International Working Group for Health Systems Strengthening

This WMHD, we call for five actions we believe will make a difference. These five actions, however, need to be situated in a common understanding. Our mental health is shaped by things that happen within us and outside us. Our mental health and the mental health system that surrounds us is an interconnected part of the overall health and well-being system, and does not exist in a siloed vacuum. We have to address the inner, individual, social, environmental, systemic, commercial, economic and political determinants of mental health. Prioritizing mental health must include effective prioritization of the critical issues that we face daily.

Beyond Silos: Making Mental Health and Well-being For All a Global Priority

This year marks 30 years since World Mental Health Day (WMHD) was first celebrated on October 10, 1992, the result of an inspiring global advocacy and awareness program started by the World Federation for Mental Health. 

A lot has changed in the mental health space in the past three decades, yet a lot remains the same. Parts of this depend on where you live, with whom, your gender, socioeconomic status, sexual orientation, whether you have a disability, cultural and social norms in your community, and other socioeconomic and political determinants of health. Further, external events such as the COVID-19 pandemic, vaccine injustice, and climate crises have also shaped our individual and collective mental health, further exacerbating mental health outcomes around the world.

Massive inequalities and inequities remain in access to mental health care and capacity, and the existence and quality of policy and legislation frameworks to support mental health action between high- and low- and middle-income countries, and across regions. We, as members of a global collaborative of emerging public health actors across the world, have spoken many times about, and acknowledge, how these inequities manifest across our own lived experiences. Alarmingly there is paucity of data on mental health, but the data we do have is screaming that the house is on fire;

• As of 2019, an estimated 1 in every 8 people in the world live with a mental disorder;
• As of 2019, an estimated 1 in every 7 adolescents in the world live with a mental disorder;
• Amidst a viral pandemic that upended our lives, anxiety and depression alone were estimated to increase ~25% around the world during just the first year of the pandemic.

The cost of inaction is not small, financially or socially. Depression and anxiety cost the global economy US$ 1 trillion annually. Mental health conditions remain among the top reasons of death and disability across regions, especially amongst young people. And what of the intangible cost — How do we identify, categorize, collect, document and compare these? Are they lost opportunities for increased social connectedness and belonging? Absence of social citizenship, personal fulfillment and self-actualization? The exhaustion of living within ableist frameworks? We will have missed many intangible costs in this list, afterall, each of us have our own individual and collective ‘unknown’ unknowns; the things we are neither aware of, nor understand. 

The theme of World Mental Health Day this year is to make mental health and well-being a global priority. We celebrate this theme and wholeheartedly commit towards making this vision a reality. And, we also entertain some questions the theme raises, such as: HOW do we make mental health and well-being a global priority? WHO is responsible for making this vision a reality? WHAT are the accountability mechanisms needed to make this vision a reality?

This WMHD, we call for five actions we believe will make a difference. These five actions, however, need to be situated in a common understanding. Our mental health is shaped by things that happen within us and outside us. Our mental health and the mental health system that surrounds us is an interconnected part of the overall health and well-being system, and does not exist in a siloed vacuum. We have to address the inner, individual, social, environmental, systemic, commercial, economic and political determinants of mental health. Prioritizing mental health must include effective prioritization of the critical issues that we face daily. To name but a few; climate action, homelessness, the food crisis, racism and discrimination, gender imbalance, war and conflict, and a primarily narrow biomedical model of disabilty and mental health, among others. Mental health actors are sounding the alarm, but the onus should not fall only on their shoulders. Sustainable and equitable mental health action requires cross-sectoral and integrated approaches. We have to ask ourselves how we can make this happen. What more can we do in our personal and professional lives, everyday, to help initiate and propagate this kind of change. 

Call to Action

1. Nurture and develop the mental health and well-being workforce 

To effectively address and prioritize mental health and well-being, we need committed investment and action towards creating and strengthening the mental health workforce to have a cohort of professionals that are accessible, available, affordable, and able to provide quality (and contextualized) care. The median number of mental health workers globally is 13 per 100,000 population. The range around this average demonstrates the inequalities present: 60 workers per 100,000 population in high income countries and only 2 workers per 100,000 population in low-income countries. Furthermore, there is a need to move beyond biomedical models of care to develop and nurture diverse cohorts of mental health and alternative providers who are able to provide contextual care to meet the needs of each community, especially those who are from and invested in supporting the care of marginalized communities.  

2. Integrate Mental Health into Existing Health and Development Systems 

Integrate mental health and well-being as a cross-cutting component of programming across health and development systems. This entails making mental health a priority in sectors beyond the mental health system, engaging a wide range of actors and sectors. Additionally, we should encourage and demand diversity in disciplines, culture, thought leadership and perspectives across mental health programming. This has the potential to strengthen multi-sectoral policies and practice, at local, national, regional, and global levels, and across all settings, such as the home, local community, schools and higher education, online and digital spaces, workplaces, and in other spaces.

3. “Nothing About Us Without Us”: Center the experiences of individuals with lived experiences of mental health

Meaningfully integrate the voices and experiences of those with lived experiences into mental health programming and services, whether through storytelling, co-production in research, involvement in leadership positions, holistic and client-centered models of collaborative care and other innovative ideas. We need to strengthen mechanisms for knowledge sharing, de-stigmatization efforts, and leverage the power of storytelling by amplifying the voices of those with the lived experience of mental health. This is not a new ask, especially in the mental health space. Groups like MindOut and Kunsul Nazzjonali, for example, offer unique and innovative solutions for mental health, directly grounding it in the expertise of individuals with lived experience of mental health issues.

4. Frame Mental health as an Evidence-Based Political and Economic Priority (and Responsibility) for Governments

Strengthen the financial and policy infrastructures for mental health. In 2020, governments globally spent on average just over 2% of their health budgets for mental health and well-being. This is simply unacceptable, given the rising need for mental health care. We need to demonstrate that investment in mental health can have economic benefits; and, we need better data ecosystems to measure action and more importantly, measure the impact of mental health action. Strengthening and generating robust data on mental health can be an effective approach to this end. Further, employing political economy analyses and co-creating prioritization frameworks with key stakeholders can guide planning, resource mobilization and allocation, and implementation at all levels of the system. This transparency also allows for critique and feedback, which are critical to the learning and accountability process.

5. Strengthen intergenerational leadership and innovative problem solving for mental health 

Mental health action is a team sport, and it necessitates innovative cross-generational and cross-disciplinary  collaboration. Young people are burdened by mental health conditions, and they play unique roles in advocating and advancing solutions for mental health and well-being. Organizations like the Shamiri Institute integrate innovative for- and by- youth solutions to address the mental health needs of young people in their communities. Another example is the Center of Excellence in Next Generation Networks which uses Natural Language Process (NLP) to assist mental health professionals during therapy sessions. Various such organizations are shaping the field by creating innovative solutions that champion and center the experiences of young people and those with lived experiences in finding solutions that work for them, and we are excited by this potential. Collective solutions to our current and future crises will rely on the creativity and resilience that we foster in children and young people. We need to prioritize and protect their mental health and, with them, advocate for a mental health system that is fit for purpose.