World Mental Health Day: on a positive trajectory

As global mental health receives increasing attention on the political stage, Kirsty Smith reflects on key developments in the past year and challenges ahead.

Depression has now been identified as one of the leading causes of disability across the world[i] and, along with conditions such as anxiety, addiction and schizophrenia, contributes to the estimated 970 million people globally living with a mental or substance abuse condition. Yet it is estimated that less than four per cent of people in low and middle-income countries, receives ‘minimally adequate’ treatment.[ii] In many sub-Saharan countries there are less than one psychiatrist per million people, and some do not have even one psychiatrist. There are also far too few of other mental health workers, for example in 2014-2016 there were an average 0.3 psychiatric nurses per 100,000 people low-income countries, compared with and 22.5 nurses per 100,000 in higher income countries.[iii]

The UK has been at the forefront of the increased understanding of and interest in responding to mental health as an essential part of any approach to health, disability or wellbeing. Alongside DfID’s commitment to mental health laid out in their 2018 Disability Strategy (Gov.uk website – open in new tab) and hot on the heels of the Global Disability Summit (Gov.uk website – open in new tab) last year, the Global Ministerial Mental Health Summit (Gov.uk website – open in new tab) brought together government ministers, experts by experience (those with direct experience of mental illness) and civil society, to tackle what Matt Hancock MP called ‘one of the defining global challenges of the 21^st century’. A number of recommendations were distilled from discussions relating to children and young people, prevention, financing, creating societal shifts, service provision and research.

Developing mental health policy and practice presents particular challenges. Physical health conditions can often be treated with a specific – or series of specific – interventions which may see dramatic and often swift positive outcomes. Responding to a person’s mental health needs is often a more complex and lengthy process– thoughts and emotions cannot be manipulated with the same certainty of result as the manipulation of bone and tissue. However, there is good evidence for what support can significantly improve mental health, and ways of measuring such improvement. Increasingly, we are also learning the impacts on population wellbeing of social determinants, or risk factors, such as drug and alcohol abuse, a lack of social support, and especially poverty and inequality. In future, we will see mental health more closely recognised as integral to achieving wider development goals, and vice versa.

The Mental Health Summit suggested specific and measureable targets, for instance that low and middle-income countries increase their mental health spend to at least 5% of the total health budget, and high-income countries to 10% by 2030; and that UN member states double the treatment coverage for people with alcohol and drug use conditions by 2030. As well as these recommendations, the final Summit Declaration (Gov.uk website – open in new tab) calls on global leaders to promote mental health and wellbeing, invest in mental health services, challenge stigma and discrimination, empower people and champion data and innovation.

DfID’s Disability Strategy (Gov.uk website – open in new tab) promises a comprehensive approach to mental health, in support of the UK Government’s aim to be a world leader in the field. DfID has spent this year carrying out research and developing its theory of change and policy paper on mental health, which are due for publication by the end of 2019. That the paper will call for action by the development and humanitarian communities is to be expected and welcomed; but we also hope the UK Government will commit itself to action that equals the scale of its ambition and its influence – even if that takes a while to achieve.

The past year has also been significant for CBM. In April, we launched our new Community Mental Health Initiative (CBM.org website – open in new tab), which builds on 15 years’ experience in the field of mental health and psychosocial disability. We work with a number of fantastic partners across the world to deliver programmes that amplify the voice of people affected by mental illness and support their full participation in community life.

In Malawi, CBM works with the Mental Health Users and Carers Association (MeHUCA) and the Malawi Council for the Handicapped (MACOHA), to establish self-help groups and to train community health workers, traditional healers and faith leaders in mental health, so that they can better support people who approach them for help. We are also working with universities in Kenyatta and Chuka, Kenya, to raise awareness of mental health and improve access to peer support and services. In Ghana, we work with local mental health organisations to improve maternal mental health through training midwives to identify and refer pregnant women with mental health difficulties. And across Ghana, India, Kenya, Nigeria and Uganda we are working with Time To Change to tackle stigma and discrimination, through training people with lived experience of mental illness to speak out and raise awareness.

This year we published our mental health policy paper which includes recommendations to the UK Government, calling on it to help create a global environment that enables good mental health to flourish and reduces risk of mental illness. This is not just a role for DfID, but across government we want departments to consider the impact of their activities and interventions on the mental health of relevant populations and communities; and through its own international advocacy to continue banging the drum for mental health. Of course, we would also like to see more funding for mental health programmes across the world, but these need to be contextually relevant, recognising local conceptualisations of mental illness and wellbeing, and appropriate to local capacity.

Of course, love, fulfilment and self-worth – all important for good mental health – cannot be legislated for or funded, but there are pressure points such as inequality and social exclusion that government policy can help relieve. The unpredictability of the human mind is also our ally here, when we place it outside the box to dream up creative policy solutions and practical interventions to reduce harm to mental health, recognising that often the most appropriate and dynamic solutions are to be found by the people with mental health conditions themselves.

[i] World Health Organisation
[ii] The Lancet Commission on global mental health and sustainable development. October 2018
[iii] Global Health Observatory, World Health Organisation

Image: Members of CBM’s partner Mental Health Users and Carers Association (MEHUCA) in Malawi.