– Sets new targets for 2030
The World Health Organization (WHO) has expressed disappointment over the inability of most of the world to meet the mental health needs for people requiring them.
The UN body revealed this while referring to a new Mental Health Atlas which paints a sad picture of a worldwide failure to provide people with the mental health services, at a time when the COVID-19 pandemic is highlighting a growing need for mental health support.
It was explained that the latest edition of the Atlas which includes data from 171 countries, indicates that the increased attention given to mental health in recent years has yet to result in a scale-up of quality mental services that is aligned with needs.
The Atlas which is issued every three years is a compilation of data provided by countries around the world on mental health policies, legislation, financing, human resources, availability and utilization of services and data collection systems.
“It is also the mechanism for monitoring progress towards meeting the targets in WHO’s Comprehensive Mental Health Action Plan”, WHO clarified.
The Director General of WHO, Dr Tedros Ghebreyesus is reported to have expressed worry that good intentions towards mental health care needs are not quite backed with investments.
“We must heed and act on this wake-up call and dramatically accelerate the scale-up of investment in mental health, because there is no health without mental health.”
The Atlas report indicates a lack of progress in leadership, governance and financing, as none of the targets for effective leadership and governance for mental health, provision of mental health services in community-based settings, mental health promotion and prevention, and strengthening of information systems, were close to being achieved.
“In 2020, just 51% of WHO’s 194 Member States reported that their mental health policy or plan was in line with international and regional human rights instruments, way short of the 80% target.
“And only 52% of countries met the target relating to mental health promotion and prevention programmes, also well below the 80% target. The only 2020 target met was a reduction in the rate of suicide by 10%, but even then, only 35 countries said they had a stand-alone prevention strategy, policy or plan.”
Steady progress was however reported, but in the adoption of mental health policies, plans and laws, as well as in improvements in capacity to report on a set of core mental health indicators.
Percentage of government health budgets spent on mental health was said to have scarcely changed during the last years, still hovering around 2%; even when policies and plans included estimates of required human and financial resources only 39% of responding countries indicated that the necessary human resources had been allocated and 34% that the required financial resources had been provided.
The report also provided information on transfer of care to the community was said to be slow.
“While the systematic decentralization of mental health care to community settings has long been recommended by WHO, only 25% of responding countries met all the criteria for integration of mental health into primary care.
“While progress has been made in training and supervision in most countries, the supply of medicines for mental health conditions and psychosocial care in primary health-care services remains limited.”
The above was said to also reflect in the way that government funds to mental health are allocated, and it highlights the urgent need for deinstitutionalization as more than 70% of total government expenditure on mental health was allocated to mental hospitals in middle-income countries, compared with 35% in high-income countries.
“This indicates that centralized mental hospitals and institutional inpatient care still receive more funds than services provided in general hospitals and primary health-care centres in many countries.
“There was, however, an increase in the percentage of countries reporting that treatment of people with specific mental health conditions (psychosis, bipolar disorder and depression) is included in national health insurance or reimbursement schemes – from 73% in 2017 to 80% (or 55% of Member States) in 2020.
“Global estimates of people receiving care for specific mental health conditions (used as a proxy for mental health care as a whole) remained less than 50%, with a global median of 40% of people with depression and just 29% of people with psychosis receiving care.”
The new edition of the Atlas indicated increase in mental health promotion, but questionable effectiveness.
There was an encouraging report of countries with increased mental health promotion and prevention programmes, from 41% of Member States in 2014 to 52% in 2020; however, 31% of total reported programmes did not have dedicated human and financial resources, 27% did not have a defined plan, and 39% had no documented evidence of progress and/or impact.
On the mental health workforce, the Atlas report indicated slight increase as the global median number of mental health workers per 100 000 population has increased slightly from nine workers in 2014 to 13 workers per 100 000 population in 2020.
The reported increase also showed a very high variation between countries of different income levels, with the number of mental health workers in high-income countries more than 40 times higher than in low-income countries.
There were new targets set for 2030, even as majority of countries failed to meet the 2020 target.
“The global targets reported on in the Mental Health Atlas are from WHO’s Comprehensive Mental Health Action Plan, which contained targets for 2020 endorsed by the World Health Assembly in 2013.”
The target includes mental health and psychosocial support in emergency preparedness plans, the integration of mental health into primary health care, and research on mental health.
The Director of the Department of Mental Health and Substance Use at WHO, Dévora Kestel was quoted as being optimistic that more seriousness will be accorded the new targets by WHO member countries.
“The new data from the Mental Health Atlas shows us that we still have a very long way to go in making sure that everyone, everywhere, has access to quality mental health care.
“But I am encouraged by the renewed vigour that we saw from governments as the new targets for 2030 were discussed and agreed and am confident that together we can do what is necessary to move from baby steps to giant leaps forward in the next 10 years.”