[MUSIC] So what are the key points in public mental health? Well, as you can see, we have a slogan, no health without mental health. But what is the substance to this slogan? Some of you may have heard somewhere else already. Well, we have three main elements. But the idea is that in the first place, we now know that mental disorders, neuropsychiatric disorders in general, have a unique burden. They contribute, amongst other chronic diseases, as we will see in a moment, for a big proportion of the DALYs, which is a global mental disorder measure that we will see in a moment. But a second reason why there is substance to no health without mental health slogan is the fact that the relationship between mental and physical health is intricate, is complex, but is also inexorable. This means essentially that we have to know what are the mechanisms, the several examples from the everyday practice and from evidence-based medicine. But also, what are the implications for the organization of health services and for public health in general, for prevention and treatment? And when we say prevention and treatment, we think about prevention and treatment of physical as well as mental disorders. Because if we do not account for the complex relationship between the two, we would miss opportunities at both ends. But the third argument for which there is substance to the slogan, no health without mental health, is what is called the moral case. And as we will see in a minute, there are a number of reasons why we have a moral case to act within the boundaries of public mental health. At a global health scale and interactive in a very, very productive way with other disciplines in the field. So this is a figure from the global burden of disease that essentially illustrates what is the contribution of neuropsychiatric disorders amongst other chronic diseases to an outcome that is widely used in a GDP, that is DALYs, which is essentially the combinations of years of life lost and years lived with disability. So these measures incorporate aspects of mortality and also of disability. And because mental disorders are, in most respect, chronic diseases which may or may not have relapses, it's important to recognize that their impact is exerted primarily but not solely through the impact on disability in the long term. As you can see, this slide is in fact, of the big cake of chronic diseases, is actually quite composite. You see at the very top in red that schizophrenia contributes to 2% of this DALYs measure in the GDP. And this is a very rare disease in population. The reason for its contribution, 2%, is because its impact is enormous. Somewhat at the opposite end, we have unipolar affective disorder, depression, which is very common. It's one of the most prevalent diseases in the world. But its impact overall, because of the relapses of the disease, because of the very different level of severity, and because we do have treatments. Not just drugs, but also interventions, psychotherapies and other forms that can attenuate the symptomatology. While the impact of these disorders, although the disorders are highly prevalent, is not as big as that one of schizophrenia. And we have several other examples. The next one down after bipolar affective disorder is dementia. And by definition, dementia is a disease that affects primarily older adults. So it is a disorder and a disease of the late stages of life. And therefore, the vast majority of the population cannot be affected by the disease. But its impact on people and their families is enormous. It's probably the most impactful disease amongst the neuropsychiatric that you see in these slides. So you see that this first argument, in the hands of public health, people who work in the field of mental health, is pretty powerful. Because we can sit around a table and say, we count, we matter amongst you. But we then have to open a very productive dialogue with the others. Because mental health may be related to cardiovascular risk factors, for instance, and risky behaviors in general. Simply because the disease may have social implications, behavioral implications that would encompass a more risky profile in these respects. And these would increase the risk of cardiovascular disease or cerebrovascular disease or these metabolic disorders, so very physical health. Or infectious diseases, simply because risky behaviors of any sort you can think of would be acquired with a higher probability. But the story doesn't end here. The complexity of the interplay with mental-physical health is also the fact that people, once they have physical disorder, will have a poorer prognosis. And that's because they tend to seek help less frequently. And because when they do reach mental health or health professionals, in case of the physical health, they get care of less quality. But let me remark the fact that the association goes off also in the opposite directions. Because mental disorders and because physical disorders and the diagnosis of these may cause mental strains that would increase the probability of mental disorders. The third reason [COUGH] for the slogan, no health without mental health, is the moral case that has been discussed and presented by three major experts in the field, amongst who Benedetto Saraceno and Vikram Patel. Well, the argument for the moral case is essentially the fact that, as we have seen, [COUGH] mental disorders are widespread in all world regions. Which means in low and middle-income countries, but in fact, also that we can do something for these diseases also in poorly resourced settings. And the generic variations of drugs for these settings are now available and can be commercialized, so we can do something for that. This is a very important moral argument, that action can be pursued and can be done, and therefore, should be done. But also, on the reverse end, so not thinking of patients but on specialists, we can also have to remark the fact that it's a moral case. The fact that there is still a brain drain of professionals from these settings that will remind us that we have a moral obligation to help these places retain the few people that can operate in the field of public mental health. And of course, the thing that is very important in psychiatry in general is the violation of human rights. And the idea that, through legislation, we can actually help not just the patients, but also the cause of public mental health. And finally, that globalization is already impacting mental health for people on a global scale, with mechanisms that has widespread very rapidly. But is also probably an opportunity to actually let the cause of public mental health spread around the world efficiently. [MUSIC]
