Mental illness affects one in four people and neuropsychiatric conditions now account for 13 per cent of the global burden of disease – 70 per cent of that burden in low- and middle-income countries. Yet mental health does not receive the attention – or the funding – that it warrants. For example, although mental health problems account for almost a quarter of all the disability in the world, the poorest countries dedicate just 0.5 per cent of their health budgets to it. Mental health was also notably absent from the Millennium Development Goals.
The post-2015 Sustainable Development Goals (SDGs), now in the final stages of drafting, are a crucial opportunity to change this. Governments, international donors and the general public respond to high-level priorities like the SDGs, and campaigners are rightly calling for mental health to be included as a target.
However, it’s not as easy as it sounds. There are four characteristics of mental health that make it particularly hard to turn the very real needs into simple policy realities and solutions. First, policy-makers are not immune to the huge stigma around mental health, which inevitably influences their treatment of the issue.
Second, there are many types of mental, neurological and substance use (MNS) disorders. Everyone’s experience is different – and so are the treatments they require. This diversity makes it difficult to develop a single, succinct ‘policy ask’ or promote one coherent solution.
Third, mental health isn’t like HIV/AIDS – people with MNS disorders are only recently starting to unite into social movements. These movements haven’t yet been able to attract the kind of funding that has empowered the larger, better-known health movements to establish support systems and active global networks.
Fourth, in low- and middle-income countries, a lot of mental health care frequently occurs in the informal sector – provided by family members or communities. Because it bypasses state systems it is effectively hidden. And all over the world, the under-diagnosis of mental illness leaves us with an inaccurate picture of the severity and scale of the problem. Consequently, the lack of evidence available on mental illness (much improved over the last decade or so thanks to the World Health Organization (WHO) creating the World Mental Health Atlas) has made it harder to persuade policy-makers to act.
There is hope. Public interest in mental health, particularly in high-income countries, has grown dramatically over the past 20 years. We are seeing real change at the intergovernmental level – at the 66th session of the World Health Assembly in 2013, 194 WHO member states committed to achieving the objectives and targets of WHO’s Mental Health Action Plan 2013-2020. This milestone is a key opportunity for activists and practitioners to be heard and have influence. Networks like the Mental Health Innovation Network (funded by Grand Challenges Canada) can play a very important role shaping the way that the world reacts to mental health issues, with the projects they fund already finding cost-effective treatment solutions that can be applied in different countries, and rolled out to new communities. This work is just starting, but will be crucial in coming years.
If this momentum can be harnessed, the SDGs will provide a formidable starting point to ensuring policy-makers worldwide recognise the vital role that mental health plays in our daily lives. It would provide the cohesion, common framework and international governance structures to effect real change. It would show that in the eyes of the international community, there can be no health without mental health.
Jessica Mackenzie is a Research Fellow at the Overseas Development Institute (ODI). For more on the characteristics of mental health as a policy issue, and the engagement strategies that the mental health community can draw upon, see the upcoming MHIN/ODI report titled ‘Global Mental Health from a Policy Perspective: A Context Analysis’