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The Presidential WPA Program on
Child Mental Heal EDITORIAL Pr. AHMED OKASHA President, World Psychiatric Association World Psychiatry – Volume N° Year |
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Half of the
world population are children. Worldwide children are impacted by war,
exploited for labor and sex, orphaned by AIDS and forced to migrate for economic
and political reasons. It is estimated that in 26 African countries the
number of children orphaned for any reason will more than double by 2010, and
68% of these will be as a result of AIDS. 40 million children in 23
developing countries will lose one or both parents by 2010 (1). 20% of
children and adolescents under the age of 18 have a diagnosable mental
disorder. Moreover, suicide is the third leading cause of death among
adolescents. The latest mean worldwide annual rates of suicide per 100,000
were 0.5 for females and 0.9 for males among 5-14 years-olds, and 12.0 for
females and 14.2 for males among 15-24 year-olds. The main target of
effective prevention of youth suicide is to identify and reduce risk factors,
foremost depression (2). The
prevalence of attention deficit/hyperactivity disorder (ADHD) has been
estimated at 3-7% in school-aged children. Over a nine-year period, the
median medical costs for children with ADHD were found to be $4306 compared
with $1944 for children without ADHD (3). Conduct disorder related behaviors
tend to persist into adolescence and adult life through drug abuse, juvenile
delinquency, adult crime, antisocial behavior, marital problems, poor
employee relations, unemployment, interpersonal problems and poor physical
health (4). Major depressive disorder often has an onset in adolescence and
is associated with substantial psychosocial impairment and risk of suicide
(5). Children with pre-pubertal major depressive disorder, as adults, have
significantly higher rates of bipolar disorder, major depressive disorder,
substance use disorders and suicidality than a normal comparison group (6).
Eating disorders are becoming more prevalent and observable across cultures
(7). These difficult to treat disorders also demonstrate a continuity between
adolescent and adult life (8). 21.6% of college age females with eating
disorders also met clinical criteria 10 years later (9). Only a small
proportion of children affected by mental disorders receive adequate care.
Barriers to treatment are several, but reflect a few dominant themes, such as
lack of resources (financial, human, facilities), fear of stigma and lack of
awareness. Also, a significant concern is the applicability of the diagnostic
categories used in the West in areas where there are limited resources. Even
in highly developed industrialized countries, mental disorders in childhood
are often not recognized nor taken seriously. Health professionals and others
involved in child care have often only rudimentary knowledge about
appropriate methods of prevention and treatment of these conditions. The
situation is made worse by the lack of awareness by health decision makers
and the general public of the magnitude and severity of the problems caused
by childhood mental disorders. There is a virtually worldwide absence of an
identifiable national child and adolescent mental health policy. A child and
adolescent mental health policy should not focus solely on the treatment of
psychopathology, but should encompass a broad range of supportive and
educative interventions to permit children to follow a normal trajectory of
development. Such policy can facilitate the ability to gather more precise
epidemiological data essential for the development of treatment and
prevention programs tailored to individual country requirements. It is
against this background that the WPA established its Presidential Program on
Child Mental Health, in collaboration with the World Health Organization and
the International Association of Child and Adolescent Psychiatry and Allied
Professions (IACAPAP), with an unrestricted grant of Eli Lilly Foundation. The objectives of the
program include: 1-
Increasing the awareness of health
decision makers, health professionals and the general public about the magnitude
and severity of problems related to mental disorders in childhood and
possibilities of their resolution. 2-
Introducing and promoting the
implementation of primary prevention of child mental disorders. 3-
Providing support to the development
of mental health services for children with mental disorders and to the
development, adaptation and use of effective methods of treatment. The WPA
program will function through three international Task Forces: Task Force on
Awareness, Task Force on Primary Prevention, Task Force on Service
Development and Management. The program will, in the course of the three
years of its duration, produce outputs that will be demonstrably useful to
child mental health care. These outputs will
include: 1-
The publication of critical reviews
of the literature on child mental health and of information about child
mental health in different countries. 2-
A functional network of individuals
and institutions committed to the achievement of the program objectives. 3-
Manuals and guidelines concerning the
prevention, early recognition and detection, and treatment of mental
disorders in childhood for health professionals and others concerned with
child care and upbringing (e.g. teachers, parents, religious leaders, social
welfare workers). 4-
Internationally accepted guidelines
for activities promoting child mental health. 5-
A data base containing information
about the current epidemiological situation and about policies and programs
relevant to the promotion of child mental health in different parts of the
world. Child and
adolescent psychiatry must be integrated into the training curricula of
medical students in every university. Services should be based on empirical
grounds using epidemiological data and modern methods of treatment evaluation
and quality assurance. Improving mental health will lead to improved physical
health, enhanced productivity and increased stability. Our target
is promotion of the mental health of half of the world population. And it is
the younger half that in a few years will be in charge of our world. It is a
cost effective enterprise, no matter how much effort and resources are spent
on it. References 1-
Foster G. Supporting community
efforts to assist orphans in Africa. N Engl J Med 2002;346:1907-10. 2-
Pelkonen M, Marttunen M. Child and
adolescent suicide: epidemiology, risk factors and approaches to prevention.
Paediatr Drugs 2003:5:243-65. 3-
Leibson CL, Katusic SK, Barbaresi
WMJ et al. Use and costs of medical care of children and adolescents with and
without attention deficit/hyperactivity disorder. JAMA 2001;285:60-6. 4-
Patterson GR, DeBarysche BD, Ramsey
E. A developmental perspective on antisocial behaviour. Am Psychol
1989;44:329-35. 5-
Weissman MM, Wolk S, Goldstein RB
et al. Depressed adolescents grown up. JAMA 1999;281:1701-13. 6-
Geller B, Zimmerman B, Williams M
et al. Bipolar disorder at prospective follow-up of adults who had
prepubertal major depressive disorders. Am J Psychiatry 2001;158:125-7. 7-
Maj M, Halmi K, Lَpez-Ibor JJ et al (eds). Eating Disorders. Chichester: Wiley,
2003. 8-
Kotler LA, Cohen P, Davies M et al.
Longitudinal relationships between childhood, adolescent and adult eating
disorders. J Am Acad Child Adolesc Psychiatry 2001;40:1434-40. 9-
Heatherton TF, Mohammedi F, Striepe
M et al. A 10-year longitudinal study of body weight, dieting and eating
disorder symptoms. J Abnorm Psychol 1997;106:117-25. |
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Document Code OP.0072 |
ترميز المستند OP.0072 |
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