Stop exclusionDare to care

M E N T A L H E A L T H

Resul ts of a GlobalAdvocacy Campa ign

W O R L D H E A L T H D A Y 2 0 0 1

World Health Organization

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World Health Day 2001 was celebrated in communities world-wide. All means were used to disseminate information about mental health.This photo shows a chalk board re-creating the WHO logo, the World Health Day slogan and relevant advice regarding the treatment andcare of those suffering from epilepsy.

In 2001, WHO hasincreased its advocacyefforts to improve themental health situationworld-wide. A communi-cations strategy to reach

the public-at-large, policy-makersand professionals began with animportant anti-stigma campaign forWorld Health Day in April, withawareness-raising at the 54th WorldHealth Assembly in May and with thepublication of this year’s World HealthReport. On 7 April, communitiesaround the world rallied around ourcall to end stigmatizing and discrimi-natory practices “Stop exclusion” andto reduce the extensive gap betweenthose in need and those receivingmental health care “Dare to care.”

The aim of World Health Day 2001was to raise awareness, increaseknowledge and change attitudesabout mental health issues among thegeneral public. The Day’s events alsosought to challenge health providersand policy makers to improve servicesas well as ensure access to and equityin care. The Day was used to disman-tle taboos and misconceptions whichhave been generally accepted for toolong. “Treatment is impossible; amental disorder may be contagious; I cannot be affected; it’s all in yourimagination; he is possessed by evilspirits; she should be locked up.”

Such false beliefs are responsible forterrible shame endured by sufferingindividuals and their families and con-tribute to the low levels of treatmentencountered today. Taboos surround-ing mental illness prevent people fromopenly discussing the subject and fur-ther isolate individuals. At the turn ofthe century, citizens the world overare ready to confront fears withknowledge and reverse the tide of dis-grace that enshrouds mental healthproblems.

Due to the relentless efforts of manyover the last twenty years, mentalhealth has been receiving increasedattention. Significant endeavours havecreated an environment conducive totransforming public perception. TheGlobal Burden of Disease Reportreleased by WHO, World Bank andHarvard University in 1996 and the1999 U.S. Surgeon General’s Reportare heralded as important signpostsfor mental health awareness-raisingworld-wide. WHO’s 2001 WorldHealth Report is the latest milestonefocusing international attention onmental health.

The world community has nowreached a crossroads where nationswill no longer choose to sweep mentalhealth under the carpet. Mentalhealth cannot be ignored and WHO,joined by an impressive chorus of pas-

sionate mental health advocates, hasexpressly called on its Member Statesto actively improve mental health carearound the world. On World HealthDay, 155 countries responded posi-tively and actions were carried for-ward with enormous enthusiasm bothby governments and communities.This document describes a number ofthe contributions made on WorldHealth Day. It would be impossible,however, to mention the countlessorganizations in countries around theworld which have played a role in thisprocess. It is the humble intention ofthis publication to honour the accom-plishments of many unsung heroeswho will recognize the endeavoursdescribed herein as similar to theirown.

World Health Day harnessed interna-tional momentum and generated amultitude of activities for influencingpublic perception, strengthening pro-fessional networks, empowering con-sumer associations and raisingawareness among decision-makers toresult in improved services, legislationand policy. It is hoped that this docu-ment will inspire further enhancementof mental health services and sus-tained commitment to rendering suchservices accessible to all.

Address by Dr Derek Yach

Executive DirectorNoncommunicable Diseases and Mental Health

F O R E W O R D

© Copyright 2001 World Health Organization

This document is not a formal publication of the World Health Organization(WHO), and all rights are reserved by the Organization. The document may,however, be freely reviewed, abstracted, reproduced or translated, in part or inwhole, but not for sale or for use in conjunction with commercial purposes. Theviews expressed in the document by named authors are solely the responsibilityof those authors.

The World Health Day 2001 advocacy campaign was conceived by NMH Com-munications and the Department of Mental Health and Substance Dependence,WHO. The campaign has been implemented under the direction of WHORegional Advisers for Mental Health and coordinated on country level by WHORepresentatives and Liaison Officers. Government ministries and civil sector asso-ciations have been instrumental in planning and carrying out all national and locallevel events.

This brochure has been written by Linda Merieau, Liaison Officer, World Health Day 2001.

Concept and layout: Tushita BosonetLogo: Marc Bizet

I N T R O D U C T I O N

Health, as defined in the WHO Con-stitution, is a state of complete physi-cal, mental and social well-being andnot merely the absence of disease orinfirmity. This definition provides forthree equal pillars on which healthshould firmly stand. Governmentshave often left mental health out ofthe equation.

The problem is important

Neuropsychiatric disorders account fornearly one-third of the disability in theworld. One in four people will sufferfrom a mental or brain disorder atsome point during their lifetime and noregion is spared. Sufficient attentionmust be given to mental health. Yet,the 2001 WHO Project Atlas indicatesthat the majority of countries allocateless than 1% of their total healthexpenditures to their mental healthbudget. The Atlas is a baseline study of185 countries designed to capture thecurrent level of resources committed tomental health worldwide.

Latest data compiled for the 2001World Health Report states that about450 million people alive today sufferfrom mental or neurological disordersor from psychosocial problems such asthose related to alcohol and drugabuse. Only a minority of those indi-viduals receive appropriate treatmentdespite the fact that we have themeans to treat many disorders and tohelp people alleviate their suffering.

Help is possible if we dare

The brain and mind are vital to humanfunctioning. Yet, we have very oftenpreferred to ignore the warning signsof psychological and emotional diffi-

culty, because of lack of knowledgeand because of fear-- fear that onecannot be treated or fear that the per-son will be labelled with an indeliblemark of scorn or contempt. Mythsand stigma are key reasons why manypeople today do not seek or receivemental health care or follow treat-ment. Other reasons include discrimi-nation (on the job, by insuranceproviders, etc), poverty, lack of essen-tial drugs, lack of trained mentalhealth professionals and a lack of skillsat primary health care level. Misguid-ed priorities that favour inappropriatepsychiatric institutions rather thancommunity-based services also pre-vent people from getting the carethey need. Furthermore, many nationsdisplay an absence of rational andcomprehensive policies and legislation.More than 40% of WHO’s MemberStates surveyed for the 2001 Atlaspublication reported having no mentalhealth policy in place.

