WHO

W o r l d H e a l t h O r g a n i z a ti o n

Transforming
Mental Health For
All
 CHAPTER 1
INTRODUCTION
A Wor ld Repor t
 1.1 TWENTY
YEARS ON
• Just over twenty years ago WHO published its
landmark World health report 2001 Mental
health: new understanding, new hope.
• Building on earlier global reports and using
insights from science, epidemiology and real-
world experience, the 2001 report shone a
light on mental health’s critical role in the
well-being of individuals, communities and
countries.
 The international health community had already
been advocating for mental health action for
decades. But the 2001 report marked a watershed
moment in global awareness of mental health’s
importance, the prevalence and impact of mental
health conditions, and the need for a public health
approach.
T h ro u g h i t s te n re co m m e n d ati o n s , t h e re p o r t p ro v i d e d o n e
o f t h e e a r l i e st a n d c l e a re st g l o b a l f ra m e wo r ks fo r a c ti o n o n
m e nta l h e a l t h . I t ca l l e d o n c o u nt r i e s to :

1. P ro v i d e t re at m e nt i n p r i m a r y ca re ;
2. M a ke p syc h o t ro p i c m e d i c i n e s ava i l a b l e ;
3. P ro v i d e ca re i n t h e co m m u n i t y ;
4. Ed u cate t h e p u b l i c ;
5. I nvo l ve co m m u n i ti e s , fa m i l i e s a n d co n s u m e rs ;
6. E sta b l i s h n ati o n a l p o l i c i e s , p ro g ra m m e s a n d l e g i s l ati o n ;
7. D e ve l o p h u m a n re s o u rc e s ;
8. L i n k w i t h o t h e r s e c to rs ;
9. M o n i to r co m m u n i t y m e nta l h e a l t h ; a n d
10. S u p p o r t m o re re s e a rc h .
 - These are structured
around leadership and
• Twenty years later, all of these recommendations governance, community-
remain valid. Yet progress has been made. based care, promotion
and prevention, and
• Since the 2001 report, countries around the information systems and
world have formally adopted international research.
frameworks that guide them to act for mental
health. Most notably, WHO Member States have
adopted the Comprehensive mental health
action plan 2013–2030 committing them to
meet ten global targets for improved mental
health.
 A visual
summary
of the
Comprehensive
mental health
action plan
2013–2030
• Historic conventions and global goals, such as the
Convention on the Rights of Persons with Disabilities
(CRPD), the Sustainable Development Goals (SDGs)
and universal health coverage (UHC), have given
countries further critical impetus to transform and
improve mental health.

• Mental health issues and experiences are now more

frequently discussed and shared in broadcast and
social media, particularly following the COVID-19
pandemic, and especially among young people. Such
coverage not only helps destigmatize mental ill-health
but also increases the value given to the voices,
priorities and expertise of people with lived
experience.
• The number of practical, evidence-based mental health
guidelines, manuals and other tools has also vastly expanded.

• The mental health needs of people affected by conflicts,

disasters and disease outbreaks have
become widely recognized, and mental
health is frequently, though not always,
addressed as part of crisis responses.
 1.2 TIME
FOR CHANGE

• Despite this progress, for most

countries and communities, mental
health conditions continue to exact
a heavy toll on people’s lives, while
mental health systems and services
remain ill-equipped to meet people’s
needs.
• Most people with mental health conditions do not have
access to effective care because services and supports are not
available, lack capacity, cannot be accessed or are
unaffordable; or because widespread stigma stops people
from seeking help.

• Financial and human resources for mental health are still

scarce in most countries and are unevenly distributed.
• Both the 2001 report and the Comprehensive mental health
action plan 2013–2030 emphasized the need for accessible
community-based mental health services.

• The COVID-19 pandemic has affected the mental health and

well-being of so many, both with and without pre-existing
conditions, and has exacerbated social inequalities as well as
systemic weaknesses in services.
• The end goal is clear: the Comprehensive mental health action
plan 2013–2030 envisions a world where mental health is
valued, promoted and protected; where high quality, culturally
appropriate, acceptable and affordable community-based
mental health care is available to everyone and anyone who
needs it; and where people living with mental health conditions
can participate fully in society free from stigma, discrimination
or abuse.
 MENTAL HEALTH TERMS

Mental health. A state of mental well-being that

enables people to cope with the stresses of life, to
realize their abilities, to learn well and work well,
and to contribute to their communities.

