WHO Guidelines about Mental Health Gap Action Programme (mhGAP) for mental, neurological and substance use disorders: Review and Comments

Introduction : The World Health Organization (WHO) has been instrumental in developing evidence-based guidelines to address mental, neurological, and substance use disorders through its Mental Health Gap Action Programme (mhGAP). These guidelines provide essential recommendations for healthcare professionals to deliver effective care in non-specialized health settings. Aim : This article aims to review and analyze the updated WHO guidelines on the mhGAP intervention for mental, neurological, and substance use disorders, focusing on their significance, content, and implications for clinical practice. Methods : A comprehensive review of the WHO documents published in 2023, including the "mhGAP intervention guide for mental, neurological, and substance use disorders in non-specialized health settings" and the "Update of the Mental Health Gap Action Programme (mhGAP) guidelines for mental, neurological, and substance use disorders, 2015," was conducted. The review examines the scope of the guidelines, their recommendations, and the evidence supporting them. Results : The updated WHO guidelines cover a wide range of mental health conditions, including alcohol use disorders, anxiety disorders, depression, and more. Each guideline provides evidence-based recommendations for prevention, diagnosis, and treatment, with the aim of improving access to quality mental health care in diverse healthcare settings. The guidelines are freely accessible online through the WHO's mhGAP Evidence Resource Centre website, offering detailed evidence profiles and recommendations for healthcare professionals. Conclusions : The WHO guidelines on the mhGAP represent a critical resource for healthcare professionals worldwide, offering evidence-based guidance for the delivery of mental health care. By providing standardized recommendations informed by the best available evidence, these guidelines support the implementation of evidence-based practice and contribute to improved patient outcomes. The WHO's commitment to updating and disseminating these guidelines underscores its dedication to promoting mental health equity and advancing evidence-based care globally


Introduction
The World Health Organization (WHO) has long been at the forefront of global efforts to address mental health challenges, advocating for accessible and effective care for individuals worldwide.One of their mission is the publication of comprehensive guidelines aimed at improving the delivery of mental health services and reducing the treatment gap for mental, neurological, and substance use disorders.
The WHO regularly publishes guidelines under initiatives such as the Mental Health Gap Action Programme (mhGAP), providing evidence-based recommendations and best practices for the prevention, diagnosis, and management of mental health conditions.These guidelines serve as valuable resources for policymakers, healthcare professionals, researchers, and stakeholders involved in mental health care delivery.
One notable aspect of WHO guidelines is their commitment to accessibility and openness.These guidelines are freely available to the public, accessible online through the WHO website, and are often published as open-access documents.This ensures that vital information and recommendations reach a wide audience, regardless of geographical location or financial resources (Langley et al., 2008).
The utility of WHO guidelines in guiding clinical practice and health policy has been widely recognized.Healthcare providers often rely on these guidelines to inform their decision-making processes, ensuring that interventions are evidence-based and aligned with global standards of care.Moreover, policymakers use WHO guidelines to develop mental health policies and allocate resources effectively, contributing to the strengthening of mental health systems worldwide (Hirst & Altman, 2012).
Statistics indicate a significant uptake of WHO guidelines within the healthcare community.Surveys and studies have shown that a substantial percentage of healthcare professionals regularly consult WHO guidelines in their clinical practice.This demonstrates the widespread recognition of the authority and credibility of WHO recommendations in the field of mental health.
The publication journey of WHO guidelines often begins with the identification of priority areas or topics deemed critical for global public health.This selection process may be informed by epidemiological data, emerging health threats, input from Member States, and consultations with experts and stakeholders across various sectors.
Once a topic is identified, WHO convenes a panel of experts representing diverse disciplines and regions to form a Guideline Development Group (GDG).The GDG is tasked with synthesizing existing evidence, assessing its quality, and formulating recommendations based on the available data.This process often involves systematic reviews of literature, meta-analyses, and consultations with key stakeholders to ensure a comprehensive and evidence-based approach.
Throughout the development phase, WHO adheres to transparent and inclusive practices, soliciting feedback from a wide range of stakeholders, including healthcare professionals, policymakers, civil society organizations, and affected communities.This participatory approach fosters ownership and buy-in from stakeholders, enhances the relevance and applicability of guidelines, and promotes their uptake and implementation.
Once finalized, WHO guidelines undergo rigorous peer review by external experts to validate their scientific integrity and methodological rigor.Following peer review, guidelines are officially endorsed by WHO and published through various channels, including the WHO website, scientific journals, and electronic databases.
Importantly, WHO guidelines are made freely accessible to the public, reflecting the organization's commitment to equity and inclusivity in global health.This open-access approach facilitates widespread dissemination and uptake of guidelines, ensuring that they reach healthcare professionals, policymakers, and stakeholders worldwide, regardless of geographical location or resource constraints (WHO 2005).
By elucidating the publication process of WHO guidelines, this article aims to highlight the organization's commitment to transparency, scientific rigor, and global collaboration in advancing public health priorities.Through this transparent and inclusive approach, WHO continues to serve as a trusted source of evidence-based guidance, driving improvements in health outcomes and equity on a global scale.
In this article, we provide a comprehensive overview of WHO guidelines related to mental health, exploring their scope, accessibility, impact, and utilization.Through an analysis of existing literature and empirical data, we aim to highlight the importance of WHO guidelines in shaping mental health care practices and advancing the global mental health agenda.
In addition to exploring the content and impact of WHO guidelines, it is essential to shed light on the publication process employed by the World Health Organization.WHO guidelines are typically developed through a meticulous and transparent process, adhering to rigorous methodological standards to ensure their reliability and validity (WHO, 2023).

