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Jennifer Highland

Mental health a global priority- The WHO action plan

Making Mental Health a Global Priority”  is a two-day high-level meeting hosted  by the World Bank Group and World Health Organization (WHO) with the objective to include mental health as a global priority. This blog post is based on the report published after the meeting.

Mental health a global priority

  • Studies estimate that at least 10% of the world’s population is affected by mental illness
  • 20% of children and adolescents suffer from some type of mental disorder
  • Mental disorders account for 30% of the non-fatal disease burden worldwide and 10% of the overall burden of disease, including death and disability

It is a known fact that two of the most common mental disorders, anxiety and depression, respond well to treatment. However, due to a lack of funding, these disorders are not treated in most cases. For governments and healthcare authorities, investing in the treatment of mental illness may seem questionable; nevertheless, mental disorders have many ripple effects, including a strong economic impact on society.  In fact, mental disorders account for almost one in three years lived with disability globally. Additionally, there is a strong link between mental disorders and potentially fatal conditions including cancer, cardiovascular disease, diabetes, HIV and obesity.

A recent analysis shows that treating anxiety and depression is a cost-effective way to promote well-being and prosperity in a community – and that failure to be treated can contribute to impoverishment at a household level and to reduced economic growth and social well-being at a national level.

To tackle today’s mental health challenges, governments and international development partners should work together to fund cost-effective alternatives to treat mental health. This funding will provide a strong return on investment, with scale-up leading to good returns in restored productivity as well as improved health.

Action plans proposed by the World Bank and WHO

1. A new mental health system

The effective care of depression and anxiety requires a comprehensive mental health system including governance, healthcare institutions and community settings to endorse holistic mental health plans. Mental health planners and policy makers need to develop, through public awareness and community engagement, care delivery systems that are sensitive to local social, economic, and cultural contexts; this will ensure that services are appropriately sought out and utilized.

2. Integrated care for depression in primary, maternal, and paediatric care

In addition to its impact on physical health, depression can affect the management of chronic co-occurring diseases, such as diabetes, hypertension, cardiovascular disease and cancer.

Collaborative care—an evidence-based approach to care for chronic illness applied in primary care settings—guides the effective use of resources for delivery of quality mental health care. It emerges as an effective way to address co-morbid conditions and commonly co-occurring risk factors while improving overall health outcomes. Collaborative care emphasizes systematic identification of patients, self-care, and active care management by clinical providers, blended with other medical, mental health, and community supports.

Anxiety and depression also play large roles in the health of expectant and new mothers and their children. A study conducted in 2007 revealed that more than 50% of pregnant women suffer from anxiety and more than 37% suffer from depression. Antenatal depression can increase the likelihood of preterm birth, low birth weight, and cognitive disturbances. In addition, 10-15% of new mothers suffer from post-partum depression. Studies have shown that antenatal and postnatal interventions are effective in reducing depression and anxiety, which improves infant outcomes.

Children and young adults are also affected by depression and anxiety, which causes a negative effect on their ability to learn and study. Besides, since 75% of all mental disorders have a first onset by the age of 18-24, integrating mental health treatment into standard paediatric health care would not only improve students’ learning outcomes, it would also allow children and young adults to obtain treatment at an early stage.

3. Information and communications technology (ICT)-based platforms

ICT-based platforms, such as the one offered by Monsenso, provide an alternative method of mental health care delivery when resources are scarce, while also addressing long-standing obstacles in mental health delivery, such as transportation barriers, stigma associated with visiting mental health clinics, clinician shortages and high costs.

These platforms, especially mobile mental health interventions, can offer remote screening, diagnosis, monitoring and treatment; remote training for non-specialist healthcare workers; and can be used to develop and deliver highly specific, contextualized interventions.

Cognitive Behavioural Therapy (CBT) has been successfully implemented through information technology platforms, demonstrating improvement in depressive symptoms, reduced costs, patient acceptance and enhanced primary care workflow. In addition, patient participation is rapidly expanding in peer-to-peer social networks where patients can access around the clock support with demonstrable improvements in depression symptoms.

4. Platforms outside the health sector

Anti-stigma campaigns

Stigma associated with mental disorders can result in social isolation, low self-esteem, and limited chances in education, employment, and housing. Therefore, anti-stigma campaigns are powerful tools to confront mental disorders.

School-based interventions

The key strength of school-based health screening and care is that it maximises outreach in school age children and adolescents. The potential benefits include the healthy development of students, improved academic performance, and opportunities to integrate school and clinic-based services.

Workplace interventions

There is a huge amount of evidence that investing in workplace wellness programs is good for employees and companies.

Workplace mental health interventions can be centred on treatment or mental health promotion such as cognitive-behavioural approaches targeting stress reduction. Organizational-level workplace interventions can include policies that address prevention and early intervention.

Interventions related to conflicts and natural disasters

Conflict exposes civilian populations and refugees to violence and high levels of stress, resulting in dramatic rises in mental illness that can continue for decades after armed conflict has ceased. Therefore, part of the rebuilding efforts in post-conflict and post-disaster societies should include building mental health services that are well integrated into primary care and public health efforts.

Reference:

Out of the Shadows: Making Mental Health a Global Development Priority. World Bank and World Health Organization. 2016