IMPROVING ACCESS TO MENTAL HEALTH CARE THROUGH A REVISION OF THE WHO LIST OF ESSENTIAL MEDICINES

Chiara GASTALDON1, Davide PAPOLA1, Beatrice TODESCO1, Giovanni OSTUZZI1, Corrado BARBUI1

1WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation Department of Neuroscience, Biomedicine and Movement Sciences Section of Psychiatry, University of Verona., VERONA, Italy

Introduction:

Despite the huge burden related to mental disorders, there is a huge treatment gap, especially in low- and middle-income countries. The WHO Model Lists of Essential Medicines (EML), updated every two years, aims to support countries in selecting a list of medicines that are considered essential for a basic health-care systems. However, the mental health section has seen limited revisions in the past 45 years. Aiming to address this gap, a proposal for a comprehensive revision of the entire mental health section was submitted to the WHO Expert Committee in 2022



Methods:

We submitted nine evidence-based applications to the WHO Expert Committee on the Selection and Use of Essential Medicines in December 2022, advocating for a substantial revision of the WHO EML mental health section. We conducted systematic reviews of the literature, meta-analyses and network meta-analyses on safety and effectiveness, GRADE assessment of the certainty of evidence, and cost-effectiveness evaluations.

 

Results:

All nine applications on psychotropic medicines for mental disorders were accepted by the WHO and contributed to the update of the EML. For psychotic disorders, first and second-generation antipsychotics were added. Substantial changes were made for mood and anxiety disorders as well, with the addition of second-generation antipsychotics for bipolar disorder and the removal of old tricyclics for depression and the addition of SSRIs to the option for obsessive-compulsive disorders.  The list of benzodiazepines was also reduced to diazepam and lorazepam. 



Discussion-Conclusion:

The comprehensive revision of the WHO EML mental health section will enhance access to the most effective, safe, and cost-effective medicines for mental disorders worldwide. Implementation of the proposed changes signifies a pivotal step toward ensuring that individuals worldwide have access to optimal treatments for mental health conditions, fostering a more inclusive and equitable approach to mental health care on a global scale.