Mental health – predicted to be the leading disease burden by 2030 – The role of the Commonwealth Nurses Federation

The 2nd Commonwealth Nurses Conference titled Nurses and midwives: agents of change, was held in March 2014 in London. Two hundred nurses from 26 countries attended the conference. The Commonwealth Nurses Federation (CNF) has several aims including contributing to the improved health by fostering access to nursing education, influencing health policy, developing nursing networks and strengthening nursing leadership and is an organisation that works tirelessly to improve the health of nations. One strong focus of the organisation has been mental health, predicted to be the leading disease burden by 2030. Some of the statistics the CNF provide are startling – Mental ill health will affect one in four people worldwide during their lifetime;  in 2010, the global economic impact of mental ill health  was approximately US$ 2.5 trillion and the cost is estimated to increase to US$ 6 trillion by 2030. The World Health Organisation have also highlighted this problem  identifying  that about half of mental health disorders begin before the age of 14 in children. Around 20% of children and adolescents in the word, regardless of culture, are estimated to have mental disorders or problems. This is a huge number and burden. Alongside this the regions of the world with the highest populations under the age of 19 have the poorest level of mental health resources.  Other worrying statistics include approximately 800,000 people committing suicide every year and mental health problems are frequently hidden, ignored or stigmatised.  Stigma about mental disorders and discrimination against patients and families prevent people from seeking mental health care. Alongside this many countries do not have a legal framework that to adequately protect the rights of people with mental health disorders (See  Human rights are regularly violated in patients in many countries with frequent use of physical restraint, seclusion and denial of basic needs and privacy (See Health Action Plan 2013-2020 (See

The CNF has adopted the World Health Organisation’s Comprehensive Mental Health Action Plan 2013-2020. The action plan has four major objectives which include strengthening effective leadership and governance, providing  integrated and  responsive mental health and social care services in community-based settings, implementing strategies for promotion and prevention in mental health, and developing  information systems, evidence and research for mental health. Importantly these plans move away from a medical model to try and address social determinates of health such as education. The action plan also aims to empower people with mental health problems. Internationally nurses must be actively engaged in advocating for reform of mental health services.

The WHO has an extensive range of online resources available to practitioners to assist with these problems. The WHO Mental Health Gap Action Programme (mhGAP) aims to increase services for mental, neurological and substance use disorders recognising that with appropriate support, psychosocial assistance and medication, many millions could be treated for illnesses such as depression, schizophrenia, and epilepsy and ultimately  prevented from suicide. People could start to lead normal lives even in areas where resources are scarce. The mhGAP Intervention Guide is a technical tool providing management guidelines for priority conditions and includes protocols for clinical decision-making. A copy can be downloaded from:

Alongside this the WHO MiNDbank is a new online platform for sharing resources

in mental health, health, human rights, disability and development. (See ). It provides easy access to a range of international resources including policies, plans, strategies, and legislation. The database allows people to share key policy,  strategy and technical documents from their countries  and supports people to implement strategies for improvement. It has a whole section on Mental Health Evidence and Research (See

The CNF makes a significant and influential contribution to the work of the Commonwealth Steering Committee for Nursing and Midwifery and is committed to collaborating with organisations such as the International Council of Nurses, the International Confederation of Midwives and the World Health Organisation. A key role is in driving forward changes in mental health using the best current evidence suited to individual cultures.

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