In recognition of World Mental Health Day, let’s all reach out to colleagues, neighbors or relatives with a brief greeting, a hug, a waving hand or a smile—a small gesture to promote mental health and well-being. Photo: Rialda Kovacevic.
The COVID-19 pandemic has severely affected the performance of primary health care services around the world, but especially in low- and middle-income countries (LMICs), although the full magnitude of this impact has yet to be measured. The pandemic also brought to the surface chronic deficiencies in the delivery of care, in particular for mental health.
Most public health programs struggled to maintain their usual quality standards as personnel and supplies were mobilized to support the unusual demand at the hospital level. Patients with neurological and mental health conditions, including substance use disorders, experienced disruption in their evaluation and treatment. At the same time, demand for mental health services increased among frontline workers, youth, migrant populations, and those living in precarious circumstances. Anxiety and depression have risen among people without pre-existing mental conditions. In sum, demand for mental health services has soared since 2020 and the provision of care has struggled to cope with the need.
The economic consequences of mental health conditions are enormous. Productivity losses and other indirect costs to society often far outstrip health care costs. On average, countries dedicate less than 2 percent of their health care budgets to mental health and lost productivity due to mental illness amounts to the equivalent of $1 trillion in losses per year. More than 70 percent of mental health expenditure in middle-income countries still goes towards psychiatric hospitals.
Adapting mental health responses to different contexts
In the Latin America and the Caribbean region, countries are addressing this challenge in different ways, including with support received from the World Bank and Access Accelerated. Colombia has deployed a technology-driven model of care for depression and risky use of alcohol by primary care providers. Chile has strengthened mental health treatment in primary care centers in synergy with the health network and the community. Peru is showcasing how to leverage results-based financing and develop community mental health services on a national scale while Paraguay is focusing on narrowing the gap between its current system and the actual reality of mental health care provision in the country under its new National Mental Health Strategy. Uruguay is adapting preventive strategies to mental health care delivery, including telemedicine as well as a community response and access to medication for chronic cases at the primary level of care. In El Salvador, the focus is on adolescent health and the impact of violence on mental health. The country is examining strategies adopted in multisectoral initiatives that have successfully reduced suicide among young men in violent contexts and gender-based violence affecting girls and young women.
Stigma remains a major issue that requires special attention. Chile adapted four cross-cultural instruments to measure stigma towards people with mental illness and substance abuse problems among primary care professionals. In Ecuador, the discussion focuses on reducing stigma and the institutionalization of patients, including mental health care at the primary level of care and strengthening community support.
In Sint Maarten, efforts are focused on overall improvement of access and quality of mental health care in the context of a small island. The country is also leading a regional initiative to make treatment available to neighboring islands, to make sure no patient is left behind.
Increasing access to mental health services through primary care
The pressing need for access to mental health services has been driving transformation in the World Bank’s approach to mental health, which puts mental health in focus at the community and primary care level. This tactic helps address several challenges. About half of the world’s population lives in countries where there is just one psychiatrist to serve 200,000 or more people , therefore training PHC providers and community mental health workers can address this gap. More importantly, such an approach can also help address the stigma associated with mental health, as a mental health visit at the PHC level is seen as a just another condition to be addressed in this setting. Because patients can address both physical and mental health conditions at the same time, this approach can help increase compliance with follow ups. Finally, outcomes for the patient can also improve, as timely care and follow-up is critical to achieving better outcomes.
Boosting financing to address mental health challenges
Providing adequate funding for mental health care may yield high economic returns. According to WHO, the return on investment in mental health care interventions in Jamaica, Peru, and Surinam proved to be two to five times higher than was initially projected. However, data from the WHO Mental Health Atlas showed that the median public expenditure allocated to tackling the mental health burden in the Americas is a paltry 3 percent – insufficient to address the scale of the challenge.
To transform mental health services, commitment must be translated into action by devoting more funds to mental health and ensure mental health services are integrated into the provision of essential health services.
As mental health is a leading cause of disability globally, it is time to pay attention to this silent pandemic before it is too late . The World Bank has been supporting countries to strengthen mental health programs and its work spans from high-level advocacy, technical assessments, and investment lending to capacity building. Together with international partners, such as Access Accelerated, the World Bank has supported efforts in several countries in addressing mental health conditions. We hope to keep building on those successes, leverage lessons learned from our current efforts, and create a world where mental health is no longer separated from physical health.
In recognition of World Mental Health Day last week, let’s all reach out to colleagues, neighbors or relatives and tell them: “U R Always on My Mind.” A brief greeting, a hug, a waving hand or a smile can have a big impact. Our small gesture will contribute to a collective effort to adopt Mental Health in All Policies (MhiAP) – an approach to promoting mental health and well-being that involves initiating action in non-health public policy areas.
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