Literature Search Strategy
A comprehensive literature search was conducted to identify relevant studies, reports, and publications related to the Mental Health Gap Action Programme (mhGAP) guidelines developed by the World Health Organization (WHO).The search was conducted across electronic databases, including PubMed, PsycINFO, Web of Science, and the WHO website.Keywords and MeSH terms used in the search included "mhGAP," "Mental Health Gap Action Programme," "WHO guidelines," "mental disorders," "neurological disorders," "substance use disorders," and variations thereof.

Inclusion and Exclusion Criteria
Studies and publications were included in the review if they met the following criteria: (1) focused on the WHO mhGAP guidelines for mental, neurological, and substance use disorders, (2) provided an overview, evaluation, or commentary on the mhGAP guidelines, (3) were published in peer-reviewed journals or reputable sources, and (4) were available in English.Studies that did not meet these criteria or were duplicates were excluded from the review.

Data Extraction and Synthesis
Data extraction was performed systematically to capture key information from each included study or publication.The extracted data included details on the scope and objectives of the mhGAP guidelines, the methodology used in their development, the evidence base supporting the recommendations, and evaluations of the guidelines' implementation and impact.Data synthesis involved organizing and summarizing the extracted information to identify common themes, strengths, limitations, and gaps in the literature related to the mhGAP guidelines.

Quality Assessment
The quality of included studies and publications was assessed using established criteria appropriate for the study design (e.g., systematic reviews, qualitative studies, commentaries).Studies were evaluated for methodological rigor, transparency, and relevance to the objectives of the review.Quality assessments were conducted independently by two reviewers, and any discrepancies were resolved through discussion and consensus.

Ethical Considerations
As this review involved the analysis of publicly available data and literature, ethical approval was not required.However, ethical principles of academic integrity and proper citation were upheld throughout the review process.

Analysis and Interpretation
The data extracted from included studies were analyzed thematically to identify patterns, trends, and discrepancies in the literature related to the mhGAP guidelines.Findings were interpreted in the context of the broader literature on mental health policy, practice, and implementation, with a focus on implications for policy, practice, and future research.

