes.
Global leaders gave a commitment to increase their efforts to prevent and treat NCDS and to improve health care and greater access to vital medicines necessary to treat those diseases.
However, even with the success of making the response to NCDs a priority development issue, world leaders have not addressed a particular NCD that has for too long been neglected – mental health and neuro-psychiatric disorders.

NEGLECTED
Guyana’s Health Minister Dr. Leslie Ramsammy, in his presentation at last Monday’s forum, said, “We believe these disorders impact too greatly on the disease burden and should be given more consideration at the global level than is presently provided for.”
Ramsammy contends that confronting the NCDs as part of the global development agenda is an important pre-requisite for the war against poverty.
At a mental health stakeholder forum, prior to the UN’s high level meeting, he said, “We are assured of a better future because we now have placed the war against the NCDs on the development agenda.”
However, he stressed that mental and neuro-psychiatric and substance abuse disorders are significant components of the battle against the NCDs.
“The non-inclusion of mental health in the High Level Meeting is short-sighted…we must continue the advocacy and the struggle to place mental health high on the development agenda. This is a global problem and not restricted to one country or to one region of the world. We need global acknowledgement and we need global collective action,” Ramsammy posited.
The Health Minister pointed out that the neglect in promoting mental health, to prevent mental illnesses, and to treat and care for those living with mental illnesses, is wrong and represents a major social and economic injustice and constitutes a grave human rights emergency.
“The truth is that mental health is an indispensable pre-requisite for health and for wealth. We will lose the battle against poverty; we will fail to reduce poverty and to eliminate poverty as a human condition as long as we continue to neglect mental health, as long as we continue to treat the mental and neuro-psychiatric disorders and substance abuse as orphan health issues,” Ramsammy said.

LIMITED DEFINITION
Mental and neurological disorders are chronic non-communicable diseases.
However, according to Ramsammy, over the years the definition of chronic non-communicable diseases has become limited to only include things such as cardiovascular disease, cancers and diabetes.
Mental health, according to the World Health Organisation (WHO), is the state of well being in which an individual realizes his or her abilities, can cope with the stresses of life, can work productively and is able to make a contribution to his or her community. It includes excessive stress, anxiety, depression, substance abuse, bipolar and schizophrenia disorders, among others.
Nearly half a billion people are affected by mental health and neuro-psychiatric disorders and these NCDs account for almost 15 per cent of the disease burden story of the world – more than cardiovascular diseases, diabetes, respiratory illness or cancer.
Yet the historical neglect and exclusion of mental health from local, regional, national and global agendas persist.
The Health Minister said, “We have to stand up for the almost one million persons who lose their lives each year because of suicide, for the millions who live lives of misery because of depression and various forms of psychosis, for the growing number of elderly whose lives have become intolerable because of various forms of dementia, for the growing number of young persons who are addicted to various substances.
We are here to stand up for the millions of women who suffer post-partum depression. We are here for the millions of children who suffer from post disaster stresses and for the millions around the world who are homeless because of their mental conditions….we must act to end the stranglehold of despair resulting from mental disorders.”
The impacts of mental and neurological disorders are crippling and the historical neglect and exclusion of mental health from local, regional, national and global agendas cannot persist.
Public health stakeholders concur that there is inadequate investment for mental health in National Health Budgets and there is an almost total lack of human resources for mental health in most developing countries.

EQUITY FOR MENTAL HEALTH
The time for action has long passed, considering the injustice heaved on those who suffered from mental and neurological disorders.
Guyana’s comeback in addressing mental health is a National Mental Health Policy and Strategic Plan 2008-2015 – a strategic framework that guides its mental health policy.
This is the first formal Mental Health Strategy for Guyana. There were previous attempts to formalize a mental health strategy for Guyana, supported by the Pan American Health Organization, but none of these attempts resulted in a formalized plan for the country.
Armed with a plan, Guyana’s Mental Health Strategy provides the basis on which to build a mental health system which is in line with WHO/PAHO recommendations and tailored to the Guyana context.
It promotes the development of community based mental health programmes which are integrated into primary care and all other levels of the health system and addresses the need to secure equitable financial resources and to allocate resources in a manner which promotes decentralization and horizontal integration of mental health services.
The National Mental Health Policy and Strategic Plan will also promote the development of advocacy groups and NGOs in mental health which can play valuable prevention/promotion, advocacy and rehabilitative roles within the mental health care system. It will also direct the development of modern civil and legislative safeguards that protect the rights of the mentally ill and frame the therapeutic address of their needs. 
“There is no Good Health without mental health,” Ramsammy posits.
There is no standard lexicon when it comes to defining mental health, but the reality of this chronic non-communicable disease and public health scourge is social and economic injustice, loss of opportunity and a life sentence of vulnerability – a reality not likely to change unless the call for action is not heeded soon.