The World Health Organization (WHO) unveiled its third edition of the Mental Health Gap Action Programme (mhGAP) guideline on November 20, 2023.
This comprehensive guide features vital new and updated recommendations aimed at improving the treatment and care of mental, neurological, and substance use (MNS) disorders, addressing a critical aspect of global health.
MNS disorders constitute a significant portion of global morbidity and premature mortality, affecting populations across all regions.
Shockingly, more than 75% of individuals grappling with MNS disorders lack access to essential treatment and care.
The latest mhGAP guideline seeks to empower countries to enhance their capacity in managing the escalating burden posed by these conditions.
Targeted at healthcare practitioners including doctors, nurses, and other non-specialist health workers operating in primary healthcare settings, the guideline also caters to health planners and managers.
Dévora Kestel, WHO’s Director for Mental Health and Substance Use, emphasized the pivotal role of mhGAP in the past 15 years in advancing access to evidence-based psychological interventions and medications for individuals with MNS disorders.
With mental health gaining increasing prominence, Kestel highlighted the guide’s heightened relevance in equipping primary healthcare workers to effectively treat individuals with MNS disorders.
Tackling Anxiety with New Guidelines Released by WHO
One of the notable updates in the 2023 guideline is the inclusion of a fresh module focusing on anxiety disorders, acknowledging the surging prevalence of these conditions globally. The module introduces key recommendations:
- Psychological interventions based on cognitive behavioral therapy (CBT) are advised for adults experiencing generalized anxiety disorder and/or panic disorder, offered through various formats such as online, in-person, group settings, or self-guided sessions.
- Stress management techniques are suggested for adults grappling with generalized anxiety and/or panic disorder.
- Consideration of Selective Serotonin Reuptake Inhibitors (SSRIs) is recommended for treating adults facing generalized anxiety and/or panic disorder.
Emphasis on Psychological and Psychosocial Interventions
The guideline underscores the continued significance of psychological treatments across various MNS conditions.
It introduces novel recommendations concerning psychosocial interventions for caregivers of individuals with psychosis or bipolar disorder.
Additionally, it features fresh suggestions on psychosocial interventions for psychosis, alcohol dependence, substance use, dementia, and children and adolescents with neurodevelopmental disorders including autism, ADHD, and cerebral palsy.
Critical Warning Regarding Valproic Acid Use in Pregnancy
Of immense importance is the guideline’s updated caution against the use of valproic acid (sodium valproate), prescribed for epilepsy and bipolar disorder, due to its associated risk of birth defects during pregnancy. Key recommendations encompass:
- Restricting prescription of valproic acid to women and girls planning pregnancy or at risk of becoming pregnant due to potential birth defects and developmental issues in exposed children.
- Advising women and girls currently using valproic acid to employ effective contraception.
- Urging consultation with healthcare providers before discontinuing valproic acid and exploring suitable alternative treatments.
- Stressing the need for periodic specialist reviews to ascertain the appropriateness of valproic acid as a treatment option.
This cautionary stance aligns with the WHO safety statement released in May 2023, addressing valproic acid’s use for epilepsy and bipolar disorder in women and girls of childbearing potential.
Additional Recommendations and Advancements
The updated guideline also highlights digitally-delivered psychological and psychosocial interventions across various modules, emphasizing their efficacy in addressing alcohol use disorders, anxiety, stress-related conditions, drug use disorders, and self-harm/suicide tendencies.
Further advancements include updated non-pharmacological interventions for dementia, advocating the incorporation of physical exercise, CBT, cognitive stimulation therapy, and cognitive training to enhance patient outcomes.
In terms of medication, specific antipsychotic and antiepileptic drugs have been included for the treatment of psychosis, bipolar disorder, and epilepsy.
The WHO‘s updated mhGAP guideline represents a significant leap in addressing the global mental health crisis, offering essential strategies and recommendations to enhance the accessibility and quality of care for individuals struggling with MNS disorders worldwide.