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An estimated 300 million people are suffering from mental and neurological disorders and in aggregate these disorders are the single largest cause of lost years of quality of life (WHO, The World Health Report 1996; World Bank, World Development Report, 1993).

Approximately 80 percent of the world's mentally disabled population lives in developing countries. The world confronts a "largely unheralded crisis" in mental, behavioral and social health problems that threatens international political and economic stability and "betrays the humanity" of tens of millions of its victims, according to a 1995 report by Harvard Medical School's Department of Social Medicine. The report declared that "mental health must now be placed on the international agenda," and pointed out that:

"While basic physical health has improved worldwide, mental health has remained stagnant or has deteriorated. An increase in the incidences of clinical depression, schizophrenia, dementia and other forms of chronic illness has accompanied increases in lifespan because more people live to the age of risk. Some of the increase is due to the very improvements in longevity to which health experts and government officials point with so much justifiable pride. Some of it is due to the crushing psychic and social burdens imposed by the urbanization and "modernization" of rural cultures. These same social, political and economic changes have been accompanied by increases in rates of alcoholism, drug abuse and suicide. Rates of violence have increased and will reverse the declines in mortality rates and life expectancy." (1)

In addition, well over 40 million of the world's refugees and internally displaced persons, the victims of civil wars, run a risk of depression, anxiety disorders, PTSD and other forms of mental distress that are consequences of political violence.

Details of the Harvard report were presented on May 15, 1995 to then UN Secretary-General Boutros Boutros-Ghali at a special briefing at UN headquarters. At this conference the Secretary-General stated: "This Report ... reminds us of the great human suffering caused by mental illness ... the international community has risen to many challenges in the past. Now it must do the same [for] mental health ... The challenge is to combine concern for mental health ... with humanitarian assistance and protection efforts. Development policies must ... protect and promote mental health."

In poor countries, persons with mental disabilities are often negatively portrayed, hidden away, abused and stigmatized. They are the last to receive services provided by the community. Society's negative attitudes further exclude them from the mainstream of social, educational and economic life. Because of prejudice or ignorance, they may lack access to essential services. Assistance from the entire international community is needed to put this "silent emergency" to an end.

The Harvard report stresses the interconnectedness of health problems on the one hand, and of psychosocial pathologies, such as violence, alcoholism, abuse of women and children, and underlying social conditions such as war, poverty and discrimination, on the other. It states that the single most important issue is to give priority to mental health around the world. In the words of Secretary-General Boutros Boutros-Ghali: "Medical and social issues which are often viewed separately must be dealt with as a whole ... the priority of mental health must be heightened ... resources must expand ... responsibilities must be recognized more completely."

UN Efforts to Advance the Situation of Mentally Disabled Persons

The UN Charter calls for a "reaffirmation of the dignity and worth of the human person." Article 62 charges ECOSOC with health and related matters. From its early days, the United Nations has sought to advance the status of disabled persons and to improve their lives. As affirmed in related human rights instruments, person with disabilities, physical and mental, are entitled to equal civil, political, social and cultural rights. In 1971, the General Assembly adopted the "Declaration on the Rights of Mentally Retarded Persons." (Resolution 26/2856). This declaration stipulates that mentally retarded persons are accorded the same rights as other human beings.

The attainment of full mental health for all people is recognized in General Assembly Resolution 46/119, "The Protection of Persons with Mental Illness and the Improvement of Mental Health Care" (adopted 12/17/91). The resolution's 25 principles define fundamental freedoms and basic rights of persons with mental illness. Later instruments, such as the Standard Rules on the Equalization of Opportunities for Persons with Disabilities, adopted in 1993, and the Convention on the Rights of the Child, which went into force in 1990, recognize that mentally disabled persons should enjoy a decent life, in conditions that ensure dignity and promote self-reliance. The UN observes the International Day of Disabled Persons every year on December 5 and World Mental Health Day on October 10.

The contribution of the UN High Commissioner for Refugees, UNICEF and the UN Department of Humanitarian Affairs in dealing with traumatized populations has been well documented. (For an excellent discussion, see International Responses to Traumatic Stress, Danieli Y, Rodle, N and Weisaeth L, Eds., Baywood Publishing, 1995).

Recent UN World Conferences reflect the growing awareness that persons with physical and mental disabilities have both special concerns and needs that require serious consideration of the international community. All of these conferences have addressed the situation of people with disabilities and made recommendations to rectify past discriminatory practices as well as protected and promoted their rights to participate in all aspects of the society as citizens of their countries.

The contribution of UN specialized agencies to advance the situation of mentally disabled persons is noteworthy: UNESCO by providing special education, ILO by improving access to the labor market and WHO by providing technical assistance in health and prevention. WHO, especially, performs an important role. Its activities with regard to traumatic stress are dealt with primarily by its Division of Mental Health and the Mental Health Advisors in the WHO Regional Offices.

Major UN Recommendations

UN programs include the following provisions:

  1. A major initiative to upgrade the quality of mental health services in countries of Africa, Asia, the Middle East and Latin America must be undertaken.
  2. The care of the mentally ill should be provided for in national and regional plans and adequate budgetary allocations must be made available.
  3. A cadre of well-trained mental health professionals is necessary to mental health programs in order to design and implement training programs and supervise the care of the chronically mentally ill.
  4. It should be accepted that in most developing countries there is extensive involvement of the patient's family in treatment.
  5. Psychosocial programs should incorporate knowledge and respect for local culture and tradition.
  6. Broad initiatives to control the causes and consequences of violence should be combined with policies that reduce poverty.

(United Nations Development Program, 1996. Human Development Report 1996. Oxford University Press; UNICEF, 1996. The State of the World's Children in 1996. Oxford University Press; WHO, 1995. Bridging the Gaps, Geneva, World Health Organization.

The Role of Nongovernmental Organizations

A major initiative to upgrade the quality of mental health services is only possible by developing an international and regional network of NGOs. Strengthening of partnerships within the United Nations system with NGOs, and civil society through collaboration in research, systematic information exchange and development of common advocacy and public awareness strategies is necessary. The recently established CONGO Committee on Mental Health is of vital importance, because it brings together NGOs from both developed and developing countries. ISTSS played an important role in the establishment of this committee. But the challenges we must face in the mental health field are overwhelming and available resources are limited. ISTSS and its representatives at the UN have an important task before them. *