It's obvious that mental illnesses have a significant impact on the lives of the suffering, as well as their family and friends, especially with the continued stigma regarding mental illness. This stigma can often delay treatment, causing the recovery process to be longer and at times involve more extensive measures, such as combined therapy and medication, for a period of time. But not everyone realizes that mental illness also brings extensive economic damage to countries with underdeveloped mental healthcare systems. Mental illnesses make up nearly 13% of the global disease burden and cost the global community approximately US $2.5 trillion per year. Despite these enormous costs, the budget for mental healthcare in nearly all countries—regardless of their relative developed, developing, or underdeveloped status—remains astonishingly low, sometimes with mental health accounting for 2% or less within the overall healthcare budget.
As with many other global issues, non-govermental organizations have been able to significantly advance the campaign for improved global mental healthcare due to their relative political and cultural neutrality. NGOs are also more eager to collaborate with local resources already present in the community in which they are working—as opposed to attempting to compete with the existing resources—leading to increased trust of the organization by the local population. Many NGOs concerned with the improvement and dispersion of mental healthcare have been created, especially since Doctors Without Borders’ 1998 acknowledgement of mental health as a significant issue in areas of distress. These NGOs often take on interdisciplinary perspectives to mental health issues, leading to increased opportunities for innovations within mental healthcare.
Though much of the heavy lifting of mental health care has been accomplished by non-governmental organizations, governments throughout the world have recently begun to take more active roles in the distribution of mental health resources. The National Institute for Mental Health established the Collaborative Hubs for International Research on Mental Health (CHIRMH) in 2011 in order to address the growing prevalence of mental illness in low- and middle-income countries (LMIC). These research centers seek to unite scientists throughout the global research community in order to gain a more complete knowledge base, which can then be applied in new and innovative medical treatment of mental illnesses. Gathering a wide variety of scientific perspectives serves an important purpose since it enables a variety of historical, social, economic, and political contextual factors to be taken into account.
Regardless of whether attempts at mental health care are made by a governmental or non-governmental organization, certain challenges remain unique to the promotion of quality mental health care on a global scale. The Mental Health Global Action Programme was released in 2002 by the World Health Organization (WHO). This analysis of the gaps which exist in the quality and availability of mental healthcare worldwide revealed that of the 185 countries which were surveyed, 41% lacked a formal mental health policy. Even more shocking is that 25% of countries lacked any legislation on mental health and 28% of countries surveyed had no separate budget for mental health. Of those countries which did have a specific mental health budget, 36% allocated less than 1% of their health budget to mental health.
Perhaps in response to these distressing results as well as to the general trend of increased awareness of the unfortunate disparity which exists within global mental healthcare, the Grand Challenges in Global Mental Health initiative was launched in 2010 in order to provide focal points upon which the international healthcare community might target. Addressing a wide variety of neuropsychiatric disorders, the initiative relied upon the collective participation of some 422 individuals representing work being done in over 60 countries across the globe. The largest representation was for Asia, which consisted of 24% of the sample, followed closely by Africa and North America at 20% each, Central and South America at 18%, Europe at 16%, and Australia and New Zealand at 2%.
The resulting data obtained forty unique “Grand Challenges” for global mental health. These challenges ranged from education—for example the obstacles involved with training health professionals in the previously mentioned LMIC in order to provide more substantial care to the local population—to public policy concerns like the need for a specific National Mental Health Plan for each country. By creating a global health system in which mental health is a more major priority while increasing the cultural sensitivity of intervention methods, the Grand Challenges initiative seeks to cross sociocultural borders in order to foster a more inclusive and effective global healthcare system.
The most complete summary of the current theories concerning the evolution of global mental healthcare comes in the form of the WHO’s Comprehensive Mental Health Action Plan 2013-2020. This plan was unanimously approved by the 66th World Health Assembly and is structured around four fundamental objectives for the next generation of mental healthcare which are listed below.
- Strengthen effective leadership and governance for mental health
- Provide comprehensive, integrated and responsive mental health and social care services in community-based settings
- Implement strategies for promotion and prevention in mental health
- Strengthen information systems, evidence and research for mental health
By focusing on these four main objectives, global mental healthcare will improve substantially by 2020. These objectives are only obtainable through the collaboration of both governmental and non-governmental organizations, both of which will require increased funding and community support in order to have truly significant impacts.
The challenges of mental healthcare may only be met through the collaboration of a global community consisting of nations varying widely in their cultural, political, social, and economic backgrounds. Only together can we lead those suffering from mental illnesses out of the darkness and into a world where each individual’s right to healthcare is genuinely respected.
