Mental disorders, such as depression, anxiety, and substance use disorders, impose an enormous global disease burden that leads to premature mortality and affects functioning and quality of life. If left untreated, mental disorders can result in worse treatment adherence and outcomes for commonly co-occurring diseases, such as tuberculosis, diabetes, cardiovascular disease, and cancer. Yet parity between mental and physical health conditions remains a distant ideal. Poor mental health also impacts on economic development through lost production and consumption opportunities at both the individual and societal level. It is estimated that the lost economic output caused by untreated mental disorders as a result of diminished productivity at work, reduced rates of labor participation, foregone tax receipts, and increased welfare payments amounts to more than 10 billion days of lost work annually – the equivalent of US$1 trillion per year (Chisholm, D., et al, 2016).
Countries are not prepared to deal with this often “invisible” and often-ignored challenge. Despite its enormous social burden, mental disorders continue to be driven into the shadows by stigma, prejudice, or fear of disclosure because a job may be lost, social standing ruined, or simply because health and social support services are not available or are out of reach for the afflicted and their families.
In spite of these challenges, there is growing support to move mental health from the periphery to the center of the global health and development agenda. As highlighted in WHO’s Mental Health Action Plan 2013-2020, a number of evidence-based, inter-sectoral strategies have been effective in promoting, protecting and restoring mental health, well beyond the institutionalization approaches of the past. Properly implemented, these interventions represent “best buys” for any society, with significant returns in terms of health and economic gains.
To fully realize the goal of universal health coverage across the world, it is critical to integrate prevention, treatment and care services for mental health disorders, along with psychosocial support mechanisms, into accessible service delivery and financial protection programs. Additionally, health and policy leaders need to identify “entry points” across sectors to help tackle the social and economic factors that contribute to the onset and perpetuation of mental health disorders.
World Bank-WHO Initiative
To highlight the scale of these issues, and the gains from addressing them, the World Bank Group and WHO co-hosted the “Out of the Shadows: Making Mental Health a Global Priority” event as part of the WBG-IMF Spring Meetings held in Washington, D.C. in April, 2016. This event aimed to put the mental health agenda at the center of global health and development priorities by spurring efforts to: increase awareness about mental health as a development challenge and the associated economic and social costs of inaction; debate the economic and social benefits of investing in mental health; and identify ways for stakeholders to act across sectors.
Key Policy Actions
Mental health matters: Visibly increase the attention given to mental disorders at the national and international levels (including migration and humanitarian aid; social inclusion and poverty reduction; and human rights protection and universal health coverage). Strong leadership is needed to make mental health a priority, to commit to innovative and quality services, to channel resources toward mental health systems, and to strengthen community services.
Mental health works: Introduce or strengthen programs that promote and protect mental well-being into general health services (integrated care), school curricula (life skills), and occupational health schemes (wellness at work); and promote better coordination across these platforms and sectors.
Mental health needs: Devote additional resources from development assistance donors and domestic health budgets towards implementing community-based mental-health programs and strengthening the overall treatment of mental disorders as part of the progressive realization of universal health coverage.
There is still a long way to go to promote investment, resources, and accountability in the mental health sector. Next steps include enhanced international cooperation; the creation of private–public partnerships, specifically with technology companies; integration of mental health into other health and development sectors; and exploration of alternate models of mental health financing, such as the dedicated use of revenue from higher taxes on tobacco and alcohol. Each sector must keep the momentum going, and it is only by increasing collaboration and resources to make mental health a global development priority that progress will be made (Kleinman et al, 2016).