Challenging the status quo

WHO’s mental health advocacyefforts target the general public,health professionals and decision-makers.

At the 54th World Health Assembly inMay 2001, WHO put mental healthon the agenda of governments anddecision makers. The 132 Ministers ofHealth participating in four roundtable sessions, generally agreed thatlimited health budgets and the realityof facing other major health problemscan no longer be obstacles to action.As speakers said, “our concern forinfectious diseases should not deter usfrom dealing with mental health prob-

Introduction

C O N T E N T S

IntroductionAdvocating for better mental health

Bringing about a change in attitudeMass events among the public-at-largeOpen Days in mental health servicesCase study: NigerCultural eventsCase study: Rovigo, Italy

Advocacy materials

Targeted events for youthGlobal school contest, theatre, sporting eventsCase Study: Lao People’s Democratic Republic

Targeted events for health professionalsSeminars, training Case Study: Goa, India

Targeted events for decision-makersInformative sessions, proclamationsCase Study: Lille, France

In partnership with the mediaCase Study: Eastern Mediterranean Region

Strengthening professional networks and consumer groupsCase study: Internet Mental Health Highway connecting Belgium, Vietnam, Bulgaria, Laos

Influencing policy change, legislation and service improvementsCase studies: Brazil, Pakistan and Papua New Guinea

Conclusion

Participating countries

Advocating for bettermental health

lems”, and “we must find a share formental health out of our limited bud-gets”.

World Health Day’s aim was to reachthe general public and break downcommonly held fallacies and taboos.Many countries responded to theWorld Health Day theme, “Stop exclu-sion – Dare to care”, by orchestratingpublic marches, concerts, theatricalperformances, and seminars, by provid-ing free diagnosis and by schedulingopen days in hospitals or community-based service centres in an effort tomake mental illness more acceptable.Targeted efforts to reach young people,health professionals and decision-mak-ers were effectively carried out in themajority of countries. Most importantly,several countries used this opportunityto improve health professionals’ knowl-edge and create new networks in men-tal health as well as to embark uponnew policies, revise legislation, and ini-tiate new services.

Advocacy efforts aim to raise aware-ness of the extent of the problem,educate the public to create a changein attitude and lead us on our way tosolving a problem instead of ignoringit. Through this process, we canreduce stigma. WHO is committed toits mental health advocacy efforts thatimprove public awareness and educa-tion, that promote human rights andthat support parity between physicaland mental health. As an advocacycampaign with a strong anti-stigmaarm, World Health Day 2001 has suc-cessfully contributed to an improvedpublic opinion, a stronger voice forprofessionals and patients and amore serious public health responseto the complex and considerablemental health burden.

Contents

B R I N G I N G A B O U T A C H A N G E I N AT T I T U D E

World Health Day events were con-ducted on both large and small scales.Nationwide mass rallies and contestswere held, leaders and activists spokeout and national pledges were made.Community football tournaments,conferences, theatrical presentations,round table discussions, art exhibits,

open houses and concerts drew largeaudiences in districts, cities and townsaround the world. Media coverage ofthe events was a primary vehicle forgenerating debate and informing thepublic about mental and brain disor-ders. Events were both of mass appealand targeted to special audiences.

Many large-scale, general publicevents included mental health service-based activities in order to informabout the realities of psychiatric insti-tutions and community-based carefacilities. WHO advises its MemberStates to establish mental health ser-vices in community-based health clin-ics and provide psychiatric beds ingeneral hospitals to allow individualsto remain close to their families. Manycountries chose to put the WorldHealth Day slogan into action anddemonstrate their commitment toWHO’s goals by inviting the publicinto these facilities.

“Niger was no exception to the massive response to World Health

Day. As in some other countries, the organizing committee was struck by

one concern at the outset of their preparations. The sanitary conditions

of the psychiatric unit at the national hospital were not considered to be

up to standard to say the least. Not only were the facilities old and run

down, but the Pavillon E was particularly littered with assorted rubbish

and filth with little maintenance undertaken since 1996. The immediate

response was to find a way to restore the basic human dignity to the

patients living in this unit. Corrective means were implemented under

the guidance and funding of WHO’s country office in Niger and the

Rotary Club. The local fire squad was called in to clean and paint the

facility. Medicine, bedding and basic toiletries were purchased; patients

were fed and clothed.

Niamey National Hospital was the site of an official ceremony on World

Health Day in the presence of the Minister of Health who toured the

renovated Pavillon E during the event. Other actions to benefit the

patients in the hospital and those who have found themselves on the

streets are being planned in Niamey. The creation of an association

called “Friends of Pavillon E” was proposed during the round table ses-

sion on World Health Day in Niger.

Item 1 of the 1991 United Nations resolution 46/119 “Principles for the

Protection of Persons with Mental Illness and for the Improvement of

Mental Health Care” requires that all persons with a mental illness, or

who are being treated as such persons, shall be treated with humanity

and respect for the inherent dignity of the human person.”Case study: Pavillon E at the National Hospital of Niamey, Niger

Bringing about a change in attitude among the public-at-large

Ringing out hope in South Africa

At noon on 7 April, the Minister of Healthrang the Union bells to symbolize theliberation from mental health prejudice.Bell-ringing was echoed by mayors andschools nationwide.

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The WHO Director-General touring Mathari Mental Hospital during World Health Daycelebrations in Nairobi. Kenya is devoting attention to the decentralization of psychiatric services.

People on all continents made theeffort to look inside psychiatric institu-tions, entering these generally hard toreach places. In many cases, theseestablishments were far from publicview and traditionally served the pur-pose of keeping individuals hiddenaway; out of sight and out of mind.Advocates in many countries usedWorld Health Day to draw attentionto inadequate conditions and humanrights abuses in some institutions. Vis-its to rehabilitation centres, exhibitionsof patients’ work and dialogue onWorld Health Day has led to a betteracceptance that individuals sufferingfrom a mental disorder can lead pro-ductive lives and participate in every-day activities. Open houses in theseoften unknown establishments weregreeted with enthusiasm by the gen-eral public.

