WHO: There is an urgent need to change the approach to mental health and mental health care

The World Health Organization today released its largest review of global mental health issues since the turn of the century. The detailed document outlines actions by governments, academia, medical professionals, civil society and others to change the way mental health issues are approached around the world.

Globally, nearly 1 billion people suffered from mental disorders in 2019, including 14 percent of adolescents. More than one percent of deaths were due to suicide, with 58 percent of suicides committed by those under age 50. Mental disorders are the leading cause of disability, accounting for one-sixth of the total number of years lost to disability. People with severe mental illness die, on average, 10 to 20 years earlier than the general population, largely due to the development of preventable physical illnesses. Childhood sexual abuse and bullying are leading causes of depression. Global systemic threats to mental health include socioeconomic inequality, health emergencies, war, and the climate crisis. In the first year of the pandemic alone, the prevalence of depression and anxiety disorders increased by more than 25%.

There is widespread stigma, discrimination, and violations of the rights of people with mental illness among the population and care providers; 20 countries still criminalize attempted suicide. The poorest and most disadvantaged members of society, who are also the least likely to receive adequate care, are at greatest risk of mental ill health in a wide variety of countries.

Even before the COVID-19 pandemic, effective, inexpensive, quality mental health care was available to only a small fraction of people who needed it. For example, globally, 71% of people with psychotic disorders did not receive psychiatric care. While in high-income countries 70% of people with psychosis are referred for treatment, in low-income countries only 12% of these patients receive psychiatric care. Significant gaps in coverage for depression exist in all countries; even in high-income countries, only one-third of depressed persons are officially treated, and coverage for minimally acceptable depression treatment is estimated to range from 23% in high-income countries to 3% in low- and lower-middle-income countries.

Using the latest available data, best practices and personal experiences, the authors of WHO's comprehensive report outline why and where change is most needed, and how it can best be achieved. They call on all stakeholders to work together to deepen understanding and attention to the value of mental health, change environmental factors affecting mental health, and strengthen mental health care delivery systems.

"Everyone encounters people with mental health problems in their lives. Good mental health contributes to good physical health, and a new report makes a compelling case for change. Given the complex linkages between mental health and public health, human rights and socioeconomic development, transforming mental health policy and practice can create real, substantial benefits for individuals, communities and countries around the world. Investing in mental health is an investment in improving the lives and future prospects of all people," said Dr. Tedros Adhanom Ghebreyesus, WHO Director-General.

All 194 WHO Member States have joined the Comprehensive Mental Health Action Plan 2013-2020, committing to global targets for change in mental health. Improvements made over the past decade in selected areas show that change is possible. They are not happening fast enough, however, and mental health care remains an underfunded and neglected area, with two-thirds of scarce public spending on mental health care allocated to specialized mental hospitals rather than community mental health services capable of optimally serving the population. Mental health has been among the most disadvantaged parts of public health for decades, receiving only a fraction of the attention and resources it objectively needs.

That's why Devorah Kestel, director of WHO's Department of Mental Health and Substance Use, is calling for change. "There is ample opportunity for every country to make tangible progress in improving the mental health of its population. Numerous examples cited in this report, whether improving mental health policies and legislation, integrating mental health care into health insurance programs, creating or improving mental health services in the community, or integrating mental health care into the general health care system to include educational institutions and places of detention, show that strategic changes can make a significant difference."

The report calls on all countries to accelerate implementation of the Comprehensive Mental Health Action Plan 2013-2020. The report makes several recommendations for action, organized into three "trajectories of change" aimed at changing attitudes towards mental health, countering mental health risks and strengthening mental health care systems. These are described below.

1. Increased understanding and attention to the value of mental health.

Increase resources for mental health care, not only by ensuring that the health sector and other sectors are adequately funded and staffed to meet mental health needs, but also by decisive leadership, focused implementation of evidence-based policies and practices, and robust information and monitoring systems.

Ensuring the participation of people with mental health problems in all spheres of public life and decision-making processes to overcome stigma and discrimination, reduce inequality and promote social justice.

2. changing environmental factors that affect mental health, including in the home, community and educational settings, the workplace, health care facilities, and the natural environment.

Strengthening collaboration across sectors, including exploring the social and structural determinants of mental health and taking action to reduce risk, build resilience and remove barriers to people with mental health problems participating fully in society.

Taking concrete steps to improve significant environmental factors for mental health, including increased opposition to intimate partner violence, child and elder abuse and neglect; creating opportunities to foster holistic early childhood development; making economic support available to people with mental health problems; implementing social and emotional skills programs along with anti-bullying efforts in schools; changing the set up of

3. Improving the quality of psychiatric care by changing the organizational forms and methods of providing and receiving it, as well as the categories of people involved.

Creating community networks that integrate linked services and move away from the closed psychiatric inpatient care model and provide a full range of care and support based on a mix of services including: mental health care in general medical care; community mental health services; and services outside the health sector.

Diversification and widespread implementation of care options for common mental disorders, such as depression and anxiety disorder, as they provide five times the benefits over costs. This widespread implementation of care involves task delegation, in which proven types of care can be more widely delivered by general health care providers and community-based service organizations. This also includes the adoption of digital technologies that allow for accompanied and unaccompanied self-help techniques and remote service delivery.