On October 14th 2010, during World Mental Health Week, Global Initiative on Psychiatry organized an international conference on Mental Health and Development Aid at the European Parliament in Brussels. This conference was the final activity of a two-year EU project titled: Increasing Recognition of Mental Heath as an Integral Part of European Development Assistance in Four EU Countries.  

Beneath the banner "Mental Health for All!" members of the international mental health community and Global Initiative on Psychiatry did what they have done for 30 years – championed the right to mental health.  
In celebration of three decades of action, GIP board members and representatives from the European Parliament and European Commission sat together to discuss the promotion of mental health as in integral part of European development assistance.  

Leonidas Donskis, member of European Parliament highlighted the potential for human rights issues such as mental health to unite us in common effort.   

Dr. Juan Garay of the European Commission has been involved in developing the new EU global health policy framework. In 2000-2010 a lot has changed in health development aid due to the MDG's. The commission had been working on a system approach while in the meantime people were dying. With HIV/AIDS there was no time to wait, people needed to get treatment soon. And so the landscape of development aid changed in the past ten years. According to Garay a coherent approach is needed for the aid to be effective. The new EU policy framework states that the EU should apply the common values and principles of solidarity towards equitable and universal coverage of quality health services in all external and internal policies and actions. Garay also stated that more evidence should be collected on the effectiveness of mental health interventions.  

Robert van Voren, chief executive of GIP, stressed that those who experience mental disorders have the same right to health care access and treatment as those who do not. In most countries this is not the case. "We know that we ourselves are part of the problem. We have not been able to convince policy makers and development aid organizations that mental health is indeed a priority issue that deserves much more attention. This meeting is, however, part of our sincere attempt to stimulate the debate, to inform and to learn, to provide a forum to discuss the paradoxical situation of mental health as one of the most costly health problems with the least financial resources, and to find a way to get the message across."

After a short tea break the focus was on mental health care and interventions of specific countries. 

Dr. Melvyn Freeman (Ministry of Health, South Africa) highlighted the recursive relationship between mental health conditions and social determinants of health in South Africa and elsewhere. "Why is it that we have more forensic mental health patients in South Africa than in Europe? It is not because we have more mad men, but because we have less early interventions". Freeman also stated that mental health interventions are necessary to improve social and economical development.

Dr. Joseph Mbatia (Ministry of Health, Tanzania) said that 10% of the governments budget goes to health and mental health has become an integral component of health care systems. Although more money is spent on (mental) health care than before, the mistake that has been made is that no money was put aside to manage the transition. To establish a good referral system for example you need to have a well developed system at all levels. In Tanzania there are not enough mental health professionals available. Another problem is that even if there is a clinic in every small town, often people living out side of the towns in rural areas do not have enough money to buy a bus ticket to visit the clinics.

Dr. Mahesan Ganesan (psychiatrist Sri Lanka) drew attention to enhancements in regional and national mental health care. "In Sri Lanka a dual approach was started after the tsunami, so now we don't only work horizontally, but also vertically". Psychiatrist in Sri Lanka are very conservative and tend to resist change. Mental health professionals do not often collaborate with families when providing treatment to the mentally ill, even though research shows better patient outcomes with family involvement. Family members learn about treatment and the also support each other by talking in the wards.

Dr. Freeman also briefly presented an overview of the recent World Health Organization publication entitled Mental Health and Development: Targeting People with Mental Health Conditions as a Vulnerable Group. The report presents compelling evidence that people with mental health conditions meet major criteria for vulnerability. The report also describes how vulnerability can lead to poor mental health, and how mental health conditions are widespread yet largely unaddressed among groups identified as vulnerable. It argues that mental health should be included in sectoral and broader development strategies and plans, and that development stakeholders have important roles to play in ensuring that people with mental health conditions are recognized as a vulnerable group and are not excluded from development opportunities.

Benedetto Saraceno, Chairman of GIP and Professor at the Universities of Geneva and Lisbon, asked the audience which word we should use when we approach 'the famous minister'. We tend to talk about mental health instead of about a specific disorder. This can be confusing. Often the data are over inclusive, because they combine data for substance abuse, neurological disorder and epilepsy. NGO's tned to approach the minister asking for money for all these disorders, but the money should be conform the number of people it actually addresses. If we say that one out of four people have a mental disorder, at some point in their lives, the minister will not talk us seriously. But if we say that every 40 seconds there is a suicide somewhere in the world then we have a better point.   At the end of his presentation Dr. Benedetto Saraceno passionately laid out his three-pronged strategy to 1) better define mental health, 2) improve epidemiological data and 3) enhance the efficacy and outcome evidence of mental health programs. Emphasizing the need for evidence-based mental health policy and programs, Dr. Saraceno emphatically proclaimed that the 'era of awareness' was over, and that a new 'era of outcomes' had begun.   Saraceno's presentation was followed by a discussion. A few of the discussion points are mentioned here:   While the GIP conference generated lively and at times dissenting discussion, one message was clear: as an integral part of development, right to mental health has never been more important!  

by Margi Kirschenmann