Achieve access for all to mental healthcare

Evidence shows that investing just $ 1 per capita annually for priority mental health conditions could reduce years lived with disability by close to 5,000 per million population each year

• The WHO South-East Asia Region is accelerating action to bring quality, affordable mentalhealthcare to all who need it

The COVID-19 crisis has impacted almost all areas of health, but few as profoundly as mental health. In 2020, cases of major depressive disorder are estimated to have increased by more than 27% globally, and cases of anxiety disorders by more than 25%, adding to the 1 billion people who were already living with a mental disorder. In many countries, this occurred alongside widespread disruptions to mental health services. Between November and December 2021, more than 33% of WHO Member States globally reported ongoing disruptions to mental, neurological and substance use services. 

To help counter this trend, at the 75th session of the WHO Regional Committee for South-East Asia, held in Bhutan in September 2022 – countries of the region unanimously adopted the Paro Declaration on Universal Access to Mental Health Care, which aims to ensure that all people in the region can access quality mental healthcare, close to where they live, without financial hardship. 

The Declaration builds on the region’s longstanding efforts to implement equitable mental health policies, laws, programs and services, in line with its Flagship Priority on preventing and controlling noncommunicable diseases. It puts specific emphasis on the need to reorient and integrate mental health services into primary health care (PHC), complementing the new Regional Strategy for PHC, launched in December 2021. It recognises that mental health is a key determinant of social and economic development, an integral part of general health and well-being, and that access to care is a basic human right. 

The cost of inaction – for both health and economies – is huge. Before the pandemic, around 1 in 7 people in the region lived with a mental health condition, as compared to 1 in 8 globally. An estimated 4 out of every 5 people in the region who required mental health services were unable to access them. Evidence shows that investing just $ 1 per capita annually for priority mental health conditions could reduce years lived with disability by close to 5,000 per million population each year. Increased investments and/or allocations towards mental health will therefore not only reduce overall treatment costs, but also increase productivity and employment and promote sustainable social and economic development. 

In the months and years ahead, the Region has several priorities. First, reorienting mental health services to strengthen PHC capacity, moving away from mental hospitals and institutions. Of immediate focus is expanding the specialised and non-specialised mental health workforce and strengthening the role of multidisciplinary teams. 

Second, establishing evidence-based and rights-oriented community mental health networks. For this, increased collaboration with civil society – including organisations of affected individuals, family members and caregivers – is especially needed, with a focus on increasing social and informal support, while at the same time enhancing formal service provision. 

Third, strengthening national and subnational programs to address suicide and self-harm, and drug and alcohol use. Evidence shows that limiting access to highly hazardous pesticides can dramatically reduce suicide mortality. Increased screening and counselling for drug and alcohol use – which can be carried out at the PHC level – can promote behavioural change, and also connect people with substance use services. 

Fourth, combatting stigma and discrimination against people with mental disorders, family members and caregivers. Communication campaigns and social contact strategies that involve people with lived experience can help shift attitudes and actions, ensuring all people feel comfortable accessing the services they need, while at the same time protecting and promoting human rights, and strengthening social support structures. 

To facilitate evidence-based action in each of these areas, the Paro Declaration highlights the need to increase data and reporting on mental health, and also strengthen operational research and performance monitoring. It underscores the importance of harnessing new digital tools to innovate and expand interventions, and of promoting multisectoral action and awareness, including in schools and workplaces. 

The Region’s Flagship Priorities, the Sustainable Development Goals, and WHO’s founding Constitution all agree: There is no health without mental health. Amid the ongoing COVID-19 response and recovery, together we must deepen commitment, reshape environments, and strengthen care to transform mental health, for a better life and future for all. 

(The writer is WHO South East Asia Regional Office’s Regional Director.)