The World Health Organization's new Mental Health Atlas paints a disappointing picture of a worldwide failure to provide people with the mental health services they need, at a time when the COVID-19 pandemic is highlighting a growing need for mental health support.
The latest edition of the Atlas, which includes data from 171 countries, provides a clear indication that the increased attention given to mental health in recent years has yet to result in a scale-up of quality mental services that are aligned with needs.
Issued every three years, the Atlas is a compilation of data provided by countries around the world on mental health policies, legislation, financing, human resources, availability and utilization of services, and data collection systems. It is also the mechanism for monitoring progress towards meeting the targets in WHO's Comprehensive Mental Health Action Plan.
"It is extremely concerning that, despite the evident and increasing need for mental health services, which has become even more acute during the COVID-19 pandemic, good intentions are not being met with investment," said Dr Tedros Adhanom Ghebreyesus, Director-General of the World Health Organization. "We must heed and act on this wake-up call and dramatically accelerate the scale-up of investment in mental health, because there is no health without mental health."
Lack of progress in leadership, governance and financing
None of the targets for effective leadership and governance for mental health, provision of mental health services in community-based settings, mental health promotion and prevention, and strengthening of information systems, we're close to being achieved.
In 2020, just 51% of WHO's 194 Member States reported that their mental health policy or plan was in line with international and regional human rights instruments, way short of the 80% target. And only 52% of countries met the target relating to mental health promotion and prevention programs, also well below the 80% target. The only 2020 target met was a reduction in the rate of suicide by 10%, but even then, only 35 countries said they had a stand-alone prevention strategy, policy, or plan.
Steady progress was evident, however, in the adoption of mental health policies, plans, and laws, as well as in improvements in the capacity to report on a set of core mental health indicators. However, the percentage of government health budgets spent on mental health has scarcely changed during the last years, still hovering around 2%. Moreover, even when policies and plans included estimates of required human and financial resources, just 39% of responding countries indicated that the necessary human resources had been allocated and 34% that the required financial resources had been provided.
Transfer of care to the community is slow
While the systematic decentralization of mental health care to community settings has long been recommended by WHO, only 25% of responding countries met all the criteria for integration of mental health into primary care. While progress has been made in training and supervision in most countries, the supply of medicines for mental health conditions and psychosocial care in primary healthcare services remains limited.
This is also reflected in the way that government funds for mental health are allocated, highlighting the urgent need for deinstitutionalization. More than 70% of total government expenditure on mental health was allocated to mental hospitals in middle-income countries, compared with 35% in high-income countries. This indicates that centralized mental hospitals and institutional inpatient care still receive more funds than services provided in general hospitals and primary healthcare centers in many countries.
There was, however, an increase in the percentage of countries reporting that treatment of people with specific mental health conditions (psychosis, bipolar disorder, and depression) is included in national health insurance or reimbursement schemes – from 73% in 2017 to 80% (or 55% of Member States) in 2020.
Global estimates of people receiving care for specific mental health conditions (used as a proxy for mental health care as a whole) remained less than 50%, with a global median of 40% of people with depression and just 29% of people with psychosis receiving care.
Increase in mental health promotion, but effectiveness questionable
More encouraging was the increase in countries reporting mental health promotion and prevention programs, from 41% of Member States in 2014 to 52% in 2020. However, 31% of total reported programs did not have dedicated human and financial resources, 27% did not have a defined plan, and 39% had no documented evidence of progress and/or impact.
Slight increase in the mental health workforce
The global median number of mental health workers per 100 000 population has increased slightly from nine workers in 2014 to 13 workers per 100 000 population in 2020. However, there was a very high variation between countries of different income levels, with the number of mental health workers in high-income countries more than 40 times higher than in low-income countries.
New targets for 2030
The global targets reported on in the Mental Health Atlas are from WHO's Comprehensive Mental Health Action Plan, which contained targets for 2020 endorsed by the World Health Assembly in 2013. This Plan has now been extended to 2030 and includes new targets for the inclusion of mental health and psychosocial support in emergency preparedness plans, the integration of mental health into primary health care, and research on mental health.
"The new data from the Mental Health Atlas shows us that we still have a very long way to go in making sure that everyone, everywhere, has access to quality mental health care," said Dévora Kestel, Director of the Department of Mental Health and Substance Use at WHO. "But I am encouraged by the renewed vigour that we saw from governments as the new targets for 2030 were discussed and agreed and am confident that together we can do what is necessary to move from baby steps to giant leaps forward in the next 10 years."