Global, national, and local approaches to mental health: examples from India

Neuropsychiatric disorders and suicide amount to 12.7% of the global burden of disease and related conditions (GBD) according to World Health Organiza tion (WHO) estimates for 1999, and recognition of the enormous component of mental illness in the GBD has attracted unprecedented attention in the fie ld of international health. Focusing on low- and middle-income countries wi th high adult mortality, this article discusses essential functions of inte rnational agencies concerned with mental health. A review of the history an d development of national mental health policy in India follows, and local case studies consider the approach to planning in a rural mental health pro gramme in West Bengal and the experience in an established urban mental hea lth programme in a low-income community of Mumbai. Local programmes must be attentive to the needs of the communities they serve, and they require the support of global and national policy for resources and the conceptual too ls to formulate strategies to meet those needs. National programmes retain major responsibilities for the health of their country's population: they a re the portals through which global and local interests, ideas, and policie s formally interact. International priorities should be responsive to a wid e range of national interests, which in turn should be sensitive to diverse local experiences. Mental health actions thereby benefit from the synergy of informed and effective policy at each level.