The burden of mental, neurological, and substance use (MNS) disorders increased by
41% between 1990 and 2010 and now accounts for one in every 10 lost years of health
globally. This sobering statistic does not take into account the substantial excess
mortality associated with these disorders or the social and economic consequences
of MNS disorders on affected persons, their caregivers, and society. A wide variety
of effective interventions, including drugs, psychological treatments, and social
interventions, can prevent and treat MNS disorders. At the population-level platform
of service delivery, best practices include legislative measures to restrict access
to means of self-harm or suicide and to reduce the availability of and demand for
alcohol. At the community-level platform, best practices include life-skills training
in schools to build social and emotional competencies. At the health-care-level platform,
we identify three delivery channels. Two of these delivery channels are especially
relevant from a public health perspective: self-management (eg, web-based psychological
therapy for depression and anxiety disorders) and primary care and community outreach
(eg, non-specialist health worker delivering psychological and pharmacological management
of selected disorders). The third delivery channel, hospital care, which includes
specialist services for MNS disorders and first-level hospitals providing other types
of services (such as general medicine, HIV, or paediatric care), play an important
part for a smaller proportion of cases with severe, refractory, or emergency presentations
and for the integration of mental health care in other health-care channels, respectively.
The costs of providing a significantly scaled up package of specified cost-effective
interventions for prioritised MNS disorders in low-income and lower-middle-income
countries is estimated at US$3-4 per head of population per year. Since a substantial
proportion of MNS disorders run a chronic and disabling course and adversely affect
household welfare, intervention costs should largely be met by government through
increased resource allocation and financial protection measures (rather than leaving
households to pay out-of-pocket). Moreover, a policy of moving towards universal public
finance can also be expected to lead to a far more equitable allocation of public
health resources across income groups. Despite this evidence, less than 1% of development
assistance for health and government spending on health in low-income and middle-income
countries is allocated to the care of people with these disorders. Achieving the health
gains associated with prioritised interventions will require not just financial resources,
but committed and sustained efforts to address a range of other barriers (such as
paucity of human resources, weak governance, and stigma). Ultimately, the goal is
to massively increase opportunities for people with MNS disorders to access services
without the prospect of discrimination or impoverishment and with the hope of attaining
optimal health and social outcomes.