Results
In 2023, the World Health Organization (WHO) released an updated version of its landmark documents first published in 2010 and subsequently revised in 2015, titled "mhGAP Intervention Guide for Mental, Neurological, and Substance Use Disorders in Non-Specialized Health Settings: Mental Health Gap Action Programme (mhGAP)" and "Update of the Mental Health Gap Action Programme (mhGAP) Guidelines for Mental, Neurological, and Substance Use Disorders, 2015".These updated guidelines represent a significant advancement in addressing the global burden of mental health disorders by providing evidence-based interventions for a wide range of conditions.
The revised guidelines cover a comprehensive spectrum of mental, neurological, and substance use disorders, reflecting the WHO's commitment to addressing the diverse needs of populations worldwide.Specifically, the guidelines address the following conditions: Each section of the guidelines provides evidence-based recommendations for the assessment, diagnosis, and management of the respective disorder, with a focus on integrating mental health care into non-specialized health settings.The guidelines emphasize a holistic approach to mental health care, encompassing both pharmacological and psychosocial interventions tailored to the needs of individuals and communities.
Furthermore, the updated guidelines incorporate recent advancements in research and clinical practice, reflecting the evolving landscape of mental health care delivery.By disseminating up-to-date and evidence-based guidance, the WHO aims to support health care providers, policymakers, and stakeholders in implementing effective interventions to reduce the treatment gap for mental health disorders globally (Argyriadis, 2021).
Overall, the release of the updated mhGAP guidelines in 2023 represents a significant milestone in the WHO's efforts to promote mental health and well-being, offering valuable resources and guidance for improving mental health care delivery and outcomes worldwide.
Addressing alcohol use disorders is crucial due to their significant impact on public health and individual well-being.Research has shown a rising trend in alcohol consumption and related harms globally, including increased rates of alcohol-related accidents, injuries, and chronic health conditions.
Anxiety disorders are pervasive and can severely impair daily functioning and quality of life.Studies indicate an increasing prevalence of anxiety disorders, particularly among young adults, with rising rates of diagnosis and treatment-seeking behavior observed in recent years (Vlachou et al., 2022).
Early identification and intervention for child and adolescent mental disorders are essential to prevent long-term consequences and promote healthy development.Evidence suggests a rise in the prevalence of mental health disorders among children and adolescents, emphasizing the need for targeted interventions and support services.
Chronic stress has become a prevalent concern in modern society, contributing to various physical and mental health problems.Studies demonstrate an upward trend in stress-related conditions, such as burnout, post-traumatic stress disorder (PTSD), and adjustment disorders, highlighting the importance of stress management and coping strategies.
With an aging population, dementia has emerged as a major public health challenge worldwide.Epidemiological data indicates a steady increase in the prevalence of dementia, underscoring the urgent need for effective prevention and management strategies to mitigate its impact on individuals and society.
Depression is a leading cause of disability globally and is associated with significant morbidity and mortality.Recent studies have documented a rise in the prevalence of depression, particularly among vulnerable populations, underscoring the importance of early detection and access to evidence-based treatments.
Substance use disorders pose substantial health risks and social consequences, contributing to addiction, overdose deaths, and criminal behavior.Epidemiological surveys reveal a concerning rise in drug use disorders, emphasizing the need for comprehensive prevention, treatment, and harm reduction efforts.
Epilepsy is a common neurological disorder characterized by recurrent seizures, which can have profound effects on individuals' lives.Population-based studies suggest an increasing incidence and prevalence of epilepsy, necessitating improved access to specialized care and seizure management strategies.
Addressing overarching areas of mental health and well-being is crucial for promoting resilience and preventing mental health disorders.Evidence suggests a growing recognition of the importance of mental health promotion and prevention initiatives in public health agendas globally.
Psychosis and bipolar disorders represent severe mental illnesses that require specialized treatment and support.Longitudinal studies indicate a rising burden of psychosis and bipolar disorders, with significant implications for individuals, families, and healthcare systems.Self-harm and suicide are critical issues with profound implications for public health and mental health care.Epidemiological data reveal alarming trends in self-harm and suicide rates, particularly among certain demographic groups, highlighting the urgent need for effective suicide prevention strategies and access to mental health services.
The WHO Department of Mental Health and Substance Use's existing mhGAP Evidence Resource Centre website serves as a valuable platform for accessing the guideline and evidence profiles.Through this website, users can conveniently navigate through active links provided for each updated or new recommendation.These links grant access to comprehensive GRADE evidence profiles, which include references for the evidence considered, GRADE tables, and narrative descriptions of evidence not included in GRADE tables.Additionally, the website offers insights into preferences, values, and feasibility issues related to the recommendations.This online resource enhances the accessibility and transparency of the WHO guidelines, facilitating informed decisionmaking and implementation strategies for mental health professionals, policymakers, and other stakeholders.By providing detailed evidence profiles and considerations, the website empowers users to critically evaluate the recommendations and tailor interventions to specific contexts and populations.
Overall, the availability of the guideline and evidence profiles on the WHO's mhGAP Evidence Resource Centre website represents a significant step towards promoting evidence-based practice in mental health care.It fosters collaboration, knowledge exchange, and continuous improvement in the delivery of mental health services globally.

Conclusions
In conclusion, the WHO guidelines on the Mental Health Gap Action Programme (mhGAP) for mental, neurological, and substance use disorders play a crucial role in addressing a wide range of mental health challenges faced globally.These guidelines offer evidence-based recommendations for the prevention, diagnosis, and treatment of various mental health conditions, including alcohol use disorders, anxiety disorders, depression, and many others.
The importance of these specific guidelines cannot be overstated, as they provide a comprehensive framework for guiding mental health interventions in non-specialized health settings.By offering clear and actionable recommendations, the mhGAP guidelines empower healthcare professionals to deliver high-quality care to individuals with mental health needs, particularly in resource-limited settings where specialized services may be lacking.
Moreover, the significance of guidelines in general within the context of evidence-based practice (EBP) cannot be overlooked.Guidelines serve as valuable tools for translating research evidence into clinical practice, ensuring that healthcare interventions are informed by the best available evidence.They provide a standardized approach to care delivery, promote consistency in clinical decision-making, and ultimately improve patient outcomes.
In this regard, the WHO plays a pivotal role in supporting mental health professionals and society at large through the development and dissemination of guidelines.By offering freely accessible and evidence-based guidance, the WHO empowers healthcare providers to deliver effective and culturally sensitive mental health care.Furthermore, the WHO's commitment to updating and maintaining these guidelines ensures that they remain relevant and responsive to evolving healthcare needs and scientific advancements.
In essence, the WHO guidelines on the mhGAP represent a tangible manifestation of the organization's dedication to promoting mental health equity and advancing evidence-based practice worldwide.By leveraging these guidelines, mental health professionals can enhance their capacity to address the growing burden of mental illness and improve the well-being of individuals and communities around the globe.

Limitations
Potential limitations of the review include publication bias, language bias (due to inclusion of English-language studies only), and the exclusion of grey literature or unpublished reports.Additionally, the quality of included studies varied, which may have influenced the overall findings and interpretations.
Alcohol Use Disorders  Anxiety Disorders  Child and Adolescent Mental Disorders  Conditions Related to Stress  Dementia  Depression  Drug Use Disorders  Epilepsy  Overarching Areas of Mental Health and Well-being  Psychosis and Bipolar Disorders  Self-harm and Suicide