Mental health condition. A broad term covering

mental disorders and psychosocial disabilities. It
also covers other mental states associated with
significant distress, impairment in functioning,
or risk of self-harm.
 MENTAL HEALTH TERMS

Mental disorder. As defined by the

International Classification of Diseases 11th
Revision (ICD-11), a mental disorder is a
syndrome characterized by clinically significant
disturbance in an individual’s cognition,
emotional regulation, or behavior that reflects a
dysfunction in the psychological, biological, or
developmental processes that underlie mental and
behavioral functioning.
 MENTAL HEALTH TERMS

Psychosocial disability. Aligned with the

Convention on the Rights of Persons with
Disabilities, psychosocial disability is disability
that arises when someone with a long-term
mental impairment interacts with various barriers
that may hinder their full and effective
participation in society on an equal basis with
others.
MENTAL HIG HLIGH TING TH E H EALTH ,
SO CIA L , ECO NOM IC, A ND
HEALTH, HUM A N R IG HTS EFFEC TS O F
UNTR EAT ED M ENTA L
POVERTY AND DISO R DERS IN LOW- A ND
M IDDLE- INCOM E COUNT RIES
DEVELOPMENT (LM ICS)

INTERNATIONAL ARTICLE
HEALTH IMPACT
1. HEALTH BURDEN
• Mental and substance abuse disorders are important causes of disease
burden, accounting for 8.8% and 16.6% of the total burden of disease in
low-income and lower middle-income countries, respectively (World
Health Organization, 2009a).
2. MORBIDIT Y AND MORTALIT Y RATES
• People with mental disorders, such as schizophrenia,
bipolar disorder and depression are far more likely than the
general population to die as a consequence of their
untreated mental or physical health problems
INTERNATIONAL ARTICLE
 3. POOR ACCESS TO QUALIT Y
HEALTH HEALTH SERVICES
IMPACT One of the most important reasons for higher
morbidity and mortality rates among people with
mental disorders is the inequitable care and
treatment that these individuals receive for both
mental and physical illnesses. And a 50-country
WHO study demonstrated that 69% of people
with schizophrenic disorders are not receiving
treatment

INTERNATIONAL ARTICLE
Mental disorders have diverse
and far-reaching social
impacts, including
homelessness, higher rates of
imprisonment, poor
SOCIAL
educational opportunities and
outcomes, lack of
IMPACT
employment and limited
income-generating
opportunities.
INTERNATIONAL ARTICLE
 1. HOMELESSNESS
• Numerous studies have documented the high
prevalence of mental disorders (such as
schizophrenia, depression, anxiety, attempted
suicide, emotional problems, and alcohol and drug
abuse) in homeless persons, including street
children
2. PRISON POPULATION
• A study of 193 prisoners in Durban South Africa
demonstrated that 23.3% of prisoners were diagnosed
with current psychotic, bipolar, depressive and anxiety
disorders. Known in Nigeria as "civil lunatics", these
inmates have not committed crimes, but are brought to
prisons by family members who could not care for them.
3. EDUCATIONAL OPPORTUNITIES AND
OUTCOMES
• Access to education is widely recognized as an
essential building block for human and economic
development due to its wide-ranging impacts on
health, employment, poverty and social capital.

4. INCOME GENERATION AND

EMPLOYMENT OPPORTUNITIES
• Mental illness is associated with high rates of
unemployment, leading individuals into economic
poverty and depriving them of social networks and
status within a community (Harnois and Gabriel,
2000).
 The stigma, myths and
misconceptions surrounding

HUMAN
mental illness are the root
cause of much of the

RIGHTS
discrimination and human
rights violations experienced

IMPACT
by people with mental
disabilities on a daily basis
(Baldwin and Marcus, 2011).

INTERNATIONAL ARTICLE
 1. Lack of knowledge about mental illness, its causes,
symptoms and recovery-oriented treatment .
2. Misconceptions around mental illness.
3. People with mental disabilities lack access to proper
judicial mechanisms to protect their rights.

HUMAN 4. People with mental disabilities also often experience

human rights violations
RIGHTS 5. People with mental disabilities also experience

IMPACT
restrictions in the right to work, to obtain an
education, as well as to marry and found a family.
6. In many countries people with mental disabilities are
denied rights of citizenship and participation, such as
the right to vote. In Thailand anyone “being of
unsound mind or mental infirmity” cannot vote
(Kingdom of Thailand, 2007).
E C O N O M I C I M PA C T
1.POVERT Y
• People with mental disorders are at much
higher risk of descending into poverty than
other people. They may not be able to work
because of their illness.

2. ECONOMIC DE VELOPMENT
Overall, not treating mental disorders is more
costly than providing treatment, due to the
high indirect costs associated with morbidity.
Recommended mental health interventions to improve
development

1.Promoting education and mental health

2.Treatment services and prevention
3.Poverty reduction and income generation
 CHAPTER 2
PRINCIPLES AND DRIVERS
IN PUBLIC MENTAL
HEALTH
 2.1 CONCEPTS IN
M E N TA L H E A L T H

2.1.1 Mental health has intrinsic and

instrumental value
• It influences how we think, feel and act.
• Mental health is also a basic human right. And
it is crucial to personal, community, and socio-
economic development.
 Mental
health has
intrinsic and
instrumental
value,
helping us to
connect,
function,
cope and
thrive
• When our mental health is impaired, and we lack access to appropriate
support, our well-being can worsen. A wide range of mental health conditions
can disturb our thoughts and feelings, change our behaviors, compromise our
physical health, and disrupt our relationships, education, or livelihoods.

• Living with a mental health condition can impose a substantial

financial burden on individuals and households.

