Six ways to advance mental health care for all

In the World Health Organization’s (WHO) most recent World Mental Health Report: Transforming Mental Health For All, Director-General Tedros Adhanom Ghebreyesus, PhD, reflected: “Mental health is a lot more than the absence of illness: it is an intrinsic part of our individual and collective health and well-being. …We need to transform our attitudes, actions, and approaches to promote and protect mental health, and to provide and care for those in need.”

To build on this call to action and PATH’s work in mental health, we partnered with United for Global Mental Health to bring together a panel of global experts to raise awareness and brainstorm collective action.

As the world continues to adjust to the effects of COVID-19, PATH urges practitioners, advocates, and ministries of health to incorporate mental health care as a core component of universal health coverage. This, we argue, can be achieved by:

• Combating stigma: Mental health is critical to the well-being of the individual and their respective communities. We must determine ways to fight stigma around mental illness.
• Integrating care: We should merge mental health services into routine primary health care.
• Prioritizing a people-centered approach: We must engage those with lived experience in governance, policy development, and service design of mental health programs and policy interventions.
• Supporting providers and caregivers: We must equip providers and caregivers with the appropriate tools and resources to support their own mental well-being, for themselves and the clients they serve.
• Increasing investments in access and data: This will involve advocating to ministries of health to increase funding for mental health services and reporting mechanisms that can be used to collect data and generate more evidence-based solutions to barriers in accessing mental health care.
• Uplifting youth perspectives: We must encourage youth to share their viewpoints and advocate for them to be given a critical role in government shaping of mental health care policies.

Our priorities as health care advocates and practitioners must be aligned to ensure that mental health care is a core component of universal health coverage.

Mental health is at the heart of personal and population resiliency. Yet individuals seeking support often face stigma, resulting in barriers that are difficult to overcome.

"Every culture has its terminology for mental health. There can be tremendous stigma and discrimination around talking about mental health and seeking support,” emphasizes co-founder and CEO of United for Global Mental Health Sarah Kline.

False ideas about mental health have long-term effects and support discrimination against individuals and families. They also perpetuate the incorrect perception that there is no reason to support mental health programs, leading to a lack of funding, further misunderstandings, and barriers for those seeking help.

Paul Bolton, MD, Mental Health and Psychosocial Support Coordinator (MHPSS) for the US Agency for International Development, emphasizes this point by reflecting on his experience as a young physician:

“I used to drive to cities far away to get treatment,” said Bolton. “I was definitely afraid that the people I was working with would find out that I had mental health issues.”

The WHO report on mental health makes the case for “deepening the value and commitment,” which includes understanding and appreciating the intrinsic value of mental health and promoting the social inclusion of people with mental health conditions.

To truly prioritize mental health, services should be integrated as part of an essential package of care that’s delivered through primary health care. Doing so will allow mental health services to be routine, proactively offered, and reimbursable by health insurance companies. To achieve this, governments must allocate a portion of their health budgets to mental health care.

Kimberly Green, PhD, PATH’s Director of Primary Health Care, emphasizes the impact that increased financing can have when mental health care is integrated into physical health services. “There are countries like Brazil, India, Indonesia, and Thailand that have embedded mental health into their financing policies,” she shared. “Because of that, there is more normalization, less stigma, and increased access.”

As demonstrated in the first phase of PATH’s caregiver mental health work in Mozambique, this integration is critical to providing person-centered comprehensive care and achieving better health outcomes. The pilot intervention involved maternal and child health nurses screening mothers for postpartum depression. More than 70 percent of suspected cases referred by the nurses were confirmed by mental health technicians, giving us stronger reason to advocate for the integration of physical and mental health services.

Advocating for governments and policies to implement a people-centered approach is a critical action item. In our efforts to broaden access to mental health services, we must engage those with lived experience in the governance, policy development, and service design of mental health programs and policy interventions.

WHO Mental Health Specialist Dan Chisholm, MD, says this work will not be done in siloes, but rather through “community-based networks of services in both primary and secondary health care levels.”

Finding the throughline between the varying networks and services will require a tailored approach that is specific to each individual, as those in low-income areas will experience different needs than those in high-income areas.

As we approach the third anniversary of the COVID-19 pandemic, providers remain on the frontlines of service delivery, yet far too many are still experiencing its detrimental effects. A recently published study by the American Nurses Foundation found that 32 percent of nurses with less than 10 years of experience indicated being either not, or not at all, emotionally healthy.

“We’ve had a triple-demic with flu, RSV, and COVID-19,” says Green. “Health care workers are overwhelmed. Burnout, depression, anxiety, and suicide are real crises. Mental health needs to be factored into training and policies in a way that supports health care workers.”

We must equip providers and caregivers with resources to support their own mental well-being—especially as they assist patients in this area. Ideally, everyone in health care would have training and access to the appropriate tools to care for a person with a mental health condition. At a minimum, we must address the burden that has, and continues to be, placed on health care workers because of the pandemic and other stressors on health care systems.

Policies around access to care and support should also consider the mental health of other caregivers, such as parents. Food for the Hungry’s Mariamu Amadi, MPH, detailed a study, conducted in part by the organization, that demonstrated the significant impact a family member’s mental health can have on their kin.

The organization piloted a community-based intervention in Uganda to reduce the burden of poor mental health on caregivers and mothers, to improve the health, nutrition, and well-being of their children. This involved creating and nurturing psychosocial support groups.

The results of this study highlighted the importance of addressing caregiver mental health when it comes to improving child health and nutrition. Governments and health ministries can bolster traditional health programs by incorporating support interventions, which the community can then sustain.

Although we’ve seen an increase in the number of individuals who desire mental health care, it is still difficult for most people to receive services. Published studies reveal that mental and addictive disorders affect more than 1 billion people globally, yet 70 percent of those who need mental health care lack access.

Lack of data on mental health feeds into a cycle of stigma and limited financing. Data enable us to learn faster and create the next generation of solutions; give advocates and providers the tools to educate ministries of health about the need to increase funding for mental health services; and can generate more evidence-based solutions.

Stronger data collection will inform the need for more funding for mental health services, more training for providers, and more support for those suffering from mental health conditions, making access to mental health services more routine.

Mental illness affects all ages. The intentional and meaningful engagement of youth brings new insights into the conversations around mental health. The work of the International Association for Youth Mental Health demonstrates the advantages of a participatory process. The organization’s Youth Vice President, Oluwaferanmi Omitoyin, highlights the fallacy of not involving youth when determining how to navigate their health challenges.

“There are policies meant for young people and services provided for them, but no young people are involved in making these policies or processes. So how exactly are you making these things work for them when you do not have the perspective of a young person involved?” Omitoyin questioned.

Many stakeholders are doing important work to increase access to mental health care. The insights shared during our Access to Mental Health Care webinar give us direction on achieving universal health coverage.

In our path forward, we must work together and ensure that we’re bringing concise messages that ministers of health and other leaders can articulate to drive much-needed resources and attention to mental health care. Together, we can make mental health a priority.