Gro Harlem Brundtland: Mental illness is not all in the mind

Taken from a speech by the head of the World Health Organisation at the launch in Geneva of the 2001 world health report

It is A great pleasure for me to address you on the occasion of the launch of the world health report for 2001, Mental Health: New Understanding, New Hope.

We are launching this report against a background of widespread horror, insecurity and grief around the world. The attacks in the United States have brought home to many people in the industrialised world a sense of fear that millions in other parts of the world are only too familiar with.

Fear, whether as a result of cruelty, violence, or disease, undermines trust among people and between groups and communities that need to function together. It undermines the safety and predictability that we all need to grow, develop and prosper. It undermines our very belief that people are good, not evil, the belief that is essential if we are to give meaning to what we do.

We are proud of the thousands of doctors, paramedics, nurses and psychologists, wherever they are, who are working to ease suffering and heal wounds – on the bodies of those injured, and inside the minds of many as they cope with horror. Their dedication and stamina is an inspiration to us all.

There has been much focus on trauma and stress, from witnessing or being victims of violence or from being close to victims. Strong reactions to violence are natural and healthy. But we need to acknowledge that some of the people who are exposed to such events will suffer long-term mental effects.

Mental good health is what enables us all to be optimistic and to continue the struggle to create a meaningful and worthwhile life, even during difficult times. The recent events have reaffirmed and strengthened the circle of caring between people and within communities.

Our global community is being tested as never before. We must continue to work together to tackle the great problems that affect the future of humanity, and sustain the impetus for freedom and democracy so that all people can live and grow together.

Let us be clear. Poverty is the most significant determinant of suffering and grief in today's world. We must carry forward the fight against global poverty with all the energy we can muster. We know that poor people are bound to remain poor if they lack physical and human security. This means that freedom from terror, violence and disease are critical foundations for poverty reduction, human wellbeing and a secure future for our world.

This is the context I want you to have in mind when you look at the report we are launching.

Mental illness is not a personal failure. If there is failure, it is in the way we have responded to people with mental and neurological disorders. I hope this report will help dispel long-held prejudices and mark the beginning of a new era in mental health care.

Physical and mental health are inextricably linked to each other and to the wellbeing of individuals. The global toll of mental illness and neurological disorders is staggering. Neuropsychiatric disorders account for 31 per cent of the disability in the world – and they affect rich and poor nations alike. Four hundred and fifty million people have a mental or neurological disorder; 121 million people suffer from depression and 50 million from epilepsy. Every year, one million people commit suicide and 10 to 20 million attempt suicide.

Because people do not get the care they need, mental and neurological disorders impose a range of costs on individuals, households, employers, and society as a whole, ranging from care to lost productivity.

A great deal of this suffering is unnecessary. For instance, 60 per cent of those suffering from major depression can fully recover if treated. But in both developed and developing countries, less than 25 per cent receive treatment, for a variety of reasons including stigma, discrimination, scarce resources, lack of skills in primary health care and deficient public health policies. This is unacceptable.