• People experiencing mental health conditions are also often

stigmatized, shunned, discriminated against, and denied basic
rights, including access to essential care .

• Close to 15% of the world’s working population is estimated to

experience a mental disorder at any given time.
 • Mental health is not a binary state: we are not
either mentally healthy or mentally ill. Rather,
mental health exists on a complex continuum with
2.1.2 experiences ranging from an optimal state of well-
MENTAL being to debilitating states of great suffering and
emotional pain
HEALTH
EXISTS • Mental health is not defined by the presence or
ON A absence of a mental disorder.
CONTINUUM
• Along the different dimensions of the continuum,
mental health issues and challenges present in
different ways and are experienced differently
from one person to the next.
Relationship
between
mental
well-being
and
symptoms
of mental
health
conditions
 • In m a ny ways , our p re n ata l
e nv i ro n m e nt s , i n fa n c y, and early
2.1.3 c h i l d h o o d c a n s e t t h e to n e fo r t h e
MENTAL re st o f o u r l i ve s
HEALTH IS
EXPERIENCED • M o st m e nta l h e a l t h c o n d i ti o n s i n a d u l t s
h ave t h e i ro n s e t b y a d o l e s c e n c e .
OVER THE
LIFE-COURSE • M ate r n a l d e p re s s i o n ca n h ave l o n g -
l a sti n g a d ve rs e i m p a c t s o n a c h i l d ’s
b ra i n d e ve l o p m e nt .
 ADOLESCENCE
Adolescence is another • Many risk behaviors, such as
d e ve l o p m e nta l l y s e n s i ti ve the use of substances, start
ti m e fo r a p e rs o n ’s m e nta l during adolescence and can
health. It is a crucial period be particularly detrimental
fo r d e ve l o p i n g t h e s o c i a l to mental health.
a n d e m o ti o n a l s k i l l s , h a b i t s ,
a n d c o p i n g st rate g i e s t h at • Suicide is a leading cause of
enable m e nta l health, death in adolescents.
i n c l u d i n g h e a l t hy s l e e p i n g
p att e r n s , re g u l a r exe rc i s e , • Teen parents in particular are
p ro b l e m - s o l v i n g , and often at higher risk of mental
i nte r p e rs o n a l s k i l l s . ill-health than their peers.
 OLD AGE
At older ages, m ental
healt h conti nues to be
s haped by physical,
s ocial, and environm ental
conditi ons as well as t he
c um ulati ve im pac t s of
earlier life experiences
and spec ifi c st ressors
related to ag ing .
• One in six older adults
experience elder abuse,
often by their own
carers, with serious
consequences for
mental health
• A life-course approach to mental health acknowledges the
critical risks and protective factors that influence mental
health at each stage of life, and designs policies, plans, and
services to address the needs of all age groups.

• It enables decision-makers to pay attention to critical stages,

transitions, and settings, where interventions to promote,
protect and restore mental health, maybe especially effective.
 M e nta l h e a l t h i s a b a s i c h u m a n r i g ht fo r
a l l p e o p l e . Eve r yo n e , w h o e ve r a n d
w h e re ve r t h ey a re , h a s a d e s e r v i n g a n d
2.1.4 i n h e re nt r i g ht to t h e h i g h e st att a i n a b l e
E V E RYO N E sta n d a rd o f m e nta l h e a l t h . T h i s i n c l u d e s :
HAS A
• The right to be protected from mental
RIGHT TO health risks;
M E N TA L
• The right to available, accessible,
H E A LT H acceptable, and good quality care; and

• The right to liberty, independence and

inclusion in the community.
 Yet all over the world, people with mental health
conditions experience a wide range of human rights
violations. Many are excluded from community life,
2.1.4 discriminated against, denied basic rights such as
E V E RYO N E food and shelter, and prohibited from voting or
getting married, many more cannot access the
HAS A mental health care they need, or can only access
RIGHT TO care that violates their human rights.
M E N TA L
H E A LT H In many places, the lack of community-based
services means that the main setting for mental
health care is long-stay psychiatric hospitals or
institutions, which are often associated with human
rights violations.
 Improving access to quality mental health care is
inherent to, and indivisible from, a better life for
self and a better life for all

A rights-based approach to mental health services

protects those at risk of human rights violations,
supports those living with mental health
conditions, and promotes mental health for all. The
UN Convention on the Rights of Persons with
Disabilities (CRPD)needs to be implemented
across the world.
 T h e h e a l t h s e c to r h a s m u l ti p l e ro l e s i n
s u p p o r ti n g t h e p o p u l ati o n ’s m e nta l
health.
2.1.5
M E N TA L Fo u r Ro l e s fo r t h e H e a l t h S e c to rs i n
s u p p o r ti n g m e nta l h e a l t h fo r a l l :
H E A LT H
IS 1. P ro v i d e C a re
E V E RYO N E ’ S 2 . P ro m o te a n d P re ve nt
BUSINESS
3 . Wo r k i n Pa r t n e rs h i p
4 . S u p p o r t Re l ate d
I n i ti ati ve s
1. Provide Care

The health sector can provide a range of equitable and rights-

based services. These services are most useful when they are
delivered at community levels, by practitioners best suited to
provide effective care within the constraints of available human
and financial resources.

