GLOBAL MENTAL HEALTH

Mental Health & Sustainable Development

Lecturer: Dr. Christopher Kemp

In this lecture, we’re going to talk about mental health and its place on the global development
agenda.

Since 2015, the UN Sustainable Development Goals (SDGs) have been calling to “transform our
world”. The SDGs replaced the Millennium Development Goals but have a much broader
agenda and a global reach, rather than a focus on only lower-resource countries. While the
MDGs focused a few infectious diseases and maternal and child health, which are the leading
causes of disease burden in low-income countries, the SDGs now have 17 goals, 169 targets and
measured though 247 indicators. The SDGs are all-encompassing, but they are also complex,
and prioritizing and implementing them has been challenging for many countries.

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Mental health is explicitly mentioned in two SDG targets, both under Goal 3 of the SDGs, which
is to ensure healthy lives and promote well-being for all at all ages. Target 3.4 asks countries to
reduce premature mortality from non-communicable diseases by a third through prevention
and treatment and to promote mental health and well-being. Target 3.5 asks countries to
strengthen the prevention and treatment of substance abuse, including narcotic drug abuse
and harmful use of alcohol. Target 3.8 also calls for universal health coverage, including
universal coverage of mental health services.

Of course, mental health cross-cuts most of the rest of the SDGs. Poverty eradication (SDG 1),
nutrition (SDG 2), health (SDG 3), education (SDG 4), women’s empowerment (SDG 5), decent
work (SDG 8), sustainable cities (SDG 11), sustainable consumption (SDG 12), climate change
and disaster recovery (SDG 13), peaceful and just societies (SDG 16) and partnerships (SDG 17—
all of these are linked to mental health.

This means that mental health is now part of the global development agenda, and progress on
mental health has the potential to support many of the other SDGs. This has provided us with a
historic opportunity to reframe the agenda of global mental health.

Well, where is mental health on the global agenda?

Mental health problems lead to trillions of dollars of economic loss globally. Nonetheless, global
expenditure on mental health care is very small, and almost non-existent in most countries in
Africa and Southeast Asia.

Or consider development assistance. An immense amount of money has gone into HIV, TB,
malaria, and maternal and child health, all of which is very much needed. But when it comes to
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non-communicable diseases and mental and substance use disorders, it’s less than 1%. It’s such
a small number that it is challenging to count. However, there are signs of promising change.

In 2013, 194 ministers of health signed the World Health Organization Mental Health Action
Plan as an agreement on what needs to be done to support public mental health globally. This
is the highest level mental health has ever reached in policymaking. This plan is an instrument
for change. Change amongst policymakers; change amongst healthcare providers; change
amongst communities and individuals.

The Action Plan has four objectives: 1) strengthen effective leadership and governance for
mental health, 2) provide comprehensive, integrated, and responsive mental health and social
care services in community-based settings, 3) implement strategies for promotion and
prevention in mental health, and 4) strengthen information systems, evidence, and research for
mental health.

The Action Plan emphasizes universal health coverage, or the idea that everyone should have
access to essential services to achieve the highest attainably standard of health. It also
emphasizes human rights. People with mental health conditions have been stigmatized and
their rights have been abused and disregarded in almost all countries for a very long time. This
photo is from a high-income country in a prison setting where, again, people are incarcerated
for indefinite period because of no fault of theirs, just because they have a severe mental
disorder.

The WHO Action Plan describes what needs to happen in order for nations to more effectively
invest in population mental health. However, the how was best described only in 2018, with the
launch of the Lancet Commission on Global Mental Health and Sustainable Development. This
was a group of the world’s leading public mental health experts, coming together to map the
future of our field.

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The Lancet Commission said that we need to reframe mental health in order to meet the goals
laid out by the WHO. What does this mean? First, we need to go beyond the treatment gap.
Although one of the big priorities in the area of mental health is to provide treatment for
people who suffer from mental disorders, we need to be much more comprehensive. We need
to think more about mental health, rather than just about mental disorders.

As described in the previous lecture, the Commission recommended a dimensional approach to

mental health. It is no longer possible and no longer helpful to divide people into two
categories: people who have mental disorders and people who don't. It is not very helpful. All
of us are somewhere on this dimension of having either very good or sometimes very poor
mental health, and we can all do something to improve our mental health and well-being. In
some cases, we might be at risk for mental health, and we can decrease the risk through
prevention. The Commission also advocates for a rights-based perspective: the rights of people
with mental disorders to be protected, the right to receive care, and the right to dignity and
freedom.

Let’s look at the recommendations from the Lancet Commission.

The first recommendations to reframe mental health as a global public good. Mental health is a
universal human quality and an indivisible part of health. It's important to all people in all
countries and is especially relevant for young people. It’s a crucial contributed to human
capital. In fact, the World Bank talks about human capital as a counterpart to the GDP, which
they relied upon for a long time. Mental health has a lot to contribute to the human capital.

The next recommendation is that mental health is an essential component of universal health
coverage. Mental health care can be delivered through task sharing, which will be discussed
elsewhere in the course. And we can use technology to facilitate and enhance care, which is
also talked about elsewhere in this course.

The next recommendation is that mental health is an essential component of universal health
coverage. Mental health care can be delivered through task sharing, which will be discussed
elsewhere in the course. And we can use technology to facilitate and enhance care, which is
also talked about elsewhere in this course.

Another recommendation is to protect mental health with action on social determinants, such
as fighting poverty and inequality, educating everyone, educating everyone, enhancing equity,
advocating for gender equality, and opposing violence and discrimination. Most of these
actions are outside the health departments and ministries of health. All sectors need to work
together to create an environment where positive mental health could be encouraged and
protected.

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The report also recommends strengthening public engagement. It’s very important implement
evidence-based interventions to reduce stigma and discrimination related to mental health.
Part of this recommendation is to also engage civil society, particularly young people and
people with lived experience. These people should be included in all activities, such as policy
making, services, and research.

It also calls for innovation in the use of technology and non-specialist providers. There have
been evidence-based innovations in care, including psychosocial interventions by non-specialist
providers, digital tools, balance care models, and community engagement to increase demand
and accountability.

Another recommendation is to make more and better investments in mental health. This is a
message again for all countries. We need to increase national financing—at least 5% of the
health budget for low- and middle-income countries and at least 10% of the budget in high-
income countries. But we also need to see to it that the resources are used efficiently and
effectively.

The last recommendation is to strengthen monitoring and accountability. If we are investing

more resources, we need to be accountable. Therefore, we need an international and national
monitoring and accountability mechanism for mental health.

The purpose of this lecture was to place mental health on the global development agenda, and
to describe how mental health is a core component of sustainable development.

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