A few examples of mental health carefacilities opening their doors acrossthe globe include:

■ Garrahan General Hospital for Chil-dren (Argentina)

■ Aarhus Centre with visits to the oldpsychiatric hospital & renovatedward (Denmark)

■ St Mary’s Psychiatric Hospital(Eritrea)

■ Ammanuel Hospital, the oldest andonly psychiatric hospital in thecountry (Ethiopia)

■ “Pink House”, part-time therapeu-tic centre in Marseille (France)

■ The work centre of the PhilippineMental Health Association

On World Health Day 2001, millionsof people declared that they would“dare to care”. Three goals wereachieved:

■ bringing about a change in atti-tude;

■ strengthening professional net-works and empowering consumergroups; and

■ exerting influence to change policy,legislation and services. Activities toreach these aims were organized in155 countries.

Mass events

B R I N G I N G A B O U T A C H A N G E I N AT T I T U D E

Public events throughout the worldincluded:

■ Display stand in Hobart City Mall(Australia)

■ Exhibition of children’s drawingsand paintings during a public eventin a major shopping mall (Bahrain)

■ 10 kilometre walk for mental health(Botswana)

■ Educational campaign featuring amental health exhibition which willtravel to public venues such as hos-pitals and mosques (Brunei)

■ Forum on homelessness and men-tal health in Ottawa (Canada)

■ A rally with speeches by officials,religious leaders, traditional healersand school teachers (Chad)

■ “Health Alley” festivities with exhi-bition of arts & handicrafts (Geor-gia)

■ Free medical consultations providedfor one week (Guinea)

■ Event at Westend City Centre, thecountry’s biggest shopping centrewhere over 15,000 people heardabout mental health (Hungary)

■ Performance of “Mind Matters”specially commissioned play por-traying the journey through a per-son’s mind in Chennai (India)

■ Free medical check-up and treat-ment offered for one month inVadodara (India)

■ “The Hidden Artist” exhibition ofpaintings by persons with mentalillness from Israel (Switzerland)

■ Information stands throughout thecity of Barcelona (Spain)

■ Mental Health Fair at the Universi-ty of South Dakota (USA)

“ Like other communities, the municipality of Rovigo in Italy

designed a full calendar of events from April to December to commemo-

rate World Health Day. Round tables, open days in therapy centres, liter-

ature conferences, theatrical and dance events, poetry and visual arts

exhibitions as well as sporting events were all used as means of raising

awareness among various groups with the message that those suffering

from mental illness are also citizens of the community and deserve the

same respect as others.

The organizers teamed up with other established city programmes to

highlight mental health in their events. For example, in the July “Vetrina

danza” festival, artists performed a show representing the creative

aspects of psychic suffering. The choreographer and audience discussed

the presentation and audience reactions. In collaboration with the

“Opera Prima” festival during June, performers gave guided tours of a

facility that once was a psychiatric hospital. They portrayed themes of

psychic suffering and prejudice toward mental illness throughout the

tours. The “Blues in the Piazza” music festival hosted a conference with

blues musicians, creative writers and journalists to discuss music as a

means for fighting against psychic suffering and exclusion. The RoWood-

stock music festival in November welcomed bands that have composed

songs dealing with uneasiness and stigma. ”Case study: A comprehensive awareness-raising programme in Italy

“I …appeal that everyone, according to

their responsibilities, should commit

themselves to defend the dignity and the

rights of the mentally ill. No-one should

remain indifferent…”Pope John Paul II on the occasion of World Health Day 2001

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Education activities about epilepsy wereconducted in 5 major cities benefittingover 1500 persons in China. This photoshows Heilonjiang province.

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Musical show at the Lagoon Rodrigo deFreitas in Rio de Janiero, Brazil with aparade of stylized strait jackets, created bylocal artists. This major event marked thestart of a six month public awarenesscampaign led by the Brazilian PsychiatricAssociation.

Mass events such as concerts, theatri-cal presentations, art exhibitions,sporting matches, rallies and marcheswere carried out in local communitiesand in national capitals. People weregiven the opportunity to have freediagnosis or consulting services atmany health stands, informationbooths, and over special telephonelines via call-in radio programmes.Lectures, conferences and debatestelevised nation-wide created usefulopportunities to inform and educatethe public on warning signs for mentalor brain disorders and on ways to pre-vent them.

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Member of Parliament Lady Carol Kidu ofPapua New Guinea participating in theWorld Health Day march with popularentertainer Kanage and hundreds ofresidents of Boroko.

B R I N G I N G A B O U T A C H A N G E I N AT T I T U D E

World Health Day events were sup-ported by a wide selection of educa-tional and promotional materialsproduced by WHO and national gov-ernments.

WHO drafted a global brochure“Mental health around the world”that provides the facts to dispel com-mon myths and inform the publicabout principal disorders, generalmovements in mental health policyand actions to be undertaken by alllevels of society. Several regionalbrochures were produced to highlightthe details of specific mental healthstrategies. In addition, many govern-ments and national associations creat-ed pamphlets and brochures onnational facts and mental healthresources, as well as posters, hats, pinsand other mementos.

For example, the China Health Educa-tion Institute distributed over 30,000posters and leaflets and 10,000brochures. 40,000 publicity leafletswere sent to the general public forepilepsy events in China organized aspart of the Global Campaign AgainstEpilepsy on the occasion of WorldHealth Day. In Chile, advocacy materi-als were distributed to 170 organiza-tions participating across the nation, arecord involvement. In Spain, over4,000 posters were distributed in thesingle province of Catalunya.

Audio/visual materials were alsodeveloped by many groups to focus

on specific themes of relevance intheir communities. A video “7 Days, 7Faces” was produced by the WHORegional Office for the EasternMediterranean. The WHO RegionalOffice for the Americas (PAHO) creat-ed public service announcements thathave been aired on major networks,including CNN. WHO HeadquartersOffice commissioned several videos todemonstrate the role of family seenfrom an NGO perspective in India,provision of mental health care incommunity-based services related bythe city of Trieste, Italy and provisionof care in impoverished settings asdemonstrated by the psychiatric ser-vices in Tanzania.