2. Promote and Prevent

The health sector can advocate for and provide promotion

and prevention programs, in collaboration with other sectors.
Such programs can build awareness and understanding of
mental health, end stigma, and discrimination, and lessen the
need for treatment and recovery services.
3. Work in Partnership

The health sector can partner with all stakeholders – in

government, civil society, the private sector, and especially
among people with lived experience – to ensure multi
sectoral, inclusive, and people-centered support for people
with mental health conditions.

4. Support Related Initi ati ves

Support-related initiatives. The health sector can advocate for

and help address the structural risks and protective factors
influencing mental health – the conditions in which people are
born and live. This can promote and contribute to a whole-of-
government and all-of-society approach to mental health.
When it comes to delivering care, a similarly multi-
sectoral and collaborative approach is needed. This is
because effectively supporting people with mental
health conditions often extends beyond appropriate
clinical care (usually given through the health sector) to
also include, for example:
• Financial support (through the social sector);
• A place to stay (through the housing sector);
• A job (through the employment sector);
• Educational support (through the education sector);
• Community support (through the social affairs
sector); and
• Various legal protections (through the judicial
sector).
 2.2
DETERMINANTS
O F M E N TA L
H E A LT H
 Individual psychological and biological factors related to
individuals’ intrinsic and learned abilities and habits for
dealing with emotions and engaging in relationships,
activities, and responsibilities.
2.2.1
• Biological vulnerabilities include genetics, but also,
SPHERES for example, high potency cannabis use, substance
OF use by the mother, and oxygen deprivation at birth.
INFLUENCE Brain health is an important determinant because
many of the risk or protective factors impacting
mental health are mediated through brain structure
and function. A person’s mental health also
depends on the stressors in their life, which are
influenced by family, community, and structural
factors in the environment.
 Family and community comprise a person’s immediate surroundings,
including their opportunities to engage with partners, family, friends,
or colleagues, opportunities to earn a living and engage in meaningful
activity, and also the social and economic circumstances in which they
find themselves.

• Parenting behaviors and attitudes are particularly influential,

especially from infancy through adolescence, as is parental mental
health.
• Local social arrangements and institutions, such as access to
preschool, quality schools, and jobs, significantly increase or reduce
the opportunities that, in turn, empower each person to choose
their own course in life.
• Restricted or lost opportunities can be detrimental to mental
health.
Structural factors relate to people’s broader sociocultural, geopolitical,
and environmental surroundings, such as infrastructure, inequality, social
stability, and environmental quality. These shape the conditions of daily
life.
• Access to basic services and commodities, including food, water,
shelter, health, and the rule of law, is important for mental health.
• Security and safety are important structural factors. And prevailing
beliefs, norms, and values – especially in relation to gender, race, and
sexuality–can also be hugely influential. Historical legacies of
colonialism influence multiple structural factors in numerous countries,
as do climate and ecological crises.
• Together, individual, family, community, and structural factors
determine our mental health. Importantly, these determinants interact
with each other in a dynamic way.
 People who are more exposed to unfavorable
circumstances are at higher risk of experiencing
2.2.2 mental health conditions.
RISK Individual, family and community, and structural
risks can manifest themselves at all stages of life,
UNDERMINE but those that occur during developmentally
MENTAL sensitive periods of life are particularly detrimental,
HEALTH often continuing to affect mental health for years or
even decades afterward.

Children with mental health problems and cognitive

impairments are four times more likely to become a
victim of violence than others
 Globally, more than half of all children aged 2–17
(around a billion individuals) experienced emotional,
2.2.2 physical, or sexual violence in the previous year.
RISK Adverse childhood experiences, including exposure
to violence, increase the risk of developing a wide
UNDERMINE range of behavioral problems and mental health
MENTAL conditions, from substance use and aggression to
HEALTH depression, anxiety, and post-traumatic stress
disorder (PTSD).

Populations who live in adverse conditions, such as

war zones, experience more mental health conditions
than people who do not.
 Living in areas where the natural environment has
been compromised –for example, through climate
2.2.2 change, biodiversity, habitat loss, exploitation, or
pollution– can also undermine mental health. For
RISK example, growing evidence suggests that exposure
UNDERMINE to air pollution is likely to adversely, affect the brain
MENTAL and increase the risk, severity, and duration of
mental health conditions at all stages of life.
HEALTH
Our gender, ethnic grouping, and place of residence
can affect our chances of developing a mental health
condition.
 Racism or discrimination against a particular group in
society increases the risk of social exclusion and
economic adversity, both of which undermine mental
2.2.2 health.
RISK Socially marginalized groups – including the long-term
unemployed, sex workers, homeless people, and
UNDERMINE refugees–tend to have higher rates of mental disorders
MENTAL than the general population but can have difficulties
accessing health care.
HEALTH
Other marginalized groups, including sexual minorities
and indigenous peoples, are similarly at greater risk of
depression, anxiety, suicide attempts or suicides, and
substance-related problems. They too can find it
difficult to access the mental health services they
need.
• Mental ill-health is closely linked to poverty THE VICIOUS
in a vicious cycle of disadvantage. This
disadvantage starts before birth and CYCLE OF
accumulates throughout life.

