Mental health is a key ingredient of human capital, but has remained one of the most neglected areas of health. For example, countless millions of people are affected by depression and anxiety, but the majority receive no care. Proven interventions for preventing mental-health problems and promoting mental wellbeing are not utilized at scale, even in high-income countries.
However, the last few years have seen an unprecedented interest in global mental health. Health ministers of all 194 countries committed their countries to specific objectives and targets on mental health in 2013 (WHO Mental Health Action Plan 2013-2020), and presidents and prime ministers included mental health and well-being in the United Nations Sustainable Development Goals in 2015. Business leaders have become more aware of the economic losses incurred due to mental health problems among the workforce (WEF Annual Meeting 2019). And civil society has taken up mental health as a priority issue with the establishment of several high-profile organizations with mental health as their exclusive agenda (for example, the Movement for Global Mental Health and United for Global Mental Health).
How can we take advantage of this unprecedented momentum on global mental health? Here are four ways that will make a real difference in people’s lives and countries’ economies:
Image: Juliana Restivo
1. By engaging communities in mental health
Mental health is a valuable asset to all of us and has to be fully conceptualized. The world cannot be divided into people who have a mental disorder and others who don’t. We all can do something to enhance our mental health, to protect us from future mental disorders, as well as getting care if we have a problem. It is important to involve communities in making our physical and social environment mentally healthy and to look after our minds better. It is also important to involve people with lived experience of mental disorders, such as the Global Mental Health Peer Network, in organizing services and care who can add meaningfully and substantially to providing solutions, including developing practical ways to implement supported decision-making for people with acute mental health problems.
2. By investing more and enhancing accountability
Countries spend a miniscule amount of money on mental health, and a large part of that goes into maintaining old-style mental hospitals catering to a few people with severe disorders while community-based care remains inadequate. It has been recommended (The Lancet Commission on Global Mental Health and Sustainable Development) that high-income countries spend at least 10% of their health budget on mental health, and the middle- and low-income countries at least 5%. In addition, international development aid for mental health must be increased substantially – currently, less than 1% of it goes into mental health. Businesses also need to invest more in the mental health of their workforce. These investments are worthwhile since return of investment for mental health interventions have been demonstrated to be very favorable. The establishment of a global financing mechanism for mental health (Vego et al 2019) will provide the necessary impetus to these efforts. An accountability framework for the existing and future investments is already being developed (Saxena et al 2019).
3. By developing effective leadership to scale up mental healthcare
More money is necessary, but is not enough; we need strong leadership to scale up mental healthcare. This should be at the political level, at governmental level, within businesses, within development agencies and within communities. All pervading stigma around mental health issues has prevented open discussion and effective leadership. Too few heads of state or government or business leaders have taken it up as an issue on a sustained basis. Mental health should be a component in all leadership programs, and a dedicated executive leadership program must be established to strengthen the capacity of leaders charged with scaling up mental health programs. These need to have a global outlook, since there are plenty of opportunities for learning across countries and cultures.
4. By building the workforce for mental health
Mental healthcare does not require hi-tech equipment or expensive medicines. It requires well-trained professionals to identify problems early and to provide effective and timely treatment. The numbers of mental health specialists (e.g. psychiatrists, psychologists) even in high-income countries are inadequate, and in most middle- and low-income countries negligible. Fortunately, it has been well proven that with adequate training and support, non-specialists (e.g. general doctors, nurses, community health workers) can provide effective care for the vast majority of mental health problems (Singla et al). Substantial efforts are needed to scale up training of the existing health workforce to deliver mental healthcare by using material available from WHO (e.g. mhGAP), and by digital platforms for training and delivering psycho-social interventions (Harvard digital platform). Ongoing support and supervision to assure quality should be part of the workforce development. The objective is that every person anywhere should have access to a mental healthcare provider.
Imagine a community that implements these four ways to improve the mental health of its people. Stigma around mental health will disappear, people will come forward to obtain help, services will be available within the community as well as in schools and workplaces, education will not be interrupted by mental health problems, productivity will improve and people will live a happier and longer life less affected by disabilities. Would we all not like to live in such a community?
Shekhar Saxena, Professor of the Practice of Global Mental Health, Harvard T.H. Chan School of Public Health
Vikram Patel, Pershing Square Professor of Global Health, Harvard Medical School
