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Editorial| Volume 8, ISSUE 11, e1352, November 01, 2020
Mental health matters
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MENTAL HEALTH MATTERS

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Open AccessPublished:November,
2020DOI:https://doi.org/10.1016/S2214-109X(20)30432-0
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October 10 marks World Mental Health Day. This year's campaign theme, developed
by WHO, United for Global Mental Health, and the World Federation for Mental
Health, recognises that investment in mental health has not matched rising
global awareness of the scale of the problem in recent years. The campaign
slogan—“Move for mental health: Let's invest”—calls the world to action and, for
the first time, will be accompanied by a global online advocacy event.
From addiction to dementia to schizophrenia, almost 1 billion people worldwide
suffer from a mental disorder. Lost productivity as a result of two of the most
common mental disorders, anxiety and depression, costs the global economy US$ 1
trillion each year. In total, poor mental health was estimated to cost the world
economy approximately $2·5 trillion per year in poor health and reduced
productivity in 2010, a cost projected to rise to $6 trillion by 2030.
Yet, despite substantial advances in research, demonstrating the clinical and
cost-effectiveness of pharmacological and psychosocial interventions to prevent
and treat common mental disorders, delivery at scale and translation into
real-world benefits has been slow. The costs involved in mental health care are
many and can involve social services, primary, secondary, and tertiary care. In
addition to direct intervention costs, expenditure can be expected to cover
facilities, staff, administration, management, training, supervision, advocacy
and outreach activities. The diversity of services and care providers can
complicate estimates of national mental health expenditure.
The WHO Mental Health Atlas 2017 requested that countries estimate their
government's total spend on mental health, using subnational and national data.
They found that, on average, mental health expenditure accounted for less than
2% of government budgets for health. The report highlighted how care and
treatment for severe mental disorders is not included in national health
insurance or reimbursement schemes in 27% of 169 responding countries. When
asked how people pay for services, 17% of 168 responding member states said that
service users paid out-of-pocket. Indeed, out-of-pocket payments for mental
health services account for 43% of mental health expenditure in the African
region and 40% in the South-East Asia region. While a combination of bilateral,
multilateral, private, and philanthropic donations have contributed somewhat to
filling the funding gap, development assistance for mental health has never been
more than 1% of global development assistance for health.
The economic case for investment in mental health is strong: for every $1
invested in scaled-up treatment for depression and anxiety, there is a $4 return
in better health and productivity. The Lancet Commission on global mental health
and sustainable development, published in 2018, called for a partnership
including academic institutions, UN agencies, development banks, the private
sector, and civil society organisations to mobilise, disburse, and invest funds
to transform mental health, stating that “When it comes to mental health, all
countries can be thought of as developing countries.”
This is a statement that certainly rings true in 2020, with the clustering of
multiple social determinants of mental health—fear and anxiety about COVID-19,
emotional distress resulting from illness, bereavement, unemployment, income
loss, and loneliness due to social isolation—all interacting, and generating or
exacerbating mental health problems at a global scale. A position paper
published in The Lancet Psychiatry in July stated that, although the
psychological toll of COVID-19 is already apparent, the effects will be
far-reaching. And “Sooner or later, health systems will be faced with widespread
demand to address these COVID-19-related mental health needs”. Indeed,
international organisations called for the inclusion of mental health and
psychosocial support in the COVID-19 response. A UN policy brief published in
May stated, “This historic underinvestment in mental health needs to be
redressed without delay to reduce immense suffering among hundreds of millions
of people and mitigate long-term social and economic costs to society.”
The COVID-19 pandemic marks a turning point, moving mental health up the list of
global health priorities. As countries struggle to rebuild their damaged
economies, they must accept the reality of the financial toll of mental
ill-health and invest wisely now.
For more on World Mental Health Day see
https://www.who.int/campaigns/world-mental-health-day
For more on the WHO Special Initiative on Mental Health see
https://www.who.int/initiatives/who-special-initiative-for-mental-health
For the WHO Mental Health Atlas see
https://apps.who.int/iris/bitstream/handle/10665/272735/9789241514019-eng.pdf?ua=1
For more on The Lancet Commission on global mental health and sustainable
development see https://www.thelancet.com/commissions/global-mental-health
For the UN policy brief see
https://unsdg.un.org/sites/default/files/2020-05/UN-Policy-Brief-COVID-19-and-mental-health.pdf



ARTICLE INFO


PUBLICATION HISTORY

Published: November 2020


IDENTIFICATION

DOI: https://doi.org/10.1016/S2214-109X(20)30432-0


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LINKED ARTICLES

 * Scaling-up treatment of depression and anxiety: a global return on investment
   analysis
   * Return on investment analysis of the kind reported here can contribute
     strongly to a balanced investment case for enhanced action to address the
     large and growing burden of common mental disorders worldwide.
   * Full-Text
   * PDF
   Open Access
 * How mental health care should change as a consequence of the COVID-19
   pandemic
   * The unpredictability and uncertainty of the COVID-19 pandemic; the
     associated lockdowns, physical distancing, and other containment
     strategies; and the resulting economic breakdown could increase the risk of
     mental health problems and exacerbate health inequalities. Preliminary
     findings suggest adverse mental health effects in previously healthy people
     and especially in people with pre-existing mental health disorders. Despite
     the heterogeneity of worldwide health systems, efforts have been made to
     adapt the delivery of mental health care to the demands of COVID-19.
   * Full-Text
   * PDF








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