The World Health Organization released its largest review of world mental health since the turn of the century. The detailed work provides a blueprint for governments, academics, health professionals, civil society and others with an ambition to support the world in transforming mental health.
In 2019, nearly a billion people – including 14% of the world’s adolescents - were living with a mental disorder. Suicide accounted for more than 1 in 100 deaths and 58% of suicides occurred before age 50. Mental disorders are the leading cause of disability, causing one in six years lived with disability. People with severe mental health conditions die on average 10 to 20 years earlier than the general population, mostly due to preventable physical diseases. 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 went up by more than 25% in the first year of the pandemic alone.
Stigma, discrimination and human rights violations against people with mental health conditions are widespread in communities and care systems everywhere; 20 countries still criminalize attempted suicide. Across countries, it is the poorest and most disadvantaged in society who are at greatest risk of mental ill-health and who are also the least likely to receive adequate services.
Even before the COVID-19 pandemic, just a small fraction of people in need had access to effective, affordable and quality mental health care. For example, 71% of those with psychosis worldwide do not receive mental health services. While 70% of people with psychosis are reported to be treated in high-income countries, only 12% of people with psychosis receive mental health care in low-income countries. For depression, the gaps in service coverage are wide across all countries: even in high-income countries, only one third of people with depression receive formal mental health care and minimally-adequate treatment for depression is estimated to range from 23% in high-income countries to 3% in low- and lower-middle-income countries.
Drawing on the latest evidence available, showcasing examples of good practice, and voicing people’s lived experience, WHO’s comprehensive report highlights why and where change is most needed and how it can best be achieved. It calls on all stakeholders to work together to deepen the value and commitment given to mental health, reshape the environments that influence mental health and strengthen the systems that care for people’s mental health.
WHO Director-General Dr Tedros Adhanom Ghebreyesus said, “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. 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. Investment into mental health is an investment into a better life and future for all.”
All 194 WHO Member States have signed up to the Comprehensive mental health action plan 2013–2030, which commits them to global targets for transforming mental health. Pockets of progress achieved over the past decade prove that change is possible. But change is not happening fast enough, and the story of mental health remains one of need and neglect with 2 out of 3 dollars of scarce government spending on mental health allocated to stand-alone psychiatric hospitals rather than community-based mental health services where people are best served. For decades mental health has been one of the most overlooked areas of public health, receiving a tiny part of the attention and resources it needs and deserves.
Dévora Kestel, Director of WHO’s Mental Health and Substance Use Department called for change: “Every country has ample opportunity to make meaningful progress towards better mental health for its population. 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.”
The report urges all countries to accelerate their implementation of the Comprehensive mental health action plan 2013–2030. It makes several recommendations for action, which are 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. For example:
Stepping up investments in mental health, not just by securing appropriate funds and human resources across health and other sectors to meet mental health needs, but also through committed leadership, pursuing evidence-based policies and practice, and establishing robust information and monitoring systems.
Including people with mental health conditions in all aspects of society and decision-making to overcome stigma and discrimination, reduce disparities and promote social justice.
2. Reshape environments that influence mental health, including homes, communities, schools, workplaces, health care services, natural environments. For example:
Intensifying engagement across sectors, including to understand the social and structural determinants of mental health and intervening in ways that reduce risks, build resilience and dismantle barriers that stop people with mental health conditions participating fully in society.
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; enabling nurturing care for early childhood development, making available livelihood support for people with mental health conditions, introducing social and emotional learning programmes while countering bullying in schools, shifting attitudes and strengthen rights in mental health care, increasing access to green spaces, and banning highly hazardous pesticides that are associated with one fifth of all suicides in the world.
3. Strengthen mental health care by changing where, how, and by whom mental health care is delivered and received.
Building community-based networks of interconnected services that move away from custodial care in psychiatric hospitals and cover a spectrum of care and support through a combination of mental health services that are integrated in general health care; community mental health services; and services beyond the health sector.
Diversifying and scaling up care options for common mental health conditions such as depression and anxiety, which has a 5 to 1 benefit – cost ratio. Such scale up includes adopting a task-sharing approach that expands the evidence-based care to be offered also by general health workers and community providers. It also includes using digital technologies to support guided and unguided self-help and to deliver remote care.