Websites added another powerfulmechanism for spreading the mes-sages of World Heath Day. WHOHeadquarters created a site in six lan-guages (www.who.int/world-health-day) and informative sites were alsohosted by each WHO Regional Office.National efforts brought the messagesof World Health Day to the internetpublic in many languages includingCzech, Turkish, Italian, Portugueseand Spanish. Furthermore, severalevents were broadcast on internetthrough live chat sessions such asthose organized by the World Assem-bly of Youth and by CNN with DrBernard Aarons, Director of the Centerfor Mental Health Services of the U.S.government.

Advocacymaterials

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Many communitiesrecognized the importanceof targeting activitiesspecifically for the youngergenerations.

Some events included:

■ A series of theatrical presentationsfor high school students by thecompany “Théâtre de Jade” inFrance

■ Regional workshop for high schoolstudents entitled “Mental Health isa social relationship”, Italy

■ Football matches and a champi-onship tournament among youthwith teams wearing World HealthDay uniforms in the main square ofBerbera, Somalia

■ “Healthy minds for a healthy gen-eration” workshop conducted foryouth in cities on 4 continents.

B R I N G I N G A B O U T A C H A N G E I N AT T I T U D E

WHO initiated a massive activityinvolving youth from ages 6-18 in aclassroom-based contest challengingthem to depict their understanding ofmental health through drawings andwritten essays.

The Global School Contestfor Mental Health

About one in five of the world's youthunder the age of 15 suffers from mildto severe mental disorders. However,despite the need for early interventionin childhood, most treatments aregeared towards adults. The globalschool contest on mental health there-fore was a way to reach young peopleand their families and to develop abetter appreciation of mental health.It encouraged schools to initiate orreinforce efforts to promote mentalhealth education in the school healthcurriculum. Mrs Rosalynn Carter, for-mer US First Lady, described the con-test as a “fruitful (exercise) forchildren of the world to spend timecontemplating in a caring way thosewho suffer with mental illness.”

The contest was also promoted byUNESCO and a variety of nationallevel partners. Schools submitted onewinner for each of the three cate-gories to the WHO Country Officesfor judging. National winners werechosen, and their entries were trans-mitted to WHO Regional Offices forthe selection of the six regional win-ners. A jury of representatives fromWHO Headquarters, NGOs, the edu-cation and artistic communities chosethree global winners on 7 April.

The finalists, Mr Dhruv Suri of India,Ms Tang Shu-wei of China and MsBibbie Kumangai of Palau, were flownto Geneva to share their experience

with ministers at the 54th WorldHealth Assembly in Geneva.

With over 80 countries participating inthe Global School contest, an estimat-ed half million children and adoles-cents were made aware of theimportance of mental health and theneed to do away with prejudice anddiscrimination. The works of thenational winners will be compiled into

a book dealing with stigma and men-tal health issues for kids, school teach-ers and professionals.

The school contest was well preparedon the local level. The St Nicolas Childand Adolescent Psychiatric Clinic(Sofia, Bulgaria) organized an informa-tion session in January for the city’sstudents participating in the contest.The Mental Health Centre for Adultsand Day Care Centre held a meetingwith teachers at the town hall in Gra-nollers (province of Barcelona, Spain)to explain the meaning of the WorldHealth Day theme to assist in thedevelopment of their lesson plans. Fullpage advertisements to promote thecontest were placed in the nationalnewspapers of several countriesincluding Algeria, India and Sri Lanka.

“This troupe of young actors has written and performed a unique

play on the occasion of World Health Day. In order to create the perfor-

mance, the young students benefited from a three day workshop orga-

nized by a Lao psychiatrist and a Belgium psychologist. The play’s intent

was to explain how to manage key disorders with a compassionate

refusal to accept the accompanying stigma. The first act depicts an

epileptic fit in a public location, the belief of its connection to “spirits”

and the nurse explaining in simple terms the medical treatment. A sec-

ond skit deals with depression of a young boy, the feelings he experi-

ences and the help he receives from family and friends. The third act

brings to life the story of a young adult with schizophrenia to explain

how he begins to hear voices and has unpredictable visions. His friends

learn to help and accept him.

The play was first performed in the context of the official World Health

Day celebration of the Lao People’s Democratic Republic. In addition to

several public shows, the play was taped on video cassette for dissemi-

nation to schools for use as an entry point in teaching the subject of

mental health. The play was also expected to be broadcast on Lao tele-

vision several times this year. Similar performances were held around the

world as an excellent means of reaching out to youth and adults.”Case study: Lao Youth Theatre Group

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Adam Szekerak, national winner of the agecategory 15-18 years, reads his essay at

the World Health Day celebration inHungary.

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“Kids on the block” puppets engagingchildren during an educational segment ofthe awareness-raising event at the PanAmerican Health Organization.

Lao Theatre Group

Targeted events for youth

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“I understood very well that alcoholism was a diseasethat mined not only the life of (my father) but also the livesof many who loved him, especially the family… I understand now that (he) could not have helped himselfwithout our help. I have learned to respect and understandthose who are different from us in order to help them.Sometimes that's all it takes.”Bibbie Kumangai addressing the 54th World Health Assembly

at the United Nations in Geneva, Switzerland

■ Joint session of pediatricians, gen-eral physicians and nurses entitled“Alarm signals among the youngpopulation to detect psychologicalpathologies” (Spain)

■ Meeting of doctors “Without a fearfrom mental disorder patients”(Yugoslavia)

■ Workshop series on rehabilitationissues and development of pro-grammes at Boston University(USA)

Publication in scientificjournals is a crucial part ofshifting the opinion ofhealth professionals, bothin the public and privatehealth sectors.

