In the largest review of the world’s mental health services since 2001, the World Health Organization Friday called for far greater investments in mental health as part of primary health care systems and a transformation of attitudes and approaches to protect mental health and provide care for people in need.

The report’s executive summary, ‘Transforming mental health for all’, calls for governments to develop more affordable, community-based mental health services, integrated into broader primary health care systems – with greater attention to human rights, quality care and freedom from stigma and discrimination. 

The report finds that on average, countries dedicate less than 2% of their health care budgets to mental health. More than 70% of mental health expenditure in middle-income
countries still goes towards psychiatric hospitals – as compared to more preventive and community-centered approaches. And around half the world’s population lives in countries where there is just one psychiatrist to serve 200 000 or more people – reflecting the dire imbalance in services available at all in low- and middle-income countries.

“Everyone’s life touches someone with a mental health condition. Good mental health translates to good physical health and this new report makes a compelling case for change,” said WHO Director-General Dr Tedros Adhanom Ghebreyesus. 

The report also showcases examples of good practice, drawing upon the advice and lived experiences of people with mental health conditions – to demonstrate how change can be achieved. 

Mental health – under treated and under-resourced 

Mental health conditions remain widespread, under treated, and desperately under-resourced, the report relates.

About one in eight people in the world live with a mental disorder, with anxiety and depressive disorders the most common in 2019. The number of people with one or both of these disorders went up by more than 25% in the first year of the pandemic alone, as mental health worsened worldwide.

Stigma, discrimination, and human rights violations have globally impacted people with mental health conditions and care systems everywhere. Additionally, only a small fraction of people in need are able to access effective and affordable mental health care, with gaps in service found especially in low-income countries. Globally, some 71% of people experiencing psychosis do not even receive mental health services. 

These statistics and others featured in the report highlight an urgent need to reshape both the environments and systems that influence and care for people’s mental health. 

More multi sectoral investment in mental health would not only advance public health and curtail frequent human rights violations of people with mental health conditions, but it would enable socioeconomic development through the better integation of people experiencing mental health issues into society and workplaces, the report says. 

“The inextricable links between mental health and public health, human rights and socioeconomic development mean that transforming policy and practice in mental health can deliver real, substantive benefits for individuals, communities and countries everywhere,” said Tedros. 

Progress has proven change is possible, but it is still ‘business as usual’ 

Despite progress in mental health achieved over the decade, 2 out of 3 dollars of scarce government spending on mental health remains focused on stand-alone psychiatric hospitals rather than community-based mental health services where people are best served, the report states: 

“For most of the world, the approach to mental health care remains very much business as usual.” 

Countries need to accelerate implementation of WHO mental health action plan 

The report urges all countries to accelerate their implementation of WHO’s Comprehensive mental health action plan 2013 – 2020, which was adopted by the World Health Assembly in May 2013. 

All 194 WHO Member States had signed up for the plan, which commits them to global targets for transforming mental health. 

“Every country has ample opportunity to make meaningful progress towards better mental health for its population,” said Dévora Kestel, Director of WHO’s Mental Health and Substance Use Department, director of WHO’s Department of Mental Health and Substance Use. 

The report makes several recommendations for action, grouped into ‘three paths to transformation’ that focus on shifting attitudes to mental health, addressing risks to mental health and strengthening systems of care for mental health. They are:

1. Deepen the value and commitment we give to mental health. This includes stepping up investments in mental health, not just by securing appropriate funds and human resources to meet mental health needs, but also through committed leadership and evidence-based policies and practices. 
2. Reshape the environments that influence mental health, including homes, communities, schools, workplaces, healthcare services, natural environments. This includes implementing concrete actions to improve environments for mental health such as stepping up action against intimate partner violence and abuse and neglect of children and older people. 
3. Strengthen mental health care by changing where, how, and by whom mental health care is received. This can be done by shifting away from custodial care in psychiatric hospitals to building community-based networks of interconnected services that are integrated in general health care; community mental health services; and services beyond the health sector. 

Concluded Kestel: “Whether developing stronger mental health policies and laws, covering mental health in insurance schemes, developing or strengthening community mental health services or integrating mental health into general health care, schools, and prisons, the many examples in this report show that the strategic changes can make a big difference.”

Image Credits: AMSA/Flickr, WHO.