Mental health: lessons learned in 2020 for 2021 and forward

Mental health is one of the most neglected areas of health globally.  This was true before COVID-19 (coronavirus), but the pandemic has further worsened the status of mental health.

There are several reasons why mental health has been ignored. The first one is an associated stigma. The second is a perception of mental health disorders as a “luxury good”, as opposed to actual illnesses. The additional top reasons include a fragmented and outdated service model. Some of these include the provision of mental health services mainly in psychiatric hospitals, severe lack of preventative mental health service; lagging policy changes and also a shortage of human resources.

Mental health in numbers

The numbers are staggering. Today, nearly 1 billion people live with a mental disorder and in low-income countries, more than 75% of people with the disorder do not receive treatment. Every year, close to 3 million people die due to substance abuse.  Every 40 seconds, a person dies by suicide. About 50% of mental health disorders start by the age of 14.

It is estimated that over 160 million people need humanitarian assistance because of conflicts, natural disasters, and other emergencies. The rates of mental disorders can double during such crises. 1 in 5 people affected by conflict is estimated to have a mental health condition.

According to the World Health Organization (WHO), the COVID-19 pandemic has disrupted or, in some cases, halted critical mental health services in 93% of countries worldwide, while the demand for mental health is increasing. Given the chronic nature of the disease, this translates into a significant economic impact worldwide. Countries spend less than 2% of their health budgets on mental health. It is expected that in the next ten years, depression will put more burden on nations than any other disease.

The World Bank and mental health

The World Bank’s overriding strategy to help countries accelerate progress towards achieving Universal Health Coverage (UHC) includes both physical and mental health.  In fact, mental health cannot be tackled in a silo because it is not just a health sector issue. Its impact percolates through every sector of a country’s economy.

This means that it is strongly linked to the socio-economic agenda as well. Mental health programs have long been part of the World Bank’s development projects. This is continuing to be the case in our delivery of emergency assistance to countries battling COVID-19. In the first 100 days of the outbreak, the World Bank delivered projects in over 100 countries.

Despite having to focus on most immediate and urgent needs for the pandemic, many countries decided to include mental health assistance into their programs , recognizing the value of good mental health in crisis. For example, in countries including Cambodia, Guatemala, Lesotho, Liberia, Mali, Marshall Islands, Morocco, Niger, Nigeria, Republic of Congo, and Sri Lanka, Bank projects are supporting psychosocial interventions to help people deal with the negative psychological effects from stressors such as lockdowns, self-isolation and quarantines, infection fears, inadequate information, job and financial losses, and stigma and discrimination.

Looking ahead at mental health in 2021

Investing in mental health makes good economic sense. As we begin 2021, I would like to reflect on a few lessons learned:

• The COVID-19 pandemic exposed the vulnerabilities of health systems globally. For health systems to achieve sustainability, strong primary health care is essential. The primary healthcare services can only be considered strong if they address both components of health: physical and mental. Therefore, mental health services must be integrated into health systems as opposed to only being provided in a silo. They need to be included in the basic health care benefits packages.
• According to the WHO, every $1 invested in mental health yields a $4 return on investment. In Ukraine, for example, it is estimated that for the period between 2017 to 2030, the country could save $2 on restored productivity and added economic value, if it invests $1 in the treatment of common mental disorders.
• Investing in mental health requires a multi-sectoral and integrated approach.  It entails a “whole of society approach,” with community-based involvement, along with primary care services, public health, social protection, jobs, and education.
• Governments need to allocate resources from development assistance and domestic health budgets to implement community-based mental-health programs and strengthen the overall treatment of mental disorders. In Peru, the government used a results-based financing model as a new way of supporting mental health services through community-based mental health centers (CBMH). By turning the approach into law, Peru ensured resources could not be diverted towards other activities. This helped increase investments in mental health by 400%, (from $25 to $104 millions). The number of CBMHCs increased from 22 to 154 centers by the end 2019, with an additional 60 being planned.  
• Prioritizing the psychosocial needs of vulnerable groups, including displaced persons, is critical to a country’s investment in health and human capital.
• For sustainable mental health programs there is a need for collaboration and accountability across several branches of government. It is necessary for all leaders to be vocal on the topic.  This support for mental health ought to be political, financial, and cross-sectoral.

Attaining the Sustainable Development Goals by 2030

Scale up and speed in addressing mental illness are essential to achieving the Sustainable Development Goals (SDGs) of ensuring healthy lives and the well-being for all at all ages by 2030. Failure to do so, could have devastating socio-economic impacts. Investing in health reaps the benefits both within and outside of the health sector.

We are witnessing the mental health crisis unfolding simultaneously with the pandemic. The data points out the consequences the world will face if mental health takes the back seat. We are left with a simple conclusion: simply put, there is no health without mental health!