Psychiatry and health in low-income populations.

Although mental health problems constitute 8.1% of the global burden of disease (GBD), mental health has been largely missing from the international health agenda. The discrepancy between needs and services is likely to increase in the next millennium. Depression alone is currently the fourth leading cause of disability-adjusted life-years (DALYs) the world over and is projected to become the second leading cause by the year 2020. The nations of the world must make a major commitment to upgrade the quality of mental health services, including early detection and prevention of psychiatric problems in childhood and adolescence; to institute the collection of systematic data on the global burden of alcohol and drug abuse and to develop innovative treatment and preventive measures; and to provide substantial support for research on treatment effectiveness. Because hunger, deprivation, and violence affect women disproportionately, there is a pressing need for coordinated efforts to improve state gender policies (including equal educational opportunity and improved health care for women) and to interdict domestic violence. In the words of Boutros Boutros Ghali, the Secretary General of the United Nations: "Medical and social issues which are often viewed separately must be dealt with as a whole...the priority of mental health must be heightened...development policies must...protect and promote mental health."