10 October 2022
Never has it been so urgent for the world to prioritize mental health. The triple impact of COVID-19, climate change concerns and ongoing wars and conflicts is creating an enormous toll on our population—be they directly or indirectly impacted.
The situation for mental health conditions across the globe is extremely worrying. Pre-pandemic, nearly 1 billion people were still struggling with a diagnosable mental health condition, 82 per cent of whom were in low- and middle-income countries (LMICs) and people with severe mental health conditions were dying 10 to 20 years earlier than the general population. Since then, the COVID-19 pandemic has harmed the mental health and well-being of many more people, both those with and without pre-existing problems, and has increased systemic service inadequacies as well as socioeconomic disparities. It is estimated that the pandemic has caused a 25 to 27 per cent increase in the prevalence of depression and anxiety around the world.
Treatment and care remain scarce, inadequate, inaccessible or too expensive, and widespread stigma discourages people from seeking help. It is estimated that 1 in 4 people around the world suffer from a mental health condition, with a treatment gap of up to 90 per cent in some countries. To make things worse, stigma and misunderstanding prevent people from identifying mental health conditions in themselves and others and for them to seek help. Human rights violations continue to pervade institutions and communities around the world, including health services. Moreover, even when services try to address mental health conditions, most overlook people’s physical health and wider social needs.
Despite available data on the economic impact of mental health conditions on the economy and evidence on how investing in mental health can yield positive return on investment, only around 2 per cent of health budgets are allocated to mental health on average. Among other things, this causes insufficient numbers of mental health workers, which can go as low as 2 per 100,000 population in some countries.
Although major advancements in our understanding of what causes mental health conditions and how to treat them have been made in the last 20 years, very few improvements in service coverage and quality have been made.
Among its many actions, in 2019 the World Health Organization (WHO) launched a flagship mental health programme—the Special Initiative for Mental Health. The WHO Special Initiative for Mental Health was created out of a need for system-level action and the implementation of programmes with long-term vision, focusing on mental health system transformation, the integration of mental health into universal health coverage (UHC) and sustainable change. The WHO Special Initiative for Mental Health seeks to be a global programme which includes, but also goes beyond, mental health and psychosocial support (MHPSS) response for emergencies, and views mental health from a public health and system strengthening perspective.
The WHO Special Initiative for Mental Health is an ambitious project looking to increase access to care for 100 million more people across 12 different countries. Nine countries have already joined the programme —Bangladesh, Jordan, Paraguay, Philippines, Ukraine and Zimbabwe being early adopters since January 2020, and Argentina, Ghana and Nepal joining them in the following 2 years.
Although major advancements in our understanding of what causes mental health conditions and how to treat them have been made in the last 20 years, very few improvements in service coverage and quality have been made.
The Programme focuses on two main areas for action in each country: (i) advancing mental health policy, advocacy and human rights and (ii) scaling up interventions and services across community-based, general health and specialist settings. These strategic priorities will further the Global Goals and the triple billion targets of the WHO Thirteenth General Programme of Work 2019-2023 and Universal Health Coverage agenda. It is also intended to demonstrate transformation of mental health services recommended in the recently published World Mental Health Report: Transforming mental health for all (2022) and to illustrate to member states how targets in the WHO Comprehensive Mental Health Plan (2013-2030) can be achieved.
It is important to note that, despite the fact that the WHO Special Initiative for Mental Health was designed prior to the onset of the COVID-19 pandemic and the crisis in Ukraine, it has proven to be key in responding to these crises. Predictably, contributing to mental health system development promoted countries’ preparedness to respond to the mental health needs created by these crises and allowed them to develop and implement strategies for action more quickly.
The WHO Special Initiative for Mental Health has made steady and positive progress in most participating countries, gradually scaling up services and fostering change. It is implementing evidence-based guidance and tools, focusing on groups in positions of vulnerability (e.g. women, children, youth, the elderly and refugees); international human rights standards to reform mental health policies, strategies and laws; and taking a mental health systems strengthening approach for long-term, sustainable change.
Another main event to be commemorated this World Mental Health Day (WMHD) is the WHO World Mental Health Report. The first such report in 20 years, it provides a plan for governments, academics, health professionals, civil society and others with an ambition to support the world in transforming mental health. It lays out the priorities that all need to take to support our mental health and allow populations to thrive. Drawing on the latest evidence available, the report uses examples of good practice from around the world to demonstrate what works. Through the voices of people with lived experience of mental health conditions, it gives a strong narrative of why things need to change.
The WHO Special Initiative for Mental Health has made steady and positive progress in most participating countries, gradually scaling up services and fostering change.
The report highlights why and where change is most needed and how it can best be achieved. The ambition for the report is that stakeholders work together to deepen the value and commitment given to mental health, reshape the environments that influence mental health and to strengthen the systems that care for people’s mental health. This can be achieved by implementing the Comprehensive Mental Health Action Plan which gives clear actions to promote mental health and well-being for all, to prevent mental health conditions for those at risk and to achieve universal coverage for mental health services.
People with mental health conditions continue to be at increased risk of physical and emotional abuse, denial of education and employment, and other human rights violations. Importantly, it is time for all to raise the bar around conversations on mental health. The heavy weight of stigma cannot be a reason for us to fail. Only through partnership and coalescing through a sense of community can we improve the state of the world’s mental health.
This year’s theme for WMHD—make mental health and well-being a global priority for all—is an opportunity for Governments and other relevant stakeholders to embrace the guidance offered in resources such as the WHO World Mental Health Report. The timing is critical because, through the lens of the post-acute phase of the pandemic, we have an opportunity and the tools to really make a difference now.
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