This activity was keenly supported byall offices of the World Health Organi-zation. Many renowned experts sub-mitted compassionate contributions tothe editorial pages of leading interna-tional journals, respected regional pub-lications and national bulletins. Wellover 25 major specialized periodicalspublished commentaries on the occa-sion of World Health Day including:

■ Acta Psychiatrica Scandinavica

■ American Journal of Public Health

■ Indian Journal of Psychiatry

■ Journal of the American MedicalAssociation

■ Journal of the College of Physiciansand Surgeons Pakistan

■ Lancet

■ Neurology and Public Health

■ South African Medical Journal

B R I N G I N G A B O U T A C H A N G E I N AT T I T U D E

Conferences, symposiums and semi-nars were held in many countries onWorld Health Day. While some weregeared toward the general public,others were tailored toward raisingawareness among health profession-als. General practitioners, nurses andeven psychiatrists and psychologistshold biases and myths about mentalillness. Stigmatization of the profes-sion has led to a low level of skilledprofessionals both in the number ofspecialists and the capacity of primaryhealth care to respond to mentalhealth problems. Many adminstrationsused World Health Day to convenetraining courses and seminars for pro-fessionals in an attempt to bothimprove knowledge and reduce preju-dice within the medical community.

A few examples of meetings attendedby health professionals around theworld include:

■ Training conference for psychia-trists in Asia (Australia)

■ Training course on epilepsy &dementia at Fudan University(China)

■ Conference entitled “From exclu-sion to mental health systems ofcare” in Cairo (Egypt)

■ Workshop on stress managementfor health workers (Guyana)

■ Conference “Strategy to take mea-sures against stigma and bias forpeople with mental illness” in Seoul(Republic of Korea)

■ Six-month series of conferences ontopics including problems of mod-ern psychiatry, current state of cau-sation, dementia and infantileautism (Russia)

“We must continually assess the

number and distribution of qualified

practitioners and look for ways to form

partnerships with international colleagues

to increase the number of trained

practitioners and researchers in mental

health.”David Satcher, MD, PhD, U.S. Surgeon General fromJAMA Editorial, 4 April 2001, Vol. 285, No. 13, 1697

“The Goa Mental Health network was created following the suc-

cess of a symposium on public health & psychiatry attended by 160

health professionals in the city of Goa, India. Several of the participants

also agreed to form a collaborative effort to improve the management

and diagnostic criteria for dementia in Goa.

The seminar’s aim was to raise awareness of mental health among gen-

eral medical practitioners. Its goals were achieved through various lec-

tures on the World Health Day themes of stigma and treatment, and on

the management of common mental disorders and dementia. The enthu-

siastic response to this workshop encouraged the organizers to hold a

workshop for teachers on the prevention of teenage suicide in the month

of July 2001.

Follow-up activities and concrete results from professional seminars as

well as public events were reported by organizers in many

countries.” Case study: Mental Health Symposium results in the launching of a mental health network

Targeted events for health professionals

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B R I N G I N G A B O U T A C H A N G E I N AT T I T U D E

Many associations, professionals andpublic servants were quick to seize theopportunity provided by World HealthDay to reach out to key decision mak-ers in their communities. In Angola, ameeting between parliamentarians,members of the governement, NGOsand religious leaders was convened tosensitize law-makers about mentalhealth issues. Special parliamentarysessions on mental health and sub-stance dependence were held inPoland, Slovakia, Sweden and Thai-land, to name only a few countries.

At national and local level, manyefforts were made to educate and per-suade legislators and government offi-cials to devote energy and resourcesto protect the mental health of theircitizens.

Proclamations were signed at all levelsof government. A few examplesinclude:

■ President, Central African Republic

■ Prime Minister, India

■ Minister of Health and Social Welfare, Lesotho

■ Minister of Health, Myanmar

■ President and Chief Executive, Pakistan

■ Deputy Mayor of Cape Town,South Africa

■ President, Sri Lanka

■ Prime Minister, Thailand

■ Mayor of Washington, D.C., USA

“The French city of Lille joined the world in celebrating mental

health on 7 April 2001. Among various activities, the Mental Health

Public Service identified the necessity to ensure a strong political com-

mitment for securing their citizens’ mental health. The signature of

proclamations by the mayors of twenty-two cities and towns comprising

the Lille metropolitan area* has been an important action for raising

awareness among government officials of the following key mental

health concerns for the local community:

■ Mental or brain disorders affect a good number of France’s citizens ofall ages in both large cities and rural towns, as in the rest of theworld;

■ Such disorders have a great impact upon quality of life and an indi-vidual’s functioning in society;

■ Services must be improved and made accessible to all;

■ Individuals suffering from a mental health problem and their familiesrisk not being able to benefit from the health services to which theyare entitled.

Ensuring political will is a major element of a successful advocacy cam-

paign and can have a marked influence on reducing stigmatization faced

by those suffering from a mental illness and their families.”Case study: Securing political will in France

* World Health Day Proclamation signed by the elected officials of Lille, Marquette, Fretin,Mouvaux, Neuville en Ferrain, La Chapelle d’Armentières, Comines Belgique, Tourcoing,Halluin, Houplines, Armentières, Mons en Baroeul, Marcq en Baroeul, Lezennes,Ronchin, Faches-Thumesnil, Frelinghien, Hellemmes, Pérenchies, Comine, Nieppe,Lesquin as well as the North Lys Metro Regional Union and the Directors of all MentalHealth Service Units of each district.

“For too long mental health problems

have been treated as dirty secrets instead of

challenges like any others, to be faced and

dealt with by individuals, families and

communities.”Oscar Arias, Former President of Costa Rica and 1987 Nobel Peace Laureate

Targeted events for decision-makers

Schizophrenia

B R I N G I N G A B O U T A C H A N G E I N AT T I T U D E

Hundreds of newspapers carried arti-cles about World Health Day and themental health situation of their nationor local community. All major newswires and international newspapers aswell as local media covered mentalhealth issues extensively. In somecases, regular mental health columnswere established as a result of WorldHealth Day. Television and radio sta-tions were very active in launching amental health debate on the occasionof World Health Day. In-depth reportshave been initiated to investigatehuman rights abuses in mental institu-tions, to track the progress of legisla-tive efforts to revise law or analyse theservice capacity of nations, states,cities and towns.

