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“The zero hour” for mental health

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At times, many of us have felt a sense of loss or detachment from our families, friends and regular routines. We also have experienced nervousness and anxiety about changes in our personal and professional lives, as well as real or imagined fears and worries that have distracted, confused and agitated us.

While these episodes tend to be transitory for most of us, since they are a normal part of human life, for millions of people across the world, frequent and severe bouts of depression and anxiety are a debilitating daily burden that interfere with family, career, and social responsibilities. They can lead to alcohol or drug abuse or other self-destructive behaviors, which increase a sense of isolation and magnify feelings of sadness, loss, anger or frustration. Sometimes, death by suicide is an unfortunate outcome.
These mental disorders can also be triggered when massive social dislocations occur—driven by economic crises, such as the financial crisis of 2008; civil conflicts in places like Central America, Africa and Asia; epidemics, such as Ebola in Guinea, Liberia and Sierra Leone; or earthquakes, such as the recent one in Nepal.  Even after economic growth returns and unemployment drops, after peace settlements are reached, after we eventually reach zero Ebola cases, after the dead are mourned, and after the rebuilding of countries gets under way, there is long-term damage left behind in the social fabric of affected communities and mental well-being of individuals.
The social costs of mental and substance use disorders -- including depression, anxiety, schizophrenia, and drug and alcohol abuse--are enormous.  They are the fifth-leading cause of overall global disease burden, accounting for 7.4% of total years lost due to disability and early death.  And estimates from a World Economic Forum study show that the lost economic output due to the cumulative global impact of mental disorders will top $16 trillion, or more than 1% of the global GDP, over the next 20 years. 
Are countries prepared to deal with this often “invisible” and often-ignored malady? The simple answer is: no. 
In the second decade of the 21st century, not much has changed in many countries regarding how society views and deals with mental illness. Despite its enormous social burden, mental disorders continue to be driven into the shadows by the ever-present reality of stigma, prejudice, fear of disclosing an affliction because a job may be lost, social standing ruined, or simply because health and social support services at the community level are not available or are out of reach for the afflicted and their families.
And some countries are still using 17th century tactics to “protect society”: confining and abandoning the “mad” in asylums or psychiatric hospitals, often for life, which compound the negative impact of mental illnesses on these individuals and on society as a whole. 
In spite of these challenges, there is a growing impatience across the world to begin a new era in which mental health moves from the periphery to the center of the global health agenda and into the larger development context. Knowledge exists to guide this effort: As highlighted in WHO’s Mental Health Action Plan 2013-2020, approved by member states, there are evidence-based, intersectoral strategies and interventions to promote, protect and restore mental health, beyond the institutionalization approaches of the past.  Properly implemented, these interventions represent “best buys” for any society, with massive returns in terms of health and economic gains
If we are going to fully embrace and support the progressive realization of universal health coverage, we must work to ensure that prevention, treatment and care services for mental health disorders at the community level, along with psychosocial support mechanisms, are integral parts of accessible service delivery platforms and covered under financial protection arrangements. We must also advocate for and identify “entry points” across sectors to help tackle the social and economic factors that contribute to the onset and perpetuation of mental health disorders.
We, as part of an international, multi-institutional, working group, coordinated by the distinguished Harvard University professor, Arthur Kleinman, have begun to discuss ways to jump start society-wide efforts to address the mental health challenge.  To this end, World Bank Group President Jim Yong Kim and Margaret Chan, the Director-General of the World Health Organization, will co-host a major event on mental health in Spring 2016.
As we move forward with this task, we will be guided by the belief that the agonies of mental health problems that distort people’s lives, family bonds and communities, and that impose a heavy economic and social burden, can be dealt with effectively if there is political commitment, broad social engagement, and international support to make mental health an integral part of health and societal well-being across the globe.   
Roberto Iunes, Senior Health Economist, World Bank Group, and Melanie Mayhew, Communications Officer, World Bank Group, also contributed to this post.
Follow the World Bank health team on Twitter: @WBG_Health

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WHO Mental Health Action Plan 2013-2020
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Patricio V. Marquez

Former World Bank Group (WBG) Lead Public Health Specialist

Shekhar Saxena

Shekhar Saxena, Director Department of Mental Health and Substance Abuse, World Health Organization

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