DISADVANTAGE
• People living in poverty can lack the financial
resources to maintain basic living standards; they
have fewer educational and employment THE VICIOUS
opportunities; they are more exposed to adverse
living environments; and they are less able to
access quality health care. These daily stresses
CYCLE OF
put people living in poverty at greater risk of
experiencing mental health conditions. DISADVANTAGE
• Similarly, people experiencing severe mental THE VICIOUS
health conditions are more likely to fall into
poverty through loss of employment and
increased health expenditures.
CYCLE OF

DISADVANTAGE
• More than 80% of all people with mental
disorders live in low- and middle-income THE VICIOUS
countries (LMICs), where the vicious cycle
between mental health and poverty is
particularly prevalent because of a lack of
CYCLE OF
welfare safety nets and poor accessibility to
effective treatment. DISADVANTAGE
 Our social and emotional skills, attributes and habits
are critical to enabling us to deal with the stresses and
daily choices of life.
2.2.3 Family and community factors can also be influential
PROTECTIVE in supporting mental health. It includes;
FACTORS • Positive family interactions,
BUILD • Quality education and employment,
RESILIENCE • Decent work conditions,
• Safe neighborhoods,
• Community cohesion and
• Shared cultural meaning and identity
Throughout adulthood, employment under decent
working conditions is particularly important for mental
health. Employment can be an enormous source of stress,
but it can also promote recovery and is associated with
improved self-esteem, better social functioning and
a higher quality of life. While
unemployment is a known risk
factor for suicide attempts.
Our natural environments are
important, it offer leisure
opportunities, access to green and
blue spaces like parks, forest,
playgrounds and beaches is linked
to better mental health for Greater democracy and equal
short and long-term access to justice, reductions
outcomes. in poverty and greater
acceptance of diversity are all
important global trends that
work towards better mental
. health.
 2 . 3 G L O B A L T H R E AT S
T O M E N TA L H E A L T H
A major structural stressors with the potential to
slow worldwide progress towards improved well-
being.
Key threats today include:
• economic downturns and social polarization;
• public health emergencies;
• widespread humanitarian emergencies and forced
displacement; and
• the growing climate crisis.
• The emergence of COVID-19 pandemic
 Economic downturns are associated with increases in
suicide rates. They also increase the risk of depression,
anxiety and alcohol use, probably through their
damaging effects on employment, income, security
2.3.1 and social networks.
ECONOMIC
Countries with greater income inequalities and social
AND polarization have been found to have a higher
SOCIAL prevalence of schizophrenia, depression, anxiety and
INEQUALITIES substance use. In all cases, it is the poorest groups that
are hit the hardest.

The COVID-19 pandemic has amplified existing

inequalities and steepening the social gradient of
mental health in many countries
 Public health emergencies can have profound and
long-lasting impacts on people’s mental health, both
exacerbating pre-existing conditions and inducing new
ones. They can also impact key infrastructure,
disrupting basic services and supplies and making it
2.3.2 difficult to provide affected people with formal mental
PUBLIC health care.

EMERGENCIES Some infectious diseases are associated with

neurological complications that impact people’s
mental health
Research on the 2013–2016 Ebola epidemic in West
Africa shows that many people have experienced
acute and long-term mental health and psychosocial
effects.
 In 2022, 274 million people were estimated to need
humanitarian assistance. People with severe mental
health conditions are extremely vulnerable during and
after emergencies. Whether they are living in
2.3.3 communities or institutions, anybody with mental
HUMANITARIAN health conditions is at increased risk of human rights
violations during humanitarian emergencies
EMERGENCIES
AND Risks to mental health that are widespread in
humanitarian emergencies such as;
FORCED
1. Violence and loss 4 . O ve rc ro w d i n g
DISPLACEMENT
2 . Po ve r t y 5 . Fo o d S e c u r i t y

3 . D i s c r i m i n ati o n 6 . Breakdown of social

networks are also
• On average 1 in 5 people in settings affected by conflict have a mental
disorder.
• People who have been forcibly displaced often find it difficult to access
mental health care and may face poor living conditions, adverse
socioeconomic conditions, discrimination, isolation, strained family and
support networks, uncertainty around work permits and legal status, and
in some cases immigration detention.
• Addressing the social and mental health impacts of emergencies is thus
not only part of humanitarian emergency preparedness, response and
recovery but also of peace building.
 The risks that the growing climate crisis pose to people’s
physical health, evidence is now accumulating to show
the climate crisis can also impact mental health, through
stresses and risks imposed by extreme weather events as
2.3.4 well as through longer-term environmental change.

CLIMATE Extreme weather events – including tropical storms,

CRISIS floods, mudslides, heatwaves, and wildfires.