A key partner for disseminating infor-mation and influencing opinion, themedia have proven willing and eagerto explore mental health in moredetail. A few examples of the varietyof radio programmes, televisiondebates between professionals,patients and the public, editorials,reporting and investigative journalismwhich took place in all countries:

■ National contest for best radio andTV broadcast for healthy lifestyleagainst alcohol and drugs (Belarus)

■ National television discussion pro-gramme on the prevention of men-tal disorders in children andadolescents (Czech Republic)

■ Question & Answer call-in show onadolescent mental health problemson All-India Radio (India)

In partnership with the media

“From 1-3 April, a number of prominent men-

tal health and media professionals from Egypt,

Lebanon, Iran, Morocco and Pakistan gathered in

Cairo to discuss strategies for the launch of an anti-

stigma campaign.

Media can contribute to public education, improve-

ment of psychiatric services, advocacy of community-

based interventions, protection of patients’ rights and

reduction of stigma. The group discussing these

points agreed that as media exerts a powerful influ-

ence on our perceptions, attitudes, emotions and

behaviours, media professionals have an immense

responsibility to avoid the pitfalls of sketchy cover-

age, misinformation and sensationalism.

The group shared examples of positive media cover-

age in their own countries and identified the barriers

they face in attempting to provide an accurate and

open flow of information. They proposed a strategy

to tackle the menace of stigma and discrimination

based on the following actions: 1. Develop a coher-

ent and consistent policy framework for ensuring

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access to mental health services within general health

care; 2. Develop guidelines for media reporting with

built-in mechanisms of monitoring the implementa-

tion; 3. Develop training workshops for media per-

sonnel to enhance their capacity for reporting about

mental health issues; 4. Develop protocols to study

the impact of media campaigns on public attitudes in

both short and long term, and incorporate the

changes required in the campaign strategy based on

the evidence generated; and 5. Encourage and

empower self-help and family groups to monitor and

expose discriminatory practices against mentally ill

persons.

The WHO Regional Office for the Eastern Mediter-

ranean plans a second instalment of this “Media and

Mental Health” meeting in the fall of 2001. (Adapt-

ed from an article appearing in Dawn, Pakistan, 2

May 2001)”Case study: Regional Meeting: Media and MentalHealth throughout the Eastern Mediterranean

S T R E N G T H E N I N G N E T W O R K S

World Health Day provided an incen-tive for professionals and patients toimprove their knowledge on mentalhealth and a motive for fostering net-works of continuous learning. Thepower of advocacy is increasedthrough the “strength in numbers”effect of grouping concerned individu-als. Their messages are more easilyheard by decision-makers and theircollaboration can lead to more wide-spread circulation of information andbest practices.

A variety of activities forbuilding networks and forthe exchange ofinformation andexperiences took placearound the world.

A few examples include:

■ “Developing and connecting net-works for mental health”, an inter-national meeting of associations,held in Naples, to overcome socialexclusion and guarantee the rightto care (Italy)

■ The creation of a Mental HealthResource Directory for the Provinceof Western Cape (South Africa)

■ A meeting of women victims ofviolence bringing together for thefirst time women from two associa-tions in Spain and Algeria.

Strengthening professional networks and consumer groups

“Four research centres specializing in medical psychology, alcohol

abuse and substance dependence at the universities of Brussels, Ho Chi

Minh City, Varna and Vientiane have inaugurated a new “internet com-

munications highway” on this year’s World Health Day. The launch of

this site was suggested as a means of cementing their contacts into a

more official and regular network that would examine different themes

on a recurring basis.

A highly publicized first debate was planned to coincide with World

Health Day, however, due to logistical difficulties, the first thematic dis-

cussion was not able to commence with the proposed internet forum.

Despite this initial set-back, the organizers of this techology-based net-

work for connecting researchers in four corners of the world have never-

theless laid some constructive foundations.

The first subject of discussion highlighted therapeutic approaches for

young persons dependent on alcohol. The debate focused on the impor-

tance of the problem, potential links with socio-economic factors, useful

prevention methods, specific treatments and collaborative efforts

between those institutions involved in the network exchange. As a pre-

liminary step, ULB (Université Libre de Bruxelles) has filmed consulta-

tions with consenting patients for use by professors in their classroom in

Brussels. To expand the discussions, ULB is exchanging filmed consulta-

tions and student debate with classes at the University of Ho Chi Minh

City. The non-confidential commentary created during these cultural

exchanges is intended to be shared on-line, accessible to all through the

internet. It will certainly be interesting to witness the expansion of this

collaboration and the benefits it can bring to other researchers, mental

health professionals and the public-at-large through growth of the inter-

net-based activities of this network.”website: http://www.ulb.ac.be/medecine/psymed/secr/inforout.html

Case study: Linking together Belgium, Viet Nam, Bulgaria and Lao People’s Democratic Republic

Influencing policy change,legislation and serviceimprovements

A memento created by Ms JuliaSerletáková in Slovakia at the ceramicmanufactory in Rimavska Sobota whichemploys patients. It is based on the officialWorld Health Day logo.

Public opinion influences policy, lawand the delivery of services. Creatinginformed public opinion that positivelyeffects the quality and availability ofmental health services is a critical stepin an advocacy strategy. Around theglobe, World Health Day 2001 soughtto change public attitudes on mentalhealth , strengthen networks andinfluence decision makers.

Many countries haveembarked upon the path to review policies and imple-ment comprehensive reformsas a means of marking WorldHealth Day 2001.

■ In Algeria, a national plan for men-tal health is currently beingreviewed on the local level with theintention of presenting it to thegovernment for adoption on 10October, World Mental Health Day(annual event as decreed by theWorld Federation of MentalHealth).

■ In France, the Ministry of Healthannounced future policy changes,currently under deliberation, thatwill phase out psychiatric institu-tions in favor of community-basedmental health services. A seminarwith consumers was held on theoccasion of World Health Day toprovide the public administration

an opportunity to listen to the basicconcerns of those in need. Patients’rights to access their personal med-ical files in cases of psychiatric ill-ness and improved information forconsumers on the nature of disor-ders were two topics of debate atthis colloquium that generatedvaluable insight for the process ofpolicy revision.

■ In Liberia, a country with no men-tal health programme, a seminarhelped build consensus on thedevelopment of a national pro-gramme with emphasis on short-term interventions. The resultingten-point strategy encompasses theproblems of stigma, the promotionof community-based mental healthcare, improved training and theparticular challenge of dealing withtrauma healing and reconciliation.

