In April I attended Out of the shadows: making mental health a global priority. This two-day event was co-hosted by The World Bank and World Health Organization, with the aim to move mental health out from the margins of the global development agenda.

It was the first time mental health has been discussed by the World Bank. Their call for global action is clear.

  • Ten per cent of the world’s population, including 20 per cent of children and adolescents will experience some sort of mental health issue in their life.
  • Depression alone affects 350 million people worldwide and is the single largest contributor to years lived with a disability globally.
  • Mental, neurological, and substance use issues increased by 41 per cent between 1990 and 2010, now accounting for one in every 10 lost years of health worldwide.
  • Suicide is the leading cause of death for young women now.
  • Half of the world’s poor will be affected by war and violence by 2030. Forced migration and sustained conflict put people at higher risk for mental health issues.

Poor mental health costs countries. The Royal Australian and New Zealand College of Psychiatrists (RANZCP) recently released a report calculating the economic cost of premature death of people with mental illnesses to be $3.1 billion (1.3% of GDP) annually, and the cost overall to be $12 billion (5% of GDP).

Yet, according to a new WHO-led study, every US$1 invested in scaling up treatment for depression and anxiety leads to a return of US$4 in better health and ability to work.

Despite its enormous health, social and economic implications, mental health continues to be driven into the shadows by stigma, prejudice and fear. This was likened to HIV/AIDS two decades ago. That health issue felt unsurmountable to start with, but a global health development movement faced down that potential catastrophe in just a handful of years. Simply put, the world got on top of HIV/AIDs with radical changes in attitudes and treatments, and the call is now to address mental health with the same kind of energy and activism.

Of course funding mechanisms and healthcare systems also need to change.

So – where to from here?

Together the world can solve this. I was left with the following thoughts from the event.

Primary care integration

Doctors need to build mental health into their practice more, and this may require upskilling. GPs are treating increasing numbers of people with mental health issues and many don’t feel equipped, either in terms of resources or training, to deal with it, according to the latest New Zealand Doctor/IMS Health fax poll. (See GPs willing to help but ill-equipped for taking on mental healthcare role from NZ Doctor – subscription required.)

Investment and returns

Countries need to think about ways to pay for increased mental health services. We all have a role to play here by reminding policy makers about the economic and social wellbeing opportunities if our population’s mental wellbeing is improved.

Funding mechanisms

The question of where funding sits is important. If we continue to treat this as a ‘health’ issue to be addressed from health budgets only we miss the opportunity to look at social determinants of mental health, which may have a bigger impact long-term. Ideally the thinking and funding needs to shift ‘closer to home’ like the health strategy suggests, looking to funding priorities in housing, education and justice budgets.

Businesses need to get involved

The private sector also has a lot to gain from investing, with reduced absenteeism and ‘presenteeism’ and increased productivity easily realised.

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