Global Mental Health Comes of Age
October 30, 2013
Dr. Layla McCay
Visiting Scholar, Johns Hopkins Bloomberg School of Public Health
The adage ‘no health without mental health’ presents a rather depressing prognosis in terms of numbers. Almost 25 percent of the total non-fatal global burden of disease is attributable to mental illness – and yet there is a massive gap between those who need treatment and those who receive it. Three-quarters of people with severe mental illnesses in low- and middle-income countries are not receiving treatment. And that is before considering the effectiveness of therapies offered – or indeed the huge numbers of people with milder forms of mental, neurological, and substance misuse disorders that receive no attention.
Part of the problem is a funding gap. In many low- and middle-income countries, mental health comprises just one to two percent of the country’s total health budget. Meager funding levels reflect the typical low priority ascribed to mental health by funders of health and development; mental health funding rarely comprises more than five percent of high-income countries’ own national health budgets. With political eyes focused on development targets like the Millennium Development Goals, mental health has not received the attention befitting its impact on global health.
However, in the past few years, change has been in the air. The catalyst: a series of landmark articles published by The Lancet medical journal in 2007. These articles examined the state of mental health systems around the world, casting light on both the current state of mental health systems and the science around how to provide high quality mental health care in financially constrained settings. With those publications, the sometimes nebulous issue of global mental health was resoundingly elevated to Global Mental Health, a bona fide, recognized scientific discipline in health and development.
The Lancet’s call to action was heard and echoed around the world. In response, new journals, research centers, national taskforces, movements, and programs emerged. One of the most interesting is the World Health Organization’s Mental Health Gap Action Program (mhGAP), launched in 2008. mhGAP provides practical, evidence-based guidelines that empower general health workers and lay carers (i.e. community members, family members, and other non-experts) to deliver high quality mental health care. The intended result: to increase the proportion of people who are able to access essential mental health treatment without having to rely on scarce specialists, thus closing the treatment gap.
With global momentum building around the new thinking, evidence, and action for scaling up mental health services, securing political will and commitment is imperative. This is why this month’s launch of WHO’s Mental Health Action Plan 2013-2020 – adopted by the World Health Assembly in May and officially launched this month – was highly anticipated. That there are recognized, effective strategies to address the global burden of mental disorders is one thing; that for the first time WHO’s member states formally recognize and endorse the importance of these strategies indicates a real shift in the political conversation around mental health.
The Action Plan generally lives up to expectations. It provides a robust framework to which governments, international agencies, researchers, and civil society can mutually align; and articulates practical, measurable indicators by which they can track progress. The overall approach is based on human rights, empowerment, and ensuring people can access effective mental health care in their own communities – and importantly, it focuses on prevention and recovery. It addresses leadership and governance, and measuring outcomes. The Plan is also holistic in its aim to mainstream mental health services across various sectors, including: public health, education, labor, and justice. Even better, it is designed with flexibility, adaptable to regions with different needs and cultures.
It also lays out practical, deliverable expectations. By 2020 WHO intends that 80 percent of countries will have updated their mental health policies and 50 percent will have updated their laws in line with international human rights. It aims to see an increase of evidence-based service coverage for those with severe mental illness by 20 percent. It expects to see at least two mental health promotion programs in place per country, with suicide rates having fallen by 10 percent. In terms of data, 80 percent of countries should have built on their existing reporting systems to collect and report a biannual core set of mental health indicators. Mental health has thus far been a quiet player in the data revolution; this objective opens the doors for the sector to play a prominent role.
A remarkably extensive stakeholder consultation has helped ensure the WHO Mental Health Action Plan chimes well with the development community – and its canny alignment with mhGAP means there is already a how-to manual to kick off some of the work. This alignment may prove an interesting model for subsequent WHO Action Plans seeking to turn aspiration into action. This seems to be an Action Plan that is actually ripe for action.
That this Action Plan comes as the Post-2015 Development Framework is starting to take shape may have interesting implications for how mental illness is prioritized in the coming years. If there is ‘no health without mental health,’ the endorsement of the WHO Mental Health Action Plan represents important progress toward a healthier global society.