By Anushka Pardikar
It was in 2001 that the World Health Organisation (WHO) published the preceding World Health Report titled Mental Health: New Understanding, New Hope. The 2001 report laid bare the impending crisis that the world was likely to set into considering the enormous public health and socio-economic impact of mental health illnesses. According to the report, the gravity of the crisis coupled with the existing vacuum in care delivery models was a recipe for disaster.
Twenty years later, the WHO on June 17, 2022 released its largest review of the world mental health since the start of the century. The report commences by laying out abysmal statistics pointing towards deteriorating world mental health. Data indicates that as of 2019 and even before the start of the Covid-19 pandemic, nearly one billion people were living with mental disorders, and that on an average, people living with mental health conditions die 10 to 20 years earlier than the general population.
1. There exists a huge gap in treatment delivery: To put in the numbers, a whopping 71% of individuals with psychosis did not receive mental health services, and only 12% of individuals with psychosis in low-income countries received medical attention. As for depressive disorders, the statistics distressingly state that only a third of individuals with depression received formal mental health care. These figures must further be contextualised in the backdrop of the pandemic where depression and anxiety went up by over 25% in the first year alone.
2. Reforming legal frameworks dealing with mental health: In addition to this, the report addresses allied aspects of concern such as discrimination, criminalisation and human rights violations that people with mental health conditions often encounter. There still exist 20 countries that continue to criminalise attempted suicide. Therefore, the existing social, and legal frameworks pose a challenge to the prevention, detection, and cure of mental illnesses. In this context, WHO re-iterates that it is often the most marginalised and disadvantaged sections of the society who are at the greatest risk of mental ill-health and also bear the brunt of inadequate medical services.
3. Improving financing structures and creating community-centric care models: Further, the report aptly remarks, “To transform mental health services, commitment must be translated into action through appropriate financing.” However, a mere increase in budgetary allocations in the absence of financing appropriate care models would prove to be futile. Statistics indicate that two out of the three dollars of the meager government spending on mental health is allocated to stand-alone psychiatric hospitals. It is of utmost importance that financial support is extended to community-based health services and away from psychiatric institutions. This would ensure that care models are premised upon people-centred and recovery-oriented models considering aspects of human dignity and human rights.
4. Political commitment will be the key to address the mental health crisis: Addressing these aspects would require coordinated efforts by not only the government but also other concerned stakeholders. To a large extent, the way forward lies in political commitment and individualised supports of other stakeholders. The report urges countries to implement strategic change such as developing a strong mental health legal framework, strengthening community mental health services, including mental health coverage in insurance schemes and integrating mental health into general health care. Broadly, the nature of recommendations made focus upon shifting attitudes to mental health, addressing risks to mental health and strengthening care models.
5. Mainstreaming lived experiences of persons with mental health conditions: Further, inclusivity in policy determinations is key to achieving strategic changes – including individuals with mental health conditions in decision-making process would not only help bring lived experiences to policies framed, but also help diminish societal stigma and widespread discrimination that these individuals often face. Most importantly, it provides the said individuals with autonomy over mental health care.
However, mere tokenistic inclusivity does no good, the search is for holistic, well-intentioned inclusivity that promotes efficient and improved decision-making. In this context, the report indicates that such participatory rights has largely been limited to high-income countries. Only a third of middle-income countries and a disappointing 16% of low-income countries have devised a strategy for inclusivity.
Anushka is a communications intern with TA. She is an incoming LL.M. student at the University of Ottawa, Canada.
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