Around the world, one billion people suffer from mental health problems. Depression and anxiety are among the top ten causes worldwide of years lived with disability.
Mental health is a foundational issue. In 1954, Dr George Brock Chisholm, the first Director-General of the World Health Organization, stated that ‘without mental health there can be no true physical health‘. Poor mental health exacerbates underlying medical conditions, undermines our immunity, and threatens our resilience against new health threats. In addition, mental ill health contributes to impoverishment and premature death.
Unlike physical illness, mental illness may be invisible, frequently going undiagnosed or inappropriately treated. In addition, stigma and fears of negative social and professional repercussions can make sufferers reluctant to seek help.
Lack of investment leaves huge gaps in care
Despite direct evidence of the economic benefits of investing in mental health — through improved health and productivity — mental health services remain underfunded. Treating mental health problems would cost $2.5 trillion per year, but countries allocate on average just 2 per cent of their health budgets to mental health care and services. In low- and middle-income countries, it is estimated that more than 75 per cent of people with mental health conditions receive no treatment at all — the ‘mental health treatment gap.’ Moreover, in many countries mental health policies and legislation remain inadequate to counter the stigma and discrimination associated with poor mental health.
People living with HIV went through a comparable period of stigma and neglect that the world has only slowly overcome. Yet finding a welcoming and inclusive way to address their illness was essential for curbing a global public-health threat. We need a similar approach to mental health.
Building on lessons learned during the Covid-19 pandemic
The Covid-19 pandemic has revealed increasing mental-health problems resulting from the illness and death of loved ones, and from employment instability and loss of livelihoods. Students have encountered mental-health stress from the difficulty posed by being unable to meet physically with peers and professors and from increased uncertainty about their future. Like online schooling, working from home has limitations. ‘Zoom burnout‘ — the term given to the growing levels of stress reportedly associated with increased videoconferencing — may reflect that digital connectivity is no substitute for human connection.
Covid-related lockdowns around the world helped to contain the pandemic and buy time until vaccines become available. However, they also fuelled mental ill health, including anxiety, substance abuse, and suicidal ideation. Lockdowns have also aggravated domestic abuse and presented new challenges in accessing care for people with existing disorders.
Frontline healthcare workers exposed to Covid-19 report growing levels of burnout syndrome, alcohol consumption, and post-traumatic stress disorder.
A survey conducted by the WHO in mid-2020 indicated that mental-health services had been disrupted in dozens of countries. That said, several countries have found new ways to provide access and support through consultations by phone and internet, and online support systems.
It’s time to take a bold leap ahead
A year into the pandemic, we should ask how we can move forward decisively to improve mental health at a global level. In any crisis that affects an entire population, established societal arrangements and ways of working are called into question. The coronavirus pandemic is no exception.
With a presence in 150 countries and close partnership with its Member States, WHO is ideally situated to provide the guidance and technical assistance needed to catalyse action and bring it to scale.
First, we are living in an era of important advances in behavioural interventions that take a holistic approach to mental health. Innovative research is key to unlocking this potential. Examples include WHO’s Program Management Plus, where behavioural interventions conducted by community workers in conflict zones successfully reduce depression and anxiety and improve function. As another example, this one more academic, AIM Youth Mental Health finds and funds research into mental illness in youth, helping even very young children overcome fear and anxiety.
Second, while research into new treatments and scientific breakthroughs is important, we must also deploy and expand treatments and services in countries where sufferers currently lack access. This is the goal of the WHO’s Mental Health Gap Action Programme (mhGAP). Since its introduction in 2008, mhGAP has been introduced in more than 100 countries, providing hundreds of millions of people with access to crucial counselling, support and treatment.
‘Without mental health there can be no true physical health.’
— Dr George Brock Chisholm, the first WHO Director-General
WHO is also at the forefront of how we approach the provision of mental health services. Well before the pandemic, the Director-General of WHO identified the urgent need to accelerate action in mental health. In 2019, the WHO Special Initiative for Mental Health was launched, which aims to bring quality, affordable mental health care to 100 million more people in twelve countries by 2023. The Initiative is already well underway in seven countries (Bangladesh, Jordan, Nepal, Paraguay, the Philippines, Ukraine, and Zimbabwe). In each country, work begins by conducting localised assessments to identify needs. By working together with government and service providers, the Initiative seeks to increase service coverage for severe mental health conditions by 50 per cent and to reduce suicide mortality by 15 per cent.
Finally, the way we are thinking about mental health is changing — and creating new openings. Policy makers and the public are increasingly looking at mental health, traditionally a taboo subject, as central to overall health. Similarly, there is increasing awareness that mental health issues affect the person, the family, and the community. This positive evolution should enable us to unlock progress faster. This shift in perception is evident in the United Nations Sustainable Development Goals (SDGs), which include two targets (3.4 and 3.5) focused on mental health and substance abuse. The fact that both are linked to SDG 8, which aims to ‘promote sustained, inclusive and sustainable economic growth, full and productive employment and decent work for all,’ recognises the economic return on investment in mental health.
In order to enhance these and other mental health-related efforts, the WHO Foundation is leveraging its platform as an independent grant-making organization to raise awareness and mobilise resources from individuals and businesses. It does so through various campaigns and partnerships, such as the Healing Arts Initiative, a collaboration with Christie’s through a series of curated auctions that seek to raise money to support the urgently needed mental-health response to Covid-19.
Convinced of the importance of grounding vision in evidence, Lombard Odier Group has also published a donor brief on mental health to inform philanthropists and foundations about the opportunities to make a difference in this space. The guide, which features inputs from the WHO Foundation and other partners, includes detailed background information on mental health and the associated challenges, as well as a series of case studies.
As a global community, we are in an unprecedented moment of change. Philanthropists now have the opportunity to take action to help address the long-term mental health effects of the pandemic and to unlock transformational change in mental healthcare for all, at all levels of society, for years to come.
Maximilian Martin, Ph.D., serves as the Global Head of Philanthropy at the Lombard Odier Group and teaches at the University of St. Gallen. Anil Soni is the CEO of the WHO Foundation.