Global Mental Health Summary

The Present and Future of Global Mental Health
a summary by Medinie Jayasiri

Introduction

Global Mental Health (GMH) has been striving to ensure mental well-being and fair treatment globally for over 15 years.
The Lancet Commission in 2018 outlined GMH principles:

Mental health is a public good
Mental health issues are a spectrum.
Mental health is unique and based on both nature and nurture.
Mental health is a human right needing a rights-based approach.

Social determinants like men’s mental health and climate risks are also explored.
The 2020 social justice movement highlighted mental health equity issues.
Criticisms involve Western-centric mental disorder descriptions.

GMH aims to improve mental health for populations and reduce global mental disorder burdens.

Global prevalence of Mental and Substance use disorders

Over 970 million people are affected by depression and anxiety in 2019.
Substance use cases, including alcohol and drugs, have surged since 1990, with over 108 million alcohol and 56 million drug cases worldwide. Opioid use disorder dominates, constituting 22% of all drug cases.
About 13% of adolescents face mental disorders, mainly anxiety and depression.
Gender differences persist: females encounter more depression and anxiety, while males face more ADHD and conduct disorders.
These conditions increase suicide risk and mortality rates.
Gathering evidence from low- and middle-income countries (LMIC) is vital for a comprehensive global mental health perspective.

Social and Economic factors of Mental Disorders

Factors impacting mental health according to SDG review include economic, neighborhood, environmental, and social/cultural aspects.
Individual characteristics like gender, age, and ethnicity can indicate discrimination associated with early development of disorders like mood swings, anxiety, developmental problems, and substance abuse.
Factors such as economic instability, exposure to violence in neighborhoods, natural disasters, social factors like parenting and education, and systemic racism are associated with childhood disorders.
Discrimination, affects racial, sexual, and religious minorities, leading to psychological disorders.
Discrimination experiences, in the USA and South Africa, are linked to developing disorders like depression, anxiety, psychosis, and substance abuse.
Discrimination based on caste and religion in India affects mental health, particularly among historically disadvantaged groups.
Stigma linked to various individual traits (sexual orientation, gender identity, health conditions) poses a risk for mental disorders like depression and anxiety.
Increased researches in countries with social hierarchy-driven mental health disparities in LMICs are required.

Treatment and Care Approaches

GMH focus on providing suitable mental health resources range from self-care to community/facility-based services and digital interventions.
However most countries face a shortage of trained mental health providers.

Integrated Care

Primary care
- Integrating mental health care into primary healthcare expands access.
- Models like Collaborative Care Model (CoCM) use a team based approach involving primary care providers and mental health specialists.
- Implementation difficulties include organizational readiness, complexity of user needs, and perceived advantages of interventions
HIV
- People with HIV are prone to mental disorders, and co-existing depression can negatively affect HIV treatment adherence and outcomes.
- Evidence-based mental health interventions for PLWH, alongside HIV care, help reduce depressive symptoms and improve HIV outcomes.
- Regions with high HIV prevalence lack access to quality mental health care.
- As multilateral organizations like UNAIDS and WHO, alongside funders such as the President’s Emergency Plan for AIDS Relief (PEPFAR) and the Global Fund for AIDS, TB, and Malaria, increasingly advocate for or fund the integration of mental health interventions.
- Implementing partners such as the International Training and Education Center for Health (I-TECH) exemplify such opportunities in HIV care settings globally.

Task Shifting

Task-shifting involves training healthcare workers to share tasks efficiently, allowing broader mental health care coverage.
Recent studies assess effectiveness, challenges, and necessary support for task-shifting.
Adequate support is crucial due to barriers like stigma and reluctance to disclose mental health issues.
Nurses often adopt task-shifting duties, but evidence on its effectiveness mainly comes from high-income countries.
Guidelines suggest formal protection and standardization for healthcare, but non-professional personnel face many challenges.

Inequities in Access to Care

The number of people receiving treatment is relatively low and varies based on area and demographics and data isn’t consistently gathered.
Data is limited also in Sub-Saharan Africa and Asia, where a significant majority of the world's population resides.
Treatment coverage studies found that for MDD, about 33% of individuals in high-income countries receive treatment compared to just 8% in LMICs.
Schizophrenia also lacks treatment coverage and estimates suggest treatment coverage is around 9.4% in Ukraine, 19% in the Philippines, and 10% in Ethiopia.
The 2020 World Mental Health Atlas indicates that many countries might struggle to achieve the targets set by WHO/UN for expanding mental health care services.
Barriers to treatment include inadequate financial investment at the government and international levels, inadequate quality of care, stigma, fear, and shame surrounding mental illness and suicide.
Using innovative and customized approaches that suit the local context has increased availability of mental health care.
An analysis by WHO indicates that countries are taking steps to improve mental health services despite starting with limited coverage and are committed to enhancing mental health care.

Mental Health Care for Youth

Interventions yield long-term benefits for well-being and health across generations.
Community and school mental health efforts improve symptoms, behavior, and social skills.
Digital platforms show promise in mental health interventions.
Strategies include safe spaces and psychological support for urban youth.
SDG 3 highlights youth mental health in global goals since 2015.
Welcome Trust's "Mental Health Priority Area" focuses on innovative youth interventions for mental health disorders prevention and treatment.
Efforts address negative impacts of social media on youth mental health such as feelings of loneliness and isolation.
US Surgeon General Dr.Vivek Murthy highlights rising adolescent mental health concerns regarding suicide rates and self harming activities.
Progress in global youth mental health, but challenges persist in LMICs.
Key actions to support youth: Increase investment, prioritize education, foster collaboration, and implement evidence-based interventions.

