Everyone’s talking about mental health – particularly its effect on the world’s poorest countries. But what do we do about it? Where do we start? Jessica Mackenzie suggests four crucial steps.
Finally, mental health seems to be getting some much-needed attention. From almost weekly articles online to Academy Award-winning films mental health has been moving up the global agenda in 2016. Even the Duke and Duchess of Cambridge were recently spotted cheering on mental health charities at the London marathon.
The development sector is taking notice too. In April, the World Health Organisation and World Bank spring meetings focused on making mental health a global priority. Two months earlier, the UK Parliament hosted an All-Party Parliamentary Group meeting on mental health and the importance of the international NGO sector in addressing it. Perhaps the most significant shift of all is that three targets in the Sustainable Development Goals incorporate mental health.
Mental health is a development issue. We know that the most severe effects of mental disorders are being felt in the poorest countries. We agree that ‘there’s no health without mental health’. And we know that the international community needs to make mental health a priority rather than leave it languishing in the shadows if we’re to reach our development goals. As a recent report by Human Rights Watch has shown in Indonesia, those experiencing mental health disorders can become some of the most marginalised in society. Yet, mental health not only affects those experiencing it: it also has significant impacts on their families. The Indonesian government is taking important steps to redress this.
So what should we, in the development sector, be doing?
Addressing mental disorders is such an enormous challenge, or series of challenges, with so many conflicting views and priorities that it’s hard to know where to begin. I suggest four critical first steps as a starting point, which – if we can get them right – should provide the foundations for real change.
- Development donors need to track funding. Often bundled into general health budgets and development aid to health – as is the case in the UK’s Department for International Development (DFID) – spending on mental health programmes is inconsistently and infrequently tracked. Knowing what is spent is crucial if we are to understand how low funding actually is, and where it is going. When you do scrape together the small pockets of funding that exist, the total figure is appalling: $133.57 million annually, split across 148 recipient countries. Especially when you consider the fact that mental disorders affect one in four of us over a lifetime.
- Global development practitioners need to recognise mental health as a cross-cutting issue. Building mental health components into development interventions can help those programmes deliver better results. Some links are obvious: agriculture and suicide; debt and depression; climate change and mental health resilience; and maternal, new-born and child health and maternal depression. Some are less obvious, but the results of development programmes that have integrated mental health aspects are promising – the Friendship Bench in Zimbabwe, for example, is an interesting case study of how such programmes can deliver real results.
- Development practitioners need to challenge assumptions about mental health being hard to implement and hard to measure. Despite prevailing narratives to the contrary, progress is measurable and there are cost effective solutions. We need to say so in our meetings and in our documents; there are solutions that work and they don’t need to cost the earth. There is an expanding body of evidence showing that mental health care can be very effectively provided by harnessing non-specialists. WHO’s mental health Gap Action Programme (mhGAP) provides guidelines for this type of work. Plus there are a range of excellent models to replicate, like BasicNeeds. Initiatives spearheaded by the Canadian-funded Mental Health Innovation Network capture what works, share learning and provide helpful case studies on how to improve effectiveness in this area. The trouble is that they need more funding, so we can get some momentum and grow the evidence base.
- Donors need to increase funding to mental health. Country governments and households carry the overwhelming majority of the burden. There are so few donors funding mental health activities in any meaningful way, that in fact it receives less than 1% of global health spending. In health, everything is a priority. But even with the plethora of competing issues faced in the world today, mental health is critically underfunded. And it’s a killer: suicide is responsible for more than 800,000 deaths a year. And economists estimate that it is costing the global economy a phenomenal 50 million years of work annually. We simply can’t afford not to fund it.
Those of us working in international development are perfectly placed to start these conversations in our own institutions. There is a global recognition that we need to prioritise mental health and a tipping point is approaching. The next questions – how to change those policies, which programmes to fund – will depend on these four steps.
For more information see Jessica Mackenzie’s forthcoming report: ‘Mental health funding and the SDGs: What now and who pays?’
Jessica Mackenzie is a Research Fellow at the Overseas Development Institute. She specialises in policy influence and improving the role of evidence in decision-making globally, with expertise in Indonesia and broader South East Asia. Jessica has been working with the World Health Organisation and London School of Hygiene and Tropical Medicine on the Mental Health Innovation Network since 2014. Prior to joining the ODI, she worked for the Australian Aid Programme on governance, education service delivery and designs for evidence-based policy and practice programmes. Follow Jessica on Twitter: @JessicaM_London