CLASSIFICATION AND DIAGNOSTIC SYSTEMS. THE ROLE OF WPA SECTIONS 14

‘What Nosology May Provide for Sound Public Policy in Psychiatry’ Helen Herrman University of Melbourne, Australia WPA Section on Public Policy and Psychiatry Nosology and Public Policy in Psychiatry  Public policy in psychiatry  Integrating nosology in health and health care  Treating and preventing mental illnesses  Promoting mental health Section on Public Policy in Psychiatry  Terms of reference…  … to consider ways in which the profession of psychiatry can contribute to the improvement of public health in all countries   Through influence on public policies affecting health care Through influence on other sectors eg education, commerce, employment, housing, child and family welfare, justice Public Policy and Psychiatry  Integrated response for people with mental illnesses, new and established  Health care and other sectors eg education, housing, welfare, vocation  Integrated response to prevention of mental illnesses  Primary health care and other sectors Community awareness of the social determinants of health and illness  Promotion of mental health  Integrating Nosology in Health and Health Care  Illnesses of all kinds cluster  Social determinants of health, illness, disability  some are common across the whole of health relevant to illnesses of all kinds feasible & important in people w mental illnesses  Experience of illness, assessment of disability   Utility measurement, generic QoL assessment   Health and illness may coexist Nosology and Public Policy in Psychiatry I  Reliable and valid classification of mental illness for use in advocacy and decisionmaking  Related to treatment services and prevention    Surveys, prevalence Social determinants Relationship to general health and illness Nosology and Public Policy in Psychiatry II  Clear definition of mental health and its relationship to health  Related to promoting mental health 1988 1998 1. Illnesses Cluster  Higher depressive symptom scores in primary care patients link to • poorer health, function & QoL, and • increased health care use  The economic consequences of depression in primary care patients • influenced more by medical comorbidity than by symptom severity alone (Chisholm et al – LIDO study – BJP 2003) 1. Illnesses Cluster  The excess mortality and morbidity demonstrated in patients with psychosis in the asylums, and in community settings • Is of a similar magnitude, but • Resulting from a different pattern of causes  Social and environmental factors are likely to contribute more than any inherent biological disadvantage to this excess (Herrman et al, Psychol Med 1983) 1. Illnesses Cluster  Mental and physical health mutually influence each other over time through two main pathways (interacting with each other and the social environment)   Physiological systems eg neuroendocrine and immune function Health behaviour eg diet, exercise, rest, smoking, sexual practices, safety belts in vehicles, adhering to medical therapies (Health and Behaviour, IOM 2001) 1. Illnesses Cluster  Mental health is a key determinant of overall health (Health and Behaviour, IOM 2001, World Health Report 2001)  Anxiety, depression, stress & immune function • common cold, wound healing  Health behaviour linked to mental health • depression, substance abuse - high risk sexual behaviour • CVD, cancer - diet, sedentary behaviour, alcohol and smoking   Depression and heart disease Depression, anxiety and persistent pain 2. Social Determinants of Health and Illness  The commonality across the whole of health becomes clearer once ‘cause’ and ‘effect’ are delineated on different axes of the classification system (Ustun, Symposium 2003)  The course of an illness (and the associated disability) is not uniquely linked to any particular symptom pattern, but related to many interacting factors – pre-existing and consequent to illness (as well as the social, cultural and environment contexts) (Kirmayer, Symposium 2003) 3. Experience of Illness, Disability and QoL Assessment  ICF - International Classification of Functioning, Disability and Health  operational basis for describing the disease and disability phenomena separately across all illnesses eg WHOQOL  Subjective, generic QoL assessment   Parity in the comparison  between physical and mental illnesses 4. Utility Measurement  Utility measures appropriate and meaningful for people with mental illnesses    Being developed Unit measure of needs across all illnesses Important aid to reverse the neglect of the patient group in resource allocation 5. Health and Illness  UN Resolution, General Assembly December 2003 58/173  The right of everyone to the enjoyment of the highest attainable standard of physical and mental health UN General Assembly Resolution A/Res/58/173  Calls upon States to guarantee that the right of everyone to the enjoyment of the highest attainable standard of physical and mental health will be exercised without discrimination of any kind. UN General Assembly Resolution A/Res/58/173  Reaffirms that the achievement of highest attainable level of health is a most important worldwide social goal, the realization of which requires action on the part of many other social and economic sectors in addition to the health sectors. Promoting Mental Health: Concepts, Emerging Evidence, Practice A Report from the World Health Organization, Department of Mental Health and Substance Abuse in collaboration with the Victorian Health Promotion Foundation (VicHealth) and The University of Melbourne 2004 Forthcoming……. The Full Report Promoting Mental Health: Concepts, Emerging Evidence, Practice. A Report from the World Health Organization, Department of Mental Health and Substance Abuse in collaboration with the Victorian Health Promotion Foundation (VicHealth) and The University of Melbourne Herrman H, Saxena S & Moodie R. Geneva, WHO 2005 Promoting Mental Health Contributors AFR Nigeria South Africa Canada Chile USA Islamic Republic of Iran Finland France Ireland Netherlands Norway Spain Sweden Switzerland The former Yugoslav Republic of Macedonia United Kingdom AMR EMR EUR SEAR WPR India Australia New Zealand Mental health is more than the absence of mental illness Mental health is described by WHO as: ... a state of well-being in which the individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her community Mental health is determined by multiple factors Mental health and mental illnesses are determined by many interacting social, economic, psychological, and biological factors Just as health and illness in general There is no health without mental health Mental health is an integral part of health The goals and traditions of public health and health promotion can be applied just as usefully in the field of mental health as they have been in heart health, infectious diseases and tobacco control