Current Priorities for GMH

4 key global events/phenomena for inequities in mental health

current COVID-19 pandemic
political conflict and instability
human rights issues
Environmental events.

COVID-19 Pandemic

Additional 53.2 million cases of depression and 76.2 million cases of anxiety due to covid also associated with an increased risk of suicidality.
Profound impact vulnerable populations with preexisting conditions with increase risk of being infected (elderly, chronic conditions) and marginalized communities in LMICs
Increase of research on the mental health of health care workers.
Mental health conditions, stress, and burnout were prevalent among health care workers—females, minority groups
Nurses, Caregivers and children are also affected.

Conflict/Instability

Displaced populations suffer most.
Russian invasion of Ukraine exposes 7.5 million children to severe mental and physical health risks.
WHO estimates half a million individuals in need of mental health treatment
Conflict in Ethiopia causes elevated anxiety and depression in Tigray's young adults.
Host countries face challenges with refugees experiencing PTSD, depression, anxiety, and substance use disorders.
Recommendations include family-based interventions and culturally adapted psychological support through existing platforms like youth employment programs.
Future efforts needed to prioritize refugee rehabilitation and address long-term impacts on vulnerable populations amid strained healthcare systems.

Human Rights

Underreported human rights violations in mental health services.
Some countries have protective legislation, but the impact and effectiveness of these policies need evaluation.
UN CRPD implementation in West Africa reveals human rights violations and poor standards of care for psychiatric inpatients.
Well-intentioned legal protections can lead to unintended adverse consequences.
Queensland's revised MH legislation sees an increase in compulsory treatment orders, contrary to efforts for less restrictive treatment.
COVID-19 enforcement measures, like quarantine, contribute to human rights abuses, particularly by law enforcement.
Strict lockdowns and curfews during the pandemic may exacerbate and prolong existing mental health issues in the post-pandemic phase.

Environmental Events and Mental Health:

Global impact from both catastrophic events and gradual climate changes.
Stress and anxiety, especially for sub-populations dependent on natural resources.
Nunatsiavut communities in Canada experience higher mental health clinic visits with prolonged warm temperatures.
Climate change linked to elevated farmer suicides, intensifying existing inequities.
Existing research predominantly from HICs, leaving a crucial gap for LMICs.
Effective interventions focus on recovery, health promotion, resilience, local knowledge, climate change education, and improved evacuation procedures.

Funding for Global Mental Health:

Robust financing crucial for strategy implementation.
Current funding falls short of mental health needs, hindered by policy and governance gaps.
Development assistance for health (DAH) from HICs to LMICs inadequate, with only $0.7 billion for NCDs in 2019 against a $28 billion target.
Only 0.3% of official DAH from 2006 to 2016 dedicated to mental health projects.
Disparities in mental health research funding, with about $3.7 billion globally per year, primarily from HICs.
Underfunding in specific areas like suicide, eating disorders, and personality disorders compared to depression and substance use.
Limited focus on younger populations in mental health research grants despite conditions occurring at younger ages.
Majority of grant funding directed to basic sciences, with less than 7% allocated to prevention.
Progress in local capacity building and mental health services with $60 million funding through the Global Alliance for Chronic Diseases in 2017.
US Health and Human Services allocates $40.22 million grant to address youth mental health.
Strategies for mobilizing funds include integrating mental health into national insurance systems.
Health systems strengthening in Nigeria advocates for mental health integration into primary care, performance-based financing, and stakeholder engagement.
Ethiopia improves mental health financing through political commitment, economic growth, and community-based health insurance expansion.

Centering Relevant Stakeholders in Global Mental Health:

GMH research must prioritize inclusion of people with lived experiences of mental illness (PWLE) for shaping interventions and policies.
WHO Special Initiative on Mental Health aims to involve PWLE in global collaborative networks.
Lancet Commission on stigma emphasizes PWLE involvement at all research stages, highlighting positive impacts on mental health programs.
Welcome Trust UK collaborates with PWLE to shape mental health programs, recognizing the importance of lived experience expertise.
Evaluation of limited evidence on research involving PWLE is crucial for future studies and reviews.

Power Dynamics in GMH Research

Attention to GMH methods in LMICs and decolonization of the field.
Inequities in research activities, often labeled as "helicopter science" or "extractive science," involve data collection by high-income country (HIC) researchers in LMICs without acknowledging local staff and knowledge.
Power imbalances between Global North and Global South centers of knowledge exacerbated by funding allocation to HIC institutes.
Research conducted in LMICs but published by HIC researchers may overlook cultural nuances, impacting analytic choices and interpretation.
Long-term sustainable multi-country research partnerships needed for equitable engagement and capacity building in LMICs.
Recognition of the necessity to directly fund local research institutions for independent development.

Conclusion

Recent Developments in GMH

Ongoing global disparities in mental health conditions persist, impacting socially disadvantaged populations.
Treatment approaches like integrated care and task-shifting show promise but face implementation challenges.
Growing recognition of the necessity to include marginalized voices and people with lived experience in research and priority-setting efforts.
Significant progress in GMH, with a need to sustain and build on promising efforts.
The evolving nature of global events and the inclusion of relevant partners expected to shape the future of GMH practice and research.

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