■ In Syria, the creation of a new men-tal health unit in the Ministry ofHealth and an integral mentalhealth programme were announced.

■ In Ukraine, a national committee tomonitor the state of human rightsof mentally ill persons and theirfamilies was established.

Improvement of serviceswas a central theme of theWorld Health Day advocacycampaign.

Both the importance of establishingservices closer to one’s home as wellas the creation of services for popula-tions often forgotten such as childrenand adolescents or the elderly hasbeen highlighted. Many new serviceswere inaugurated during WorldHealth Day celebrations to meet theneeds of the concerned populations.

■ A new adolescent day unit was cre-ated at Calvary Hospital (Australia)

■ A new psychiatric unit was estab-lished at Belmopan General Hospi-tal (Belize)

■ A mental health centre “Chocekol-ubie” was opened in the town ofPazardjik (Bulgaria)

■ A new facility managed by theNational Federation of Patients andex-psychiatric patients was openedin Paris (France)

Increased funding formental health initiatives isthe next logical step.

As reported in the Deccan Herald (17July 2001) of India, governments arefollowing suit by revisiting mentalhealth care budgets. 30 million dollars(150 crore) have been allocated tomental health in the next five-yearplan (2002-2006) of India. This repre-sents a five-fold increase over the pre-vious five-year period. The money willbe used for collecting mental healthdata and extending the available ser-vices and facilities across the country.

P O L I C Y , L E G I S L A T I O N A N D S E R V I C E S

“After 12 years of debate, Brazil’s psychiatric reform law was

approved and came into effect in April 2001. The Ministry of Health

took advantage of World Health Day by organizing a ceremony on 6

April for the signing of this law and announcing its plans for other policy

changes such as auditing of psychiatric hospitals.

The Brazilian law emphasizes community-based care and patients’

rights. About 90% of the mental health expenditure in 2000 was allo-

cated to hospitals as much of the treatment in Brazil is still based on

hospital care. There has been a gradual reduction in hospital beds for

psychiatric patients although “there has not been a reallocation of

resources to assist these people, and extra-hospital care numbers are

much below what they should…be,” said Valentim Gentil Filho of the

University of São Paolo. “The law will have no impact in health care if

it’s not followed by an increase in mental health care expenditure,”

agreed Jair Mari of the Federal Universidade of São Paolo.1

Ordinance Eight of 2001, or the Mental Health Ordinance, proclaimed

by the President of Pakistan, effective February 2001, consolidates and

amends the law relating to people with mental disorders, the manage-

ment of their property and other related matters and replaces the out-

dated Lunacy Act of 1912. The law covers the establishment of a federal

mental health authority, assessment and treatment of mental disorders,

leave and discharge from psychiatric services, judicial matters, financing

of mental health services and protection of human rights.

These new laws in Brazil and Pakistan are milestones in securing human

rights of persons with mental illness. They are also guarantees that

resources will be utilized so as to ensure appropriate care in the best

conditions possible. Other nations are following suit to respect interna-

tionally accepted standards as laid out in the 1991 United Nations reso-

lution 46/119 “Principles for the Protection of Persons with Mental

Illness and for the Improvement of Mental Health Care”. Principle 7 of

this resolution states that every patient shall have the right to be treated

and cared for, as far as possible, in the community in which he or she

lives.”Case study: Adopting new legislation in Brazil and Pakistan

1. The Lancet, Vol 357, April 28, 2001

“In Papua New Guinea, the government organized awareness-

raising activities for a full month in all districts of the nation with cultur-

al events, seminars and service-based activities. A new psycho-social

rehabilitation centre was opened and the existing mental health ward in

the general hospital was entirely renovated. The sixth annual national

health expo focused on the stigma, exclusion and discrimination that

surround mental disorders. Nationally-renown comedian, Kanage, per-

formed imaginative skits on drug abuse, child abuse and mental health

at the site of the expo, the Sir John Guise Stadium. As the numerous

articles report, the citizens of Papua New Guinea, with its population of

5.1 million, over 800 languages and only four psychiatrists, were given a

wealth of information and deeper awareness of mental health issues.

The Health Department’s Mental Health division also used this occasion

to embark upon a new mental health programme for members of the

armed services. Confronting a traditional bastion where the “weakness”

of a mental health disorder would seem impossible to admit in any

nation, the Papua New Guinea team should be commended for their

efforts. Mental health disorders generated by atrocities of a guerrilla war

were a “shamefully hidden secret” in the rank and file of their army. The

objectives of the programme are to highlight the importance of mental

health among the officers and staff as well as to focus on combat trau-

matic stress disorders, identification of common signs and symptoms of

mental disorders and discussing better ways to manage these problems.

Provision of appropriate mental health services to assist soldiers, sailors,

airmen and civilian employees, covering all Defense Force establish-

ments is now a reality in Papua New Guinea.”Case study: New mental health programme for members of the armed services

The National newspaper, Papua New Guinea, 20 June 2001

Other countries have usedthe months of preparationfor World Health Day toensure that acts, decreesand various legislation thatwere in the process ofbeing up-dated, andsometimes stuck in endlessdebate, be voted into law.

■ In Nigeria, new mental health legis-lation was sent to Parliament on 20March to replace the Lunacy Act of1914.

■ In Thailand, a special session ofParliament was held in April forsubmission of the Mental HealthAct.

■ In Shanghai, China, the city legisla-ture is currently drafting a law toprotect the rights of mentalpatients and improve mental healthservices for submission to theShanghai Municipal People’sCongress in late 2001.

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Community-based mental health careservices. This photo shows a clinic inCavite, Philippines run by the Sisters ofCanossa.

C O N C L U S I O N

WHO has advocated for putting men-tal health squarely on the health,development and political agendas ofall nations. On World Health Day,nations have declared that they willno longer settle for “throwing away”those with a mental illness.

Countless individuals abandoned bysociety still suffer needlessly in manycountries. World Health Day hasshown that people are ready and will-ing to act. We must enable individualssuffering from a mental or brain disor-der to partake in everyday life activi-ties and allow them to be treated andrehabilitated. We must not exclude

the medical professionals who areoften treating these people in far offplaces but integrate these services intogeneral health care systems. We can-not continue to ignore treatments andsolutions that exist.