Incremental environmental change can also be

devastating. It can upset food and water supplies, alter
growing conditions, reshape natural habitats and
landscapes and weaken.
• Even watching the slow impacts of climate change unfold can
be a source of stress. Various terms have emerged to describe
the psychological reactions people experience, including
“climate change anxiety”, “solastalgia”, “eco-anxiety”,
“environmental distress”, and many others.

• Young people, indigenous peoples, people living in

poverty, and people with cognitive or mobility impairments
may also be more vulnerable to the mental health
consequences of the climate crisis.
• Higher ambient temperatures are linked with higher risk of
hospitalization, suicidal behaviour and death for people
with mental health conditions.

• A number of protective factors have been identified

that may promote resilience in the face of the
climate crisis, including social support and
mental health literacy.
LOCAL/NATIONAL
JOURNAL ARTICLE:

Community-Based Mental Health

Interventions in The Philippines:
An Ecological Perspective
 Experienc es of environm ental and
psycholog ical adversit y inc rease
vulnerabilit y to m ental healt h
disorders. Unfort unately, in low
resourc e count ries, m ental healt h
t reat m ent is largely inac cessible to t he
poor.

LOCAL/NATIONAL ARTICLE
 • A study by the Human Cities Coalition (2016)
suggested that the steep increase in
urbanization has contributed to a 300% increase
in inequality in the country.

• Unemployment and the lack of basic urban

services make the urban poor vulnerable to
environmental health risks as well as the danger
(Human Cities Coalition, 2016).

LOCAL/NATIONAL ARTICLE
 • Concomitant with urbanization and its problems
is the issue of mental health. Stressors such as
overcrowded and polluted environments, high
levels of violence, and employment migration
are associated with an increase in mental health
disorders (Srivastava, 2009).
• A study by Reddy and Chandrashekar (1998)
revealed a higher prevalence of mental disorders
such as anxiety and depression in urban rather
than rural areas.
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 Wor ld Health • The first tier include specialized
Or ganization’s interventions delivered by mental health
(WHO, 2010) professionals.
public health • The second tier includes focused, non-
specialized interventions delivered by
pyr amid trained community mental health workers.
suggests four • The third tier includes family and
tier s of a community support services and
mental health programs.
ser vice • The fourth tier involves providing for
community members’ basic needs.
deliver y
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 The term community-based intervention (CBI) has taken
on different meanings and applications. McKleroy et al.’ s
(2003) typology classified CBIs into four types.

The first type is communities as settings for

Community- interventions.
Based
The second type of CBI is where the community as a
Interventions whole is the target of change.

The third type of CBI is the community as a resource in

designing and delivering interventions.

The fourth type of CBI is where the community itself is

LOCAL/NATIONAL ARTICLE both the target and agent of change.
 Socio-ecological theories, such as that of Bronfenbrenner
(1979), view individual behaviors not only as a product
of individual knowledge, values, and attitudes, but as a
result of a host of social influences.

Psycho- McKleroy et al. (2003) contend that understanding a

Ecological community’s ecology can lead to the development of
Systems more appropriate interventions and more refined
methods for a d d re s s i n g complex public health
Model problems, such as infant mortality, violence, and
substance abuse.

Bronfenbrenner’s ecological theory describes a number

LOCAL/NATIONAL ARTICLE of systems that influence individuals.
 Bronfenbrenner ’s ecological
systems that infl uence individuals.

The microsystem
The meso-system
The exo-system
The macro-system

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 Building on
Bronfenbrenner’s Vulnerabilities are internal risk factors such as
model, Reeb et al.
low self-esteem, maladaptive behavior, mental
(2017) proposed the
illness, and risky behavior.
psycho-ecological
systems model
(PESM) that Resilience factors are internal characteristics that
highlights individual promote adaptation and enable people to
vulnerabilities and overcome challenging situations. These may
resilience factors.
include intelligence, adaptive coping skills, and
good health.

LOCAL/NATIONAL ARTICLE
ME Case One: Katatagan: A resilience intervention for Filipino
Disaster Survivors
TH
OD
• In November 2013, the deadliest typhoon in the history of the
S Philippines affected 16 million, killed over 6,000 and displaced
four million Filipinos (NDRMMC, 2014). Half a year later, the
World Health Organization estimated that 80,000 survivors
were at risk of mental health disorders and were in need of
mental health services (WHO, 2014).
• Beside the provision of Psychological First Aid, the country did
not have access to any evidence-based mental health
interventions for survivors who were experiencing trauma after
the disaster.
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• The Psyc h o l o g i ca l A s s o c i ati o n o f t h e P h i l i p p i n e s ( PA P )
embarked on the development of a mental health intervention for
disaster survivors in the recovery phase.
• To respond to survivors’ psychosocial needs, the intervention focused
on key elements of resilience: self-efficacy, managing physical reactions,
managing emotions, managing cognition, problem solving, social
support, and giving hope.
• The intervention was eventually named Katatagan (Filipino for strength
or resilience).
• Katatagan was founded on cognitive behavioral therapy (CBT) and
mindfulness that both have a robust evidence base for helping disaster
survivors.
LOCAL/NATIONAL ARTICLE
 The subject experts identified the needs, protective factors, and
vulnerabilities of survivors.
• Protective factors included • Vulnerabilities included
 including a strong faith in God  inadequate resources,
 family and community  lack of information on
support, and services, and
 a sense of humor amidst  the inefficient delivery of
adversity. services.

