WHO emphasizes the urgent need to transform mental health and mental health care
The World Health Organization today published its largest overview of global mental health since the turn of the century. The detailed work provides a blueprint for governments, academics, health professionals, civil society and others to help the world transform mental health.
In 2019, almost a billion people – including 14% of the world’s youth – were living with a mental disorder. Suicide was responsible for more than 1 in 100 deaths, and 58% of suicides occurred before the age of 50. Mental disorders are the leading cause of disability, resulting in one in six living with a disability. People with severe mental illness die on average 10 to 20 years earlier than the general population, mostly from preventable physical illnesses. Childhood sexual abuse and bullying victimization are major causes of depression. Social and economic inequalities, public health emergencies, war and the climate crisis are among the global, structural threats to mental health. Depression and anxiety increased by more than 25% in the first year of the pandemic alone.
Stigma, discrimination and human rights abuses against people with mental illness are widespread in communities and care systems everywhere; 20 countries still criminalize attempted suicide. In all countries, it is the poorest and most disadvantaged in society who are most at risk of mental illness and who are least likely to receive adequate services.
Even before the COVID-19 pandemic, only a small proportion of those in need had access to effective, affordable, and quality mental health care. For example, 71% of people with psychosis worldwide do not receive mental health services. While 70% of people with psychosis are reported to receive treatment in high-income countries, only 12% of people with psychosis in low-income countries receive mental health care. For depression, the gaps in care are large in all countries: even in high-income countries, only a third of people with depression receive formal mental health care, and the minimum appropriate treatment for depression is estimated at 23% in high-income countries. income countries to 3% in low- and middle-income countries.
WHO’s comprehensive report draws on the latest available evidence, provides examples of good practice and expresses people’s lived experience of why and where change is most needed and how best to achieve it. It calls on all stakeholders to work together to deepen the value and commitment to mental health, reshape the environments that affect mental health, and strengthen the systems that care for people’s mental health.
Director-General of the WHO dr Tedros Adhanom Ghebreyesus said: “Everyone’s life touches someone with a mental illness. Good mental health means good physical health and this new report makes a compelling case for change. The inseparable links between mental health and public health, human rights and socioeconomic development mean that transforming mental health policy and practice can bring real, substantial benefits to individuals, communities and countries around the world. Investing in mental health is investing in a better life and future for everyone.”
All 194 WHO Member States have signed the Comprehensive Mental Health Action Plan 2013–2030, which commits them to global goals for mental health transformation. The advances that have been made over the last decade prove that change is possible. But change is not happening fast enough, and the history of mental health remains one of hardship and neglect, with $2 in $3 of scarce government mental health spending allocated to standalone mental hospitals rather than to community mental health services where people live are best served. For decades, mental health has been one of the most overlooked areas of public health, receiving only a tiny fraction of the attention and resources it needs and deserves.
Devora Kestel, Director of the WHO Division of Mental Health and Substance Use, called for change: “Every country has ample opportunity to make meaningful strides towards improving the mental health of its population. Whether it’s developing stronger mental health policies and laws, covering mental health in insurance systems, developing or strengthening community mental health services, or integrating mental health into universal health care, schools and prisons, the many examples in this report show that strategic changes possible are a big difference.”
The report calls on all countries to accelerate their implementation of the Comprehensive Mental Health Action Plan 2013-2030. There are several recommendations for action grouped into three “pathways to transformation” that focus on changing mental health attitudes, addressing mental health risks, and strengthening mental health care systems. They are:
1. Deepen the value and commitment we place on mental health. For example:
Intensifying investment in mental health, not only by securing adequate funds and human resources across health care and other sectors to meet mental health needs, but also through committed leadership, following evidence-based policies and practices, and establishing more robust ones information and surveillance systems.
Involving people with mental illness in all aspects of society and decision-making to overcome stigma and discrimination, reduce inequalities and promote social justice.
2. Redesign environments that affect mental health, including homes, communities, schools, workplaces, health services, and natural settings. For example:
Increasing cross-sectoral engagement, including understanding the social and structural determinants of mental health and intervening in ways that reduce risk, build resilience and break down barriers that prevent people with mental illness from participating fully in society.
To implement concrete actions to improve the mental health environment, e.g. B. stepping up action to address intimate partner violence and abuse and neglect of children and the elderly; Fostering early childhood development, supporting livelihoods for people with mental illness, introducing social and emotional learning programs while tackling bullying in schools, Changing attitudes and empowering mental health services, improving access to green spaces and banning highly hazardous pesticides linked to one in five suicides worldwide.
3. Strengthen mental health care by changing where, how and by whom mental health care is provided and received.
Building community-based networks of interconnected services that move away from incarceration care in psychiatric hospitals and provide a spectrum of care and support through a combination of psychiatric services integrated with universal health care; community mental health services; and services beyond the healthcare sector.
Diversification and expansion of care options for common mental illnesses such as depression and anxiety, which have a benefit-to-cost ratio of 5 to 1. Such an increase includes the adoption of a task-sharing approach that expands evidence-based care to also be provided by general health workers and community providers. This includes the use of digital technologies to support guided and unguided self-help and to provide remote care.