The World Health Organization today released its largest survey of global mental health since the turn of the century. The detailed work is a blueprint for governments, scientists, health professionals, civil society and others seeking to support the world in transforming mental health.
In 2019, almost a billion people, including 14% of the world’s adolescents, were suffering from a mental disorder. Suicide accounts 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 years living with a disability. People with severe mental disorders die on average 10–20 years earlier than the general population, largely due to preventable physical illnesses. Childhood sexual abuse and victimization of bullying are major causes of depression. Social and economic inequalities, public health emergencies, wars and the climate crisis are among the global structural threats to mental health. In the first year of the pandemic alone, depression and anxiety increased by more than 25%.
Stigma, discrimination, and human rights violations against people with mental illness are widespread in communities and care systems everywhere; 20 countries continue to criminalize attempted suicide. In all countries, the poorest and most disadvantaged segments of society are most at risk of mental illness and also 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 care. While 70% of people with psychosis receive treatment in high-income countries, only 12% of people with psychosis receive mental health care in low-income countries. For depression, service coverage gaps are large in 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. countries with income levels up to 3% in low-income and lower-middle income countries.
Drawing on the latest available evidence, showcasing examples of good practice and sharing people’s experiences, the comprehensive WHO report highlights 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, change the environment that affects mental health, and strengthen systems that care for people’s mental health.
WHO Director General Dr. Tedros Adhanom Ghebreyesus said: “Every life concerns someone with a mental illness. Good mental health means good physical health, and this new report makes a strong case for change. The inextricable link between mental health and public health, human rights and socioeconomic development means that transforming mental health policy and practice can bring real, significant benefits to individuals, communities and countries around the world. An investment in mental health is an investment in 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 to transform mental health. The small advances made over the past decade prove that change is possible. But change isn’t happening fast enough, and the history of mental health remains a history of need and neglect: $2 out of $3 of meager public mental health spending goes to individual mental hospitals, not community mental health services, where people are best served. For decades, mental health has been one of the most neglected areas of public health, receiving only a tiny fraction of the attention and resources it needs and deserves.
Devora KestelThe director of the WHO Department of Mental Health and Addictions called for change: “Each country has ample opportunity to make significant progress in improving the mental health of its population. Whether it is the development of stricter mental health policies and laws, the inclusion of mental health in insurance schemes, the development or strengthening of community mental health services, or the integration of mental health into the general health system, schools and prisons, the numerous examples in this report show that strategic changes can make a big difference.”
The report calls on all countries to accelerate implementation of the Comprehensive Mental Health Action Plan 2013–2030. It contains several actionable recommendations grouped under three “paths of transformation” that focus on changing attitudes towards mental health, addressing mental health risks, and strengthening mental health systems. They are:
one. Deepen the value and commitment we place on mental health. For example:
Scaling up investment in mental health not only by allocating appropriate funds and human resources in health and other sectors to meet mental health needs, but also through committed leadership, evidence-based policies and practices, and building strong information and monitoring systems.
Inclusion of people with mental disorders in all aspects of society and decision-making to overcome stigma and discrimination, reduce inequalities and promote social justice.
2. Change the environment that affects mental health, including homes, communities, schools, workplaces, health services, natural environments.. For example:
Increased engagement across sectors, including to understand the social and structural determinants of mental health and interventions in a way that reduces risks, builds resilience and removes barriers that prevent people with mental disorders from fully participating in society.
Implementation specific actions to improve conditions for mental health, such as stepping up action against intimate partner violence, abuse and neglect of children and the elderly; ensuring care for early childhood development, providing livelihoods for people with mental illness, implementing social and emotional learning programs while countering bullying in schools, changing attitudes and strengthening rights to mental health, increasing access to green space, and banning the use of highly hazardous pesticides, which account for one fifth of all suicides worldwide.
3. Strengthen mental health care by changing where, how and by whom it is provided and received.
Creation of networks of interconnected community-based services that move away from psychiatric detention and cover a range of care and support services through a combination of mental health services integrated into the general health system; community mental health services; and services outside the health sector.
Diversify and scale up treatment options for common mental disorders such as depression and anxiety with a 5 to 1 benefit-to-cost ratio. This expansion includes the adoption of a division of tasks approach that expands evidence-based care to be offered also by general health professionals and service providers at the community level. It also includes the use of digital technologies to support managed and unmanaged self-care and remote assistance.