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 Case One: Katatagan: A resilience intervention for Filipino
Disaster Survivors

• It consisted of six modules:

 Kalakasan (finding and cultivating strengths)
 Katawan (managing physical reactions)
 Kalooban (managing thoughts and emotions)
 Kapakipakinabang na Gawain (engaging in regular and positive
activities)
 Kalutasan at Kaagapay (seeking solutions and support), and
 Kinabukasan (moving forward)
(Hechanova et al., 2015).
LOCAL/NATIONAL ARTICLE
Findings on Evaluation and Implementation.
• In addition, the sixth-month follow-up scores were significantly higher
in five of the six skills: harnessing strengths, seeking solutions and
support, managing physical reactions, moving forward, and seeking
solutions and social support.
• However, there was a lack of significant improvement in two coping
self-efficacy measures (managing thoughts and emotions, and positive
activities).
• Follow-up focus-group discussions with displaced survivors revealed a
number of continuing challenges that may have affected the decrease
in adaptive coping behaviors
LOCAL/NATIONAL ARTICLE
ME Case Two: Community-Based Drug Recovery Intervention

TH
OD
S • The Philippines, like other countries worldwide, has
always struggled with the issue of illegal drugs.
• Unfortunately, the Philippines did not have a
history of community- based drug rehabilitation
(CBDR). The CBDR programs that emerged were
mainly diversion programs that included
recreational activities, counseling, religious
activities and community service
LOCAL/NATIONAL ARTICLE
 Case Two: Community-Based Drug Recovery Intervention

The PAP developed a community-based drug

intervention.
• The design team embarked on a cultural adaptation of existing
evidence-based programs using the Map of Adaptation Process”
(MAP):
1) assessment of needs and risk factors;
2) designing the intervention based on cultural and contextual nuances;
3) training of facilitators and pre-testing of materials;
4) pilot-testing; and
5) implementation and continuous evaluation (McKleroy et al, 2006).
LOCAL/NATIONAL ARTICLE
 Case Two: Community-Based Drug Recovery Intervention

The community-based drug intervention was named Katatagan Kontra Droga

sa Komunidad (Resistance to Drugs in the Community).
It consisted of fifteen modules; twelve were individual modules and three
were family modules.
The first six individual modules focused on drug recovery skills:

1) Understanding Drug Addiction; 4) Managing Triggers;

2) Importance of Change; 5) Saying NO to Drugs; and
3) Coping with Cravings; 6) Adopting a Healthy Lifestyle.

LOCAL/NATIONAL ARTICLE
 Case Two: Community-Based Drug Recovery Intervention

The next modules focused on life skills: The family modules included:

1) Managing Thoughts & Emotions; 1) Understanding Drug Use;

2) Relating to Others; 2) Drug Use and the Family;
3) Restoring Family Relationships; and
4) Problem Solving; 3) Families Recovering from
5) Recognizing My Strengths; Drug Use.
6) Finding Meaning and Planning for
the Future.

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Motivational interviewing (Miller &
Rollnick, 2012) was used to make 1. Motivational
clients reflect on the benefits and Interviewing
risks to them and their family.

Cognitive behavioral therapy (Beck,

2. Cognitive 1970) that has the broadest evidence
Behavioral base for drug recovery (Magill & Ray,
Therapy 2009), was used to help people
understand what drives them to use, and
the link between drug use, emotions,
and cognition.
LOCAL/NATIONAL ARTICLE
Mindfulness-based relapse therapy (Li,
Howard, Garland, McGovern, & Lazar, 2017)
as a means to help recovering users gain 3. Mindfulness
control of their cravings. Mindfulness was
used in centering exercises and to manage
cravings, stress, and negative emotions.
The family modules were designed using
Minuchin’s (1974) structural family theory.
4. Family Systems
The modules sought to help family members
Theory
understand how their dynamics may influence
drug use or recovery. The modules also used
de Shazer and Berg’s (1986) solution focused
therapy to help families set goals and plan for
the future.
LOCAL/NATIONAL ARTICLE
Findings on Evaluation and Implementation.
• Surveys were administered pre, mid, and post-intervention. They
measured substance dependence, adaptive coping skills, and
psychological well-being.
• Post-program focus-group discussions and interviews were conducted
with participants. Feedback revealed that the ability to manage
participants’ cravings and avoid triggers of drug use were the most
common skills acquired from the course.
• Focus group discussions with family members revealed that
participants became more responsible, and would even reach out to
friends who were still using to encourage them to seek help.
LOCAL/NATIONAL ARTICLE
 Challenges face during delivery of service
• A major challenge was the dearth of personnel to deliver the
interventions.
• Participant attrition.
• The lack of resources in communities.