Efforts to eradicate the stigma andsubsequent exclusion associated withmental and brain disorders are farfrom over. WHO’s advocacy work willcontinue to shine the spotlight onareas of mental health that requireattention. WHO’s Mental Health Pro-gramme is focusing its efforts in theareas of information, advocacy, policyand research.

Conclusion

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Gregoire Ahongbonon, a concerned citizenwith no special training, has taken it uponhimself to re-habilitate many neglectedmen and women over the last years(photos on these pages). Mr Ahongbonondescribed their stories to a captivatedaudience of international NGOs and UNAgencies during the World Health Daycelebrations at WHO Headquarters inGeneva. Footnotes

Additional sources of relevant information

from WHO include the 2001 World Health

Report, Mental Health Call for Action by

World Health Leaders, Atlas: Mental

Health Resources in the World, Mental

Health Policy Project, Policy and Service

Guidance Package: Executive Summary. A

detailed report of World Health Day activi-

ties in the 155 participating countries can

be reviewed at www.who.int/world-

health-day. Consult WHO’s Mental Health

Programme website at www.who.int/men-

tal_health for further information.

Organizers have not been listed by name as

this document is not intended to highlight

individual efforts or specific institutions,

governments or NGOs but to demonstrate

the level of commitment world-wide to

improving the mental health situation.

Despite years of suffering, it is clearly ajoyous occasion to stand proudly as arenewed citizen of our world. Examples ofhuman rights violations perpetuatedagainst those with mental or braindisorders can be found in many countries.The people helped by Mr Ahongbononhope their story will serve to help others.

P A R T I C I P A T I N G C O U N T R I E S

Albania

Algeria

Andorra

Angola

Argentina

Armenia

Australia

Austria

Bahamas

Bahrain

Bangladesh

Barbados

Belarus

Belgium

Belize

Bhutan

Bolivia

Bosnia and Herzegovina

Botswana

Brazil

Brunei Darussalam

Bulgaria

Burundi

Cambodia

Cameroon

Canada

Central African Republic

Chad

Chile

China

Colombia

Comoros

Congo

Cook Islands

Costa Rica

Croatia

Cuba

Cyprus

Czech Republic

Denmark

Djibouti

Dominica

Dominican Republic

Ecuador

Egypt

Eritrea

Estonia

Ethiopia

Fiji

Finland

France

Gambia

Georgia

Germany

Ghana

Greece

Guatemala

Guinea

Guyana

Haiti

Honduras

Hungary

Iceland

India

Indonesia

Iran (Islamic Republic of)

Iraq

Israel

Italy

Jamaica

Japan

Jordan

Kenya

Kiribati

Kuwait

Kyrgyzstan

The following 155 countries havereported activities in celebrationof World Health Day 2001

Lao People’s DemocraticRepublic

Latvia

Lebanon

Lesotho

Liberia

Libyan Arab Jamahiriya

Lithuania

Madagascar

Malaysia

Maldives

Malta

Mauritania

Mauritius

Mexico

Micronesia (Federated States of)

Mongolia

Morocco

Mozambique

Myanmar

Namibia

Nauru

Nepal

Netherlands

Niger

Nigeria

Niue

Norway

Oman

Pakistan

Palau

Papua New Guinea

Paraguay

Peru

Philippines

Poland

Portugal

Qatar

Republic of Korea

Republic of Moldova

Romania

Russian Federation

Rwanda

Samoa

San Marino

Saudi Arabia

Seychelles

Sierra Leone

Singapore

Slovakia

Slovenia

Somalia

South Africa

Spain

Sri Lanka

Suriname

Swaziland

Sweden

Switzerland

Syrian Arab Republic

Thailand

The former Yugoslav Republic of Macedonia

Togo

Tonga

Trinidad and Tobago

Tunisia

Turkey

Uganda

Ukraine

United Arab Emirates

United Kingdom of Great Britain and Northern Ireland

United Republic of Tanzania

United States of America

Uruguay

Venezuela

Viet Nam

Yemen

Yugoslavia

Zambia

Zimbabwe

I don’t know what they’ve told you,I don’t know what you’ve heard,But if you care to hear my thoughts,Please listen to these words.I dream to bridge the distance,And make ourselves aware,That we must accept each other,And erase these frosted stares.

You see a psychological problem,Can make someone stressed,They cannot find a healthy means,Of putting thoughts to rest.Neurosis and psychosis are,Somewhat difficult to explain,But to make it all sound simple,They both affect the brain.

Problems sometimes manifest,And cause people to believe,That what they see is different,From what someone else perceives.This is part of mental illness,Like personality disorders,Where anxiety and insecurity,May cause a lack of order.

Abnormal thought and behaviour,Often leads to great confusion,And all the answers can’t be found,In mental institutions.Caregivers must find tolerance,To restore the health of mind,Instead of isolating them,And keeping them confined.

To not express frustration,Cuts a person like a knife,They sadly may blame themselves,And attempt to take their life.A person may withdraw,From the world as we know it,And it takes special love and care,That can heal if we show it.

In some special cases,Drugs must be used,To bring about mental health,And they mustn’t be abused.For all the people who suffer,There’s pain to be endured,With all my heart I hope we find,A solution or a cure.

Many families have been weakened,Through shear misunderstanding,Of a mentally ill family member,Whose needs are quite demanding.But a problem in a family,Is a problem to be shared,Discussion speeds resolution,And shows how much we care.

If you feel your life is empty,And that the sun won’t shine,Think of those who have fallen ill,In emotion and in mind.Then look beyond their misfortune,And love them for they’re worth,A place in our empty hearts,A place upon this earth.

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A national entry to to the Global School Contest on

Mental Health, World Health Day 2001, category 15-18 years:

What do I know about a mentally ill person?

World Health OrganizationDepartment of Mental Health and Substance Dependence

Avenue Appia 20 • CH-1211 Geneva 27 • Switzerland

Telephone: +41 22 791 21 11 • Fax: +41 22 791 41 60E-mail: mnh@who.int

www.who.int/world-health-day • www.who.int/mental_health

By Damien Ah Sam, International Secondary School, Fiji