Chapter 8: Global Health and Behavioral Medicine

INTRODUCTION

Global health and behavioral medicine intersect in two important ways. First, mental, neurological, and substance use (MNS) disorders affect every community in the world. We relate to MNS disorders at a local level, where they are embedded in our customs, culture, and context. MNS disorders also exert global influence, through their massive burden of disease, the human and economic costs of treated and untreated illness, and their secondary effects on the outcomes of other health conditions.

Second, most MNS disorders are treatable: people get better. Recent advances in behavioral health care delivery have demonstrated that a collaborative (ideally, linked to primary care), nonspecialist, and transdiagnostic approach can deliver evidence-based care with population-level benefits. We understand how to alleviate the suffering of MNS disorders in high, middle, and low-income settings. Given the frequent disenfranchisement of people living with mental illness, an equity and human rights-based approach to care is essential.

With the goal of offering students a broad overview of mental health care in the global context, we have organized this chapter into three sections:

1. The global treatment and systems gap.

2. New approaches to addressing behavioral health: collaborative, nonspecialist, and transdiagnostic approaches.

3. The importance of context.

THE GLOBAL TREATMENT & SYSTEMS GAP

The Problem

To appreciate the global treatment and systems gap, we must first understand the level of need. Mental disorders represent the greatest collective cause of disability globally today. Recent estimates suggest that the disease burden of mental disorders accounts for 32.4% of years lived with disability (YLDs) and 13.0% of disability-adjusted life-years (DALYs). Depression, the most common mental disorder, affects an estimated 350 million people globally. Depression represents the leading cause of disability (as measured by DALYs) around the world-more than ischemic heart disease, road traffic accidents, cerebrovascular disease, and chronic obstructive pulmonary disease. Severe mental disorders, including schizophrenia, affect at least 1 in 100 people globally, across cultures, with significant severity of illness, morbidity, low life expectancy, and economic impact on families. According to a report by the World Economic Forum, the direct and indirect costs of mental illnesses totaled 2.6 trillion dollars in 2010 alone. By 2030, the cumulative costs are expected to exceed 15 trillion dollars.