Barriers
• Still, yet another barrier was the bottleneck in screening.
• Families were both a recovery capital as well as a barrier.
• Finally, a major barrier was the apparent turf war between government
agencies.
LOCAL/NATIONAL ARTICLE
 Case Two: Community-Based Drug Recovery Intervention

Enablers of CBDR
• An important enabler was good governance.
• Community support and donations.
• Citizen engagement and a strong relationship between community.
• Another enabler was the social support.

LOCAL/NATIONAL ARTICLE
 DIS
CU
SSI Both recovering users and disaster survivors also have
ON other needs beyond the psychosocial that must be
addressed to ensure their continued recovery
Five types of recovery capital:
1) human capital
2) physical and financial assets
3) natural capital
4) social capital
5) institutional and community capital

LOCAL/NATIONAL ARTICLE
 DIS
CU
SSI Designing and Implementing Community-Based Mental
ON Health Interventions
1. Incorporating culture in designing interventions.
2. Participatory action research and design
3. Field supervision and coaching
Competencies in developing and implementing mental
health CBIs.
1. Social change agent
2. Partner and collaborator
3. Interventionist
4. Trainer and coach.
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I N T E R N AT I O N A L
JOURNAL ARTICLE:

Barriers and Drivers

To S e r v i c e D e l i v e r y I n
Global Mental Health
Projects
 In the context of global mental health (GMH),“
service delivery” refers to a structured set of
implementation activities or interventions for
mental health promotion, prevention, detection,
treatment, and support taking place on multiple
delivery platforms. Depending on the severity of
the condition, the frequency of need, contextual
considerations, and human resource requirements
and costs, service delivery can take place in
different settings.
INTERNATIONAL ARTICLE
 The most common types of providers involved in
the delivery of mental health services include
specialists such as mental health practitioners and
nurses, and non-specialists such as general
practitioners and nurses, lay health workers,
families, and other community members.

INTERNATIONAL ARTICLE
 A wide variety of groups were targeted by the projects
(Group Mental Health Project), with a majority focusing
their intervention on children and adolescents
(from1month to 14 years) as well as young and older
adults (from 15 to 60 years). Around 34% of the projects
also targeted vulnerable groups such as those affected
by natural disasters or conflict. Capacity-building (79%),
detection, treatment, care, and rehabilitation (76%)
were the most commonly incorporated elements to the
interventions conducted by the projects.
INTERNATIONAL ARTICLE
 Drivers for the successful
implementation of mental health
promotion included recruiting
providers who were based in the
DRIVERS
communities where they worked
because these providers would be able
to continue to support One participant reported
their communities. that incentive schemes
and team-building
activities were useful in
motivating frontline
providers
INTERNATIONAL ARTICLE
 The most common types of providers involved in
the delivery of mental health services include
specialists such as mental health practitioners and
nurses, and non-specialists such as general
practitioners and nurses, lay health workers,
families, and other community members.

INTERNATIONAL ARTICLE
BA
RR
IE • Shortage and unequal distribution of human resources
for providing mental health services, which is more
RS pronounced in low-and middle-income countries
(LMICs)by fragmented health systems, ineffective referral
pathways, lack of effective leadership, and in adequate
financing mechanisms.

• Insufficient research expertise within the team to

conduct validity and reliability analyses
of the screening tools.

INTERNATIONAL ARTICLE
BA
RR
IE • While there may be international pressure to adopt new
interventions, participants argued that it might not be
RS realistic to implement the minspecific contexts.

• For settings struggling with limited resources, these

challenges can impede efforts to scale upon sustain
project activities.

• The lack of mental health specialists for guiding the

design and implementation of effective mental health
detection efforts.
INTERNATIONAL ARTICLE
 DETECTIONS • Paper forms
OF MENTAL • mHealth Applicati ons
HEALTH

INTERNATIONAL ARTICLE
REFERENCES
 World mental health report: transforming mental health for all. Geneva: World
Health Organization; 2022. Licence: CC BY- NC-SA 3.0 IGO.
 Hechanova, Ma. Regina M. (2019) "Development of Community- Based Mental
Health Interventions in The Philippines: An Ecological Perspective,"
Psychological Resear ch on Urban Society : Vol. 2: No. 1, Article 8. DOI:
10.7454/proust.v2i1.41
 Onaiza Q., Tarik E., Grace R., Georgina M.E., Srividya N.I., Julian E., Mary D.S.,
Jill M. Barriers and Drivers to Service delivery in global mental health
projects.2021.https://doi.org/10.1186/s13033-020-00427-x
 Lally J., Samaniego R.M., Tully J. Mental health legislation in the Philippines:
Philippine Mental Health Act. Department of Psychosis Studies, Institute of
Psychiatry, Psychology and Neuroscience, Kings College London, De
Crespigny Park, London SE5 8AF, 201doi:10.1192/bji.2018.33
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 https://core.ac.uk/download/pdf/9694016.pdf

 Graphics and Icon: CANVA, slidesgo.com

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