Advancing global mental health action: lessons from Canada

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In 2016, a lot of effort was placed on shining the light on mental health as a neglected issue in the global health and development agendas.  The flagship event organized by the World Bank Group (WBG) and the World Health Organization (WHO) during the Spring Meetings of the WBG/IMF held in Washington D.C. was an important step to galvanize attention and commitment to change this situation.

There are countries, such as Canada, that show that well-designed frameworks, built upon broad consultations involving local, regional, and national groups, agencies, governments, and vulnerable population groups such as Indigenous peoples and people with lived experience, and that enjoy the highest level of political commitment, can serve as good roadmaps for advancing the mental health agenda over the medium term.

The “Changing Directions, Changing Lives: The Mental Health Strategy for Canada”, along with the “Advancing the Mental Health Strategy for Canada: A Framework for Action (2017–2022)” adopted to accelerate uptake and implementation of the strategy, offer some lessons for designing and implementing comprehensive national mental health strategies.

A key aspect of the Canadian mental health strategy is its humanistic orientation.  It positions people living with mental health problems and illnesses and their families as the drivers of change in mental health.  It also recognizes that success depends on the commitment of governments to set policies and fund services, as well as of other actors to regulate, accredit, monitor, and deliver services.  

The framework for action is structured around four pillars that are geared to improve the mental health and well-being of people in Canada and the services they need:

• Leadership and funding:  the mobilization of commitment and support from the highest political level is critical to better resource the mental health response and increase the capacity to deliver quality, evidence-based, and integrated services and better meet the needs of diverse population groups. While funding is important, it is emphasized that leaders need to focus on achieving parity between physical and mental health care, better integrating mental health and physical health, and fostering collaboration across the health, social, education, and justice sectors.
• Promotion and prevention:  given the multisectoral nature of mental health problems and illnesses, upstream efforts are needed, placing more emphasis on holistic prevention strategies, promotion of mental wellness, increased awareness and education about positive mental health across the lifespan, and a more refined focus on the social determinants of health in a culturally competent and safe manner.  Promotion and prevention must be complemented with efforts to uphold human rights, social inclusion, and eliminate stigma and discrimination.
• Access and services:  making timely access to evidence-based, integrated, person-centered, holistic, high-quality mental health services across the continuum of care should be a priority.  People with lived experience and their caregivers must be engaged at all service points and in the policy development process to truly improve the availability and quality of mental health services.
• Data and research:  aside from developing benchmarks and ongoing evaluation of system performance, as well as the translation of evidence-based mental health knowledge into policy and practice, this pillar includes support for  comprehensive, innovative, interdisciplinary research and evaluation on mental health problems and illnesses and mental health programs and treatments; facilitating the involvement of people living with mental illnesses in research; improving data collection systems and population-level monitoring to collect comprehensive information on mental health, wellness, illness, service access, and wait times and ensure that publicly-funded data is available to researchers and policy makers.

These pillars are in line with WHO’s Mental Health Action Plan 2013-2020, adopted by the World Health Assembly, consisting of all ministers of health, including of Canada.

Canada has also established itself as a leader on global mental health. Many Canadian agencies have been collaborating with international and national partners. For example, since 2012, Grand Challenges Canada (GCC) has invested more than 35 million Canadian dollars to fund over 70 innovative mental health projects in more than 28 low-and middle-income countries. These innovations have led to tens of thousands people receiving mental health care; GCC funded grants have the potential to improve thousands of additional by 2030. GCC has also supported the establishment of Mental Health Innovation Network, which shares information and knowledge for decision making to innovators, researchers, civil society and policy makers.

By defining a broad, multi-stakeholder, social compact to support mental health promotion and mental illness prevention and treatment, Canada’s mental health strategy and the framework for action show the importance of alternative “distributive social ethics” or “moral values” in developing ­ public policies. That is, the well-articulated, socially inclusive goals and participatory mechanisms of the strategy illustrate that broad social goals are the basic parameters that ultimately guide and shape policy and institutional decisions concerning the most appropriate and contextually relevant organizational forms, financing arrangements, and service delivery mechanisms. The strategy also clearly distinguishes the intermediate goals (improved access, quality, efficiency, and fairness) from the ultimate goals of integrated mental health and social systems (improved social and mental and physical health conditions, financial protection, and user satisfaction with the services received), avoiding the risk of confusing the means and ends of policy action.  

While recognizing that heterogeneous social, economic, and cultural country contexts preclude the mechanical adoption of other countries’ experiences, the transnational sharing of knowledge and adaptation of relevant aspects of those international experiences to specific country realities is one of the benefits of living in an interconnected, globalized world.  If inclusive mental health policy, programs, and services are going to thrive across the world to improve health outcomes for people with mental health problems and illnesses and their families, we will do well in recognizing that more than technical processes, their realization will depend, as Canada’s experience shows, on social and political decisions as to what kind of society a country wants to have.  Canada’s contributions at the international level, also set an example for other countries to contribute to global mental health.

Related

WBG/WHO “Out of the Shadows: Making Mental Health a Global Priority” event WBG/IMF Spring Meetings, Washington, D.C. April 13-14, 2016
Mental health services in situations of conflict, fragility and violence: What to do?
Mental health among displaced people and refugees: making the case for action at the World Bank Group
Changing Directions Changing Lives: The Mental Health Strategy for Canada
Advancing the Mental Health Strategy for Canada: A Framework for Action (2017–2022)
Ethics, values and health systems
WHO Mental Health Action Plan 2013-2020
WBG Mental Health site
Mental Health Innovation Network