New England Journal of Medicine
February 6, 2014  Vol. 370 No. 6
http://www.nejm.org/toc/nejm/medical-journal

Perspective
Transforming Lives, Enhancing Communities — Innovations in Global Mental Health
V. Patel and S. Saxena

Excerpt  [Free Full Text]
Mr. K. spent nearly a year and a half bound to a log in his home village in northeastern Ghana. His crime? He had a psychotic disorder, and his family could not afford the $17 for antipsychotic medication that would have stabilized his condition. Instead, they consulted a traditional healer, who pinned Mr. K.’s right leg inside a hole in the log and warned his family not to free him lest the wrath of the gods be visited on them.

At least 10% of the world’s population is affected by one of a wide range of mental disorders; as many as 700 million people had a mental disorder in 2010. The 2010 Global Burden of Disease Study showed that mental disorders account for 7.4% of the world’s burden of health conditions in terms of disability-adjusted life-years1 and nearly a quarter of all years lived with disability — more than cardiovascular diseases or cancer (see pie chart Proportions of Global Disability-Adjusted Life-Years Associated with Mental Disorders Accounted for by Various Types of Disorders. for the contribution of different mental disorders to this burden). Incredibly, these numbers probably underestimate the true burden, since they do not include the effects of mental disorders on other high-priority health conditions — for example, the effect of maternal depression on infant undernutrition in low-income settings.2 Furthermore, the trends in the global burden of disease suggest that the proportionate burden of mental disorders will continue to grow…