Think Global, Act Local

This year, World Mental Health Day marks the conclusion of Mental Illness Awareness Week (MIAW). It’s fitting to realize that many of the mental challenges in the U.S. are global in nature.

NAMI fights for strengthening and expanding community mental health services and ensuring access across the nation. Meanwhile, the World Health Organization (WHO) adopted a mental health action plan three years ago that seeks to increase global mental health service coverage by 20% by 2020.

Can it be done? Setting goals and timetables that reflect aspirations creates pressure to succeed. Although much depends on how much society is willing to invest in mental health. The success of these goals requires growing movements for change—which often involves transformation of the current system.

Recently, the U.S. State Department asked NAMI to meet with a visiting group of psychiatrists from Serbia. They wanted to learn more about NAMI’s education and support programs and American visions for change. Our discussion identified common themes: eliminating stigma and the isolation of people living with mental illness, the need for community services and involving family members in the recovery process.

We also talked about a fundamental shift taking place worldwide: early identification of mental health problems needs to be followed by early actions—rather than focusing only on points of crisis. It’s analogized to catching problems upstream on a river, rather than downstream, and before a person is swept over the falls.

In Europe, some countries seem to be ahead of the U.S. in developing early action programs. Others are behind. We all have a lot of work to do.

Around the time that WHO adopted its mental health action plan, NAMI Medical Director, Ken Duckworth, co-authored a report with several international experts on Schizophrenia: Time to Commit to Policy Change. It calls for a more comprehensive, recovery-based approach in treatment and support for people living with schizophrenia, enabling them to be better integrated into their communities.

The report reaches three evidence-based conclusions:

• The likelihood of a positive outcome for people with schizophrenia has improved in recent decades.
• A modern approach should aim to move people along a pathway towards recovery of normal function, rather than simply lessening symptoms.
• Financing a more positive approach requires fundamental, outcome-oriented changes in public policy.

Globally, more than 25 million people live with schizophrenia. In the United States, the number is 2.6 million—representing 1% of our adult population, the same rate as worldwide prevalence. The condition is one of the top 10 causes of disability worldwide.

The report focused especially on the need for all persons working with individuals living with schizophrenia—health care professionals working in hospital and the community settings, social care professionals, families and advocacy groups and their families—to work more closely.

“We conducted a number of in-depth discussions among all those involved in the management of people living with schizophrenia and it became increasingly evident that there was a lack of provision of integrated care,” commented the chair of the report’s policy group, Professor Wolfgang Fleischhacker of Medical University Innsbruck, Austria. “The key recommendation of our report is that policy frameworks need to be put in place at both national and local levels to ensure that a more integrated approach is taken.”

On World Mental Health Day it’s important to remember that we are all part of a global community that faces many common challenges, and there is a lot we can learn from each other.