The World Health Organization’s new Mental Health Atlas, paints a disappointing picture of a worldwide failure to provide people with the mental health services they need, at a time when the COVID-19 pandemic is highlighting a growing need for mental health support.
The latest edition of the Atlas, includes monitoring data from 171 countries. The Atlas was released ahead of World Mental Health Day today. The focus this year is scaling up access to quality mental health care under the campaign slogan “Mental health care for all: let’s make it a reality”.
“It is extremely concerning that, despite the evident and increasing need for mental health services, which has become even more acute during the COVID-19 pandemic, good intentions are not being met with investment,” said Dr Tedros Adhanom Ghebreyesus, Director-General of the World Health Organization.
“We must heed and act on this wake-up call and dramatically accelerate the scale-up of investment in mental health, because there is no health without mental health.”
In 2020, just 51% of WHO’s 194 Member States reported that their mental health policy or plan was in line with international and regional human rights instruments, way short of the 80% target. The only 2020 target met was a reduction in the rate of suicide by 10%, but even then, only 35 countries said they had a stand-alone prevention strategy, policy or plan.
Steady progress was evident, however, in the adoption of mental health policies, plans and laws, as well as in improvements in capacity to report on a set of core mental health indicators.
Reporting on mental health expenditure remained on a low level, with only 67 countries responding to the question (thereof 31 in the European Region). The percentage of general government health budgets spent on mental health has scarcely changed during the last years, still hovering around 2,1% globally. The highest figure was reported from the European Region with 3,6%.
Mental health research as a percentage of total health research output varies by WHO region and is the highest in the European Region with 8,2%. Overall, there is a significant positive correlation between total government spending per capita on mental health and gross national income.
Hower, the Atlas does not include a breakdown of the figures by country. A WHO spokesperson told The Brussels Times that country profiles are in preparation and expected to be available on the WHO website early next year.
Transfer of care to the community is slow
While the systematic decentralization of mental health care to community settings has long been recommended by WHO, only 25% of responding countries met all the criteria for integration of mental health into primary care.
Community-based mental health services are defined as services that are provided in the community outside a hospital setting and providing overnight residence for persons with mental health conditions (e.g. staffed or unstaffed group homes or hostels, halfway houses, therapeutic communities).
Such facilities scarcely exist in countries in the low- and lower-middle[1]income groups, where the number of facilities reported was less than 0.05 per 100 000 population. Overall, there is a significant positive correlation between total government spending per capita on mental health and gross national income.
The European Region had the highest number of facilities (2.8 facilities per 100 000 population), and the number of beds per 100 000 population in this region rose from 42.3 beds in 2017 to 53.3 in 2020.
Centralized mental hospitals and institutional inpatient care still receive more funds than services provided in general hospitals and primary health-care centres in many countries.
There was, however, an increase in the percentage of countries reporting that treatment of people with specific mental health conditions (psychosis, bipolar disorder and depression) is included in national health insurance or reimbursement schemes – from 73% in 2017 to 80% (or 55% of Member States) in 2020.
The global median number of mental health workers per 100 000 population has increased slightly from nine workers in 2014 to 13 workers per 100 000 population in 2020. However, there was a very high variation between countries of different income levels, with the number of mental health workers in high-income countries more than 40 times higher than in low-income countries.
The global targets for 2020 reported on in the Mental Health Atlas were adopted in 2013. The Mental Health Action Plan has now been extended to 2030 and includes new targets for the inclusion of mental health and psychosocial support in emergency preparedness plans, the integration of mental health into primary health care, and research on mental health.
A previously reported, WHO recently also launched a new Pan-European Mental Health Coalition. The Coalition is a new partnership dedicated to improving mental health across the WHO European Region.
According to WHO, more than 150 million people in the WHO European Region live with a mental health condition, and only one in three people living with depression receive the care they need. Lockdowns, school closures, isolation and joblessness caused by the COVID-19 pandemic have only made things worse.
M. Apelblat
The Brussels Times
