Mental health

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We can and should do this by transforming the envi ronments that influence our mental health and by developing community-based mental health services capable of achieving universal health coverage for mental health.

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As part of these efforts, we must intensify our collaborative action to integrate mental health into primary health care.

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Using examples of positive change from across the globe, this report shows that every country, no matter its situation, has many opportunities to significantly improve mental health for its adults and children.

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Because the factors determining mental health are multisectoral, interventions to promote and protect mental health should also be delivered across multiple sectors.

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People with lived experience are important agents of change to improve public awareness of mental health and acceptance of people with mental health conditions.

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At the same time, care for common conditions such as depression and anxiety must be scaled up.

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This report focuses specifically on mental health and people with mental health conditions (see Box 1.1 Mental health terms).

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At times, the report also refers to neurological disorders, substance use disorders and cognitive and intellectual disabilities.

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We define mental health as an integral part of our general health and well-being and as a basic human right.

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We highlight the key risks and protective factors for mental health and identify some of the greatest threats to world mental health today.

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Teen parents in particular are often at higher risk of mental ill-health than their peers.

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Even in adulthood, family building can be a risky time for mental health.

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Even though the biological and social determinants of mental health are hugely influential, people are more than just their biology and the external environment.

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Employment has also been shown to reduce symptoms of depression and anxiety, while unemployment is a known risk factor for suicide attempts (19).

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Plenty of us became more anxious during various waves of COVID-19; but for some the pandemic has sparked or amplified much more serious mental health problems.

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By early 2022 there were fewer disruptions, but too many people still could not get the mental health support they needed.

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Chapter summary In this chapter we outline the state of mental health and mental health systems in the world and show that mental health needs are high and that responses are insufficient and inadequate.

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In most cases, the data pre-date the COVID-19 pandemic, which has greatly exacerbated the risk factors for mental health conditions for many people.

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The pandemic is sure to impact the prevalence and burden of mental disorders, just as access to mental health services has been compromised (see Chapter 2, In focus: COVID-19 and mental health).

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This estimate includes people living with schizophrenia, depressive disorders (including dysthymia), anxiety disorders, bipolar disorder, autism spectrum disorders, attention-deficit/hyperactivity disorder, conduct disorder, idiopathic devel opmental intellectual disability, eating disorders and other mental disorders, as covered in the GBD 2019.

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These are GBD 2019 data and do not necessarily represent ICD-11 categorization.

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All prevalence data reflect point prevalence, except for bipolar disorder for which a 12-month prevalence was calculated.

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We lost my brother when he was just 33 years of age, without a conclusive diagnosis.

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This cost includes both direct costs of treatment and other services as well as other costs such as foregone production and income.

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And 76% of WHO Member States confirmed their ability to report against five core mental health indicators, compared with 60% in 2014 and 62% in 2017.

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To address this challenge, the Countdown Global Mental Health 2030 initiative uses a broad and integrated set of indicators to track progress in mental health (135).

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Chapter summary In this chapter we make the case for investment in mental health, explaining how transforming mental health care provides a platform for advancing public health and well-being, protecting human rights and promoting social and economic development.

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A solution must be found for people to enjoy their right to care and rehabilitation so they can be part of society.

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Diabetes is significantly linked with depression, intermittent explosive disorder, binge eating disorder and bulimia nervosa.

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People with common mental health conditions have an excess mortality of 8–12% through smoking, diabetes, history of myocardial infarction and hypertension.

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The growth in participatory processes for people with lived experience has mainly taken place in high-income countries (209).

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Only a third of middle-income countries – and just 16% of low-income ones – have a formal mechanism in place for involving service user associations in the mental health system (5).

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It also gives people a level of choice and autonomy they may not have received otherwise.

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Gender equality • Inequity and gender-based violence are risk factors for mental health conditions.

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Exposure to community-level violence is a risk factor for mental health conditions.

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Developing and enforcing zero discrimination policies that help the mental health workforce unpack biases will also help bring about much-needed change.

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For example, they had lower housing standards, lower household income, fewer assets, and higher health care expenditures (216).

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It enables reorgani zation and scaling up of services and supports.

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These can be used to track trends and clusters of cases, identify at-risk groups and measure mental health outputs and outcomes (including coverage).

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Public expressions of support to mental health by government leaders and decision-makers.

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Harnessing digital technologies for mental health Digital technologies – from websites and online platforms to smartphones and mobile applications – have long been able to help people achieve better mental health (266).

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This trend was amplified during the COVID-19 pandemic as service users and providers searched for ways to deliver and access mental health care amid social restrictions.

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In remote rural areas, tele-mental health may be more convenient for logistical purposes.

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I can actually feel a difference Nour’s experience Since birth, I have suffered with brittle bone disease.

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This requires all sectors, not just health, to allocate resources to mental health.

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All mhGAP training is designed to be followed up with ongoing supervision and support.

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Do something meaningful, important and valuable to provide a sense of purpose (Commit).

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Reshaping the individual, social and structural factors that influence mental health often requires power, experience and expertise that lie beyond the health sector.

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Multisectoral collaboration is more likely to succeed when there is transformative leadership to inspire and make the case for action, to focus efforts, and to drive through the necessary negotiations (see section 5.2.1 Strengthening political will and engagement).

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It prevents people from seeking life-saving help, and it creates barriers to implementing policies, delivering effective support and to getting accurate knowledge on the size of the problem (356).

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Such declines have not been associated with reductions in agricultural yield (363).

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Conversely, stories that include information on where to seek help contribute to suicide prevention (369).

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Together, they support access to care and social inclusion for children with mental health conditions.

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And those that do not comply with the new guidelines may be fined.

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For each person, the aim is to avoid breaks or gaps in the support provided.

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These services can be commissioned by the government or established independently.

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The new model of care is also cheaper, delivered at 37% of the cost of the old asylum in Trieste.

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It is also feasible, affordable and cost–effective, including in LMICs (478).

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Sources: Ahmed Hajebi, Director of Mental Health and Substance Use, Ministry of Health and Medical Education, Islamic Republic of Iran, personal communication, April 2022; Smith, 2020 (480).

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Most doctors were observed to comply with standards of care defined in training.

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Importantly, it can also help services reach vulnerable people with higher risk of mental health conditions.

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These centres are typically staffed by multidisciplinary teams and need to be well connected with primary care facilities, local hospitals and with organizations beyond the health sector (see Box 7.13 Peru: comprehen sive community-based mental health care).

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They may provide clinical services in non-health settings such as prisons.

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There are now more than 100 Headspace centres in Australia and 28 in Denmark.

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Not all loans are paid back; and some are used simply to cover the costs of emergency care; but many are used to support livelihood activities.

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Training assessors on mental health conditions and associated social problems may also help improve the assessment processes.

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The result is that for too many people, achieving and maintaining good mental health is a challenge.

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Global status report on the public health response to dementia.

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The World mental health report: transforming mental health for all is designed to inspire and inform better mental health for everyone everywhere.

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Drawing on the latest evidence available, showcasing examples of good practice from around the world, and voicing people’s lived experience, it highlights why and where change is most needed and how it can best be achieved.

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