The journey of making mental health a development priority

May 23, 2019

     By Maria Faciolince     

Dr Dixon Chibanda is a psychiatrist and creator of the Friendship Bench, an initiative that has revolutionised mental health care in Zimbabwe. Elisha London is CEO of United for Global Mental Health, a global mental health NGO, which combines advocacy, campaigning and financing expertise. In her work, Elisha draws on her own mental health experiences, having been diagnosed with Post Traumatic Stress Disorder (PTSD) and chronic depression.

For years, we’ve seen first-hand that mental health support and services globally are too sporadic, poorly funded and insufficient to meet the enormous demand for them.

Over three-quarters of people with mental health conditions in low- and middle-income countries receive no support at all, meaning depression has become the leading cause of ill health for all ages and suicide a major killer of young people worldwide. Yet governments, on average, allocate less than 2% of their health spending and donors devote less than 1% of global health aid to mental health.

We’re writing now because it finally feels like some of the voices of people with lived experience of mental health conditions, advocates for their rights and the policy experts supporting them are being heard by decision-makers.

But we see the need to do more – and fast.

Speaking our mind

Driven by people with lived experience of mental health conditions, Speak Your Mind is a global civil society campaign, which is currently in 15 countries (and growing) and launched at the World Health Assembly (WHA) this week, aiming to get the attention of health ministers.

Speak Your Mind’s asks to governments at WHA are: invest, educate and empower societies. Enabled by bigger budgets for mental health, they should run public education campaigns to end the stigma and ignorance surrounding mental health. Leaders should also look to people with lived experience to guide the reform and implementation of policies.

This campaign is building on a wellspring of activity, especially over the past six months but reaching back decades. One such organisation, set up by one of the authors of this post, is the Friendship Bench, a project in Zimbabwe (and soon growing globally), which trains grandmothers in basic mental health counselling techniques. The grandmothers then sit on designated benches outside health centres to help people with mental health needs. Studies prove the effectiveness of the Bench, including a randomised clinical trial, which found that patients with common mental disorders assigned to the Friendship Bench intervention had fewer symptoms than the control group.  

Making space for Mental Health at high level events

On 10 October 2018, World Mental Health Day, the Director-General of the WHO, Dr Tedros Adhanom Ghebreyesus, joined forces with Lady Gaga to write movingly about the 800,000 people who die by suicide every year, showcasing that action is needed.  

As a leading cause of death and suffering worldwide, suicide deserves much more attention from the global community. Suicide mortality rate is the Sustainable Development Goals’ indicator for mental health, alongside the call for promoting mental health and well-being. Suicide prevention is the theme of this year’s World Mental Health Day, which will see campaigners push for closing the huge gap in support for those at risk of suicide and to help end the surrounding stigma.

As last year went on, there was growing global leadership on mental health by both the UN Secretary-General António Guterres and the WHO’s Dr Tedros. The UN Secretary-General announced an initiative to improve the mental health of UN staff. He also called for a collective push by the UN to address mental health, recognising that change requires action across different sectors – not just within health. Dr Tedros focused on mental health in the WHO’s latest General Programme of Work and WHO just announced a new Special Initiative on mental health.

Marking World Mental Health Day last year, the ministerial-level global mental health summit has now become an established fixture. The UK hosted last year, the Dutch will take it on this year and the French in 2020. With a particular focus on mental health and psychosocial support in emergency settings, we hope this year’s ministerial meeting will accelerate progress to both fund and deliver mental health support for those caught up in humanitarian catastrophes, wars and disease outbreaks such as Ebola.

It’s time to act

Throughout these moments, much of the global mental health community has shared the message that while there is a growing conversation around the importance of mental health, not enough is being done to provide tangible support and protect human rights.

Building on the work of advocates committed to improving global mental health, there are a number of important opportunities to enshrine mental health as a vital part of Universal Health Coverage (UHC) throughout the latter half of 2019.

The UN Secretary General has stressed the need to ensure mental health is a key component of Universal Health Coverage (UHC). This has real significance in a year when UHC is the main focus of the World Health Assembly and a high level event at UNGA, which will include a negotiated statement and speeches by heads of state outlining their commitments to achieve UHC. Honing in on the UHC promise to look at specific diseases, the Global Fund replenishment in October must also include mental health if prevention and treatment, especially of HIV/AIDs and TB, is to be effective.

Mental health has frequently been left out of health plans – this is not acceptable. Mental and physical health should be treated equally by policy makers, just as they are equally valued by us all.