Interview with Dr. Shekhar Saxena

Dr. Shekhar Saxena is the Director of the WHO’s Department of Mental Health.

NCCR-Synapsy — What is the current global mental health situation?

Shekhar SaxenaThe current situation requires a lot of improvement. The burden of mental disorders is very high and the number of people with mental disorders or other mental health problems is extremely high and is continuously increasing. Moreover, the available resources to look after people’s needs are extremely scarce. On average, governments spend 3% of their total health budget on mental health and this percentage is much smaller in low and middle-income countries. A serious increase of financial and human resources is needed, not solely for people suffering from mental disorders but also for their families, which also require a lot of support.

NSWhat could be done in order to improve global mental health?

S.S. — A number of steps are required. First, the socio-economic reality needs to be changed to make this world more equity based. That would certainly help but even then, people with mental disorders will still be there. Thus, health and social services need to be strengthened to look after their needs. In most countries, the primary health care system —the general doctors and nurses or even the community health workers— is not able to identify or treat even common mental disorders. This is a pity because it’s the logical place to identify depression, anxiety or other mental health problems and provide treatment. This isn’t happening because the initial training of workers is not good enough on mental disorders. Moreover, in many countries, the treatment of mental disorders is still institutionally based in large and old-fashioned mental hospitals that serve more custodial purposes rather than the treatments purposes. WHO’s advice is to provide treatments in a community-based setting, e.g. in primary health care centers, in general hospitals as well as in mental health centers. That’s a very urgent requirement because most of mental hospitals are neither good for treatments nor for respecting human rights.

NS — Synapsy’s aim is to bring together psychiatry, psychology and neuroscience in order to better treat mental disorders. What is your opinion regarding our approach?

S.S. — There is definitely a need to develop and use knowledge together. Neurologists, neuroscientists and even basic neuroscientists need to work much more closely with psychiatrists and other mental health professionals to understand the needs of people and work to find solutions. They have to find answers that can be applied to every health care setting and for all classes, rich and poor. When the manpower is small and the facilities are primitive, interventions that can reach everybody in this world are needed. Those interventions can be diagnostics. For example, finding out a quick economic way to diagnose common and severe mental disorders in a short time with a high amount of reliability. Today, most psychiatrist’s diagnoses are based on symptoms and signs through an expert interview, a check list. We are looking forward to identify some biomarkers, electromarkers or other mechanisms which can be used to diagnose on a wide population base with a high reliability. Thus, moving forward in neurosciences or electrophysiology ca be extremely beneficial for this purpose. Unfortunately, we keep thinking that it would be next year, but it doesn’t come! Projects like Synapsy, which are putting together professionals from different areas to think together, can be useful.

NS — What are the ways in which we could encourage biopharmaceutical companies to re-invest in research programs?

 S.S. There is a need for more research. The question is who should do it and where the resources should come from. This certainly will be a joint exercise between private companies, governments and philanthropic organizations. We cannot expect companies to invest if the risk-reward ratio does not improve. In such situations, other financial resources can join hands and work toward a system which can be sustainable, have enough rewards for investors but also for public health. I believe that new models need to be sampled in order to situate that there are enough resources for global and sustainable solutions.

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