Mental, neurological and substance use disorders (MNS) are common, highly disabling, and associated with significant premature mortality. The human, social and economic toll imposed by lack of attention to MNS across the world is enormous. It is estimated that at least 10 percent of the world’s population is affected, and that 20 percent of children and adolescents suffer from some type of mental disorder. In fact, according to recent WHO data, mental illness account for 30 percent of non-fatal disease burden worldwide and 10 percent of overall disease burden, including death and disability. MNS impact on the social and economic well-being of individuals, families, and societies is large, underestimated, and often ignored. If untreated, MNS undermines health capital, and hence human capital development, since they, unlike many of the high-burden diseases, have an early age of onset – often in childhood or early adolescence – and are highly prevalent in the working-age population. In OECD countries mental ill-health affects an estimated 20 per cent of the working-age population at any given time. The global economy loses about $1 trillion every year in productivity due to depression and anxiety.
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, and more recently in the 2018 report of The Lancet Commission on global mental health and sustainable development, 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. Indeed, as showed in a study prepared for the 2016 WBG/WHO global mental health conference, the estimated cost of treatment interventions at the community level for moderate to severe cases of depression, including basic psychosocial treatment for mild cases and either basic or more intensive psychosocial treatment plus antidepressant drug for moderate to severe cases, is quite low: the average annual cost during 15 years of scaled-up investment is $.08 per person in low-income countries, $0.34 in lower middle-income countries, $1.12 in upper middle-income countries, and $3.89 in high-income countries. (Chisholm et al., 2016). And the economic returns on investment are high: the benefit-to-cost ratios for scaled-up depression treatment across country income groupings were in the range of 2.3 to 2.6, and for anxiety disorders, the ratios were slightly higher, with a range 2.7–3.0.
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 and use “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, in partnership with WHO and other national and international organizations, beginning with the “Out of the Shadows: Making Mental Health a Global Priority” event held as part of the WBG-IMF Spring Meetings held in Washington, D.C. in April, 2016, and more recently at the Global Ministerial Mental Health Summit held in London in October 2018 hosted by the UK Government, is supporting efforts to put mental health at the center of global health and development agendas. These efforts are geared 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.
Confronting the health and development challenge of mental health conditions will require additional funding to bridge resource gaps and address low availability and quality of treatment. Indeed, while 7.4% of the global burden of disease, only 2% of national health budgets is devoted to mental health programs. However, rather than advocating for another “silo” approach, focused on funding for individual health conditions, multi-sectoral funding must be leveraged to scale up mental health interventions, while also promoting efforts to reduce duplication and inefficiencies as well as stigma and discrimination.
lastupdated: Apr 03, 2019