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Mental health is a universal human right

By Caroline Manuela Hartanto, RHC Consultant


We have come a long way in recognising mental health as one of the most important drivers in achieving health for all, proven by the inclusion of mental health promotion as part of the UN Sustainable Development Goals target 3.4. The acknowledgment of mental health as a field or discipline on the world stage transpired in 1946 through establishing the National Association for Mental Health (NAMH) in England. Four years later, at the second session of the World Health Organization’s (WHO) Expert Committee on Mental Health, “mental health” was defined as “a condition, subject to fluctuations due to biological and social factors, which enables the individual to manage their natural conflicting urges; to form and maintain harmonious relations with others; and to participate in constructive changes in his social and physical environment” (1).


Nonetheless, the global economic burden attributable to mental, neurological and substance use conditions remains substantial, and is projected to cost a staggering US$ 16 trillion between 2011 and 2030 (2). Beyond the quantifiable economic toll, people living with mental health conditions endure the weight of societal stigma and bias, often being unfairly characterized as dangerous, inept, or unworthy (3). Some even bear the brunt of physical and emotional abuse, face discrimination, are denied access to education and employment opportunities, and are excluded from their own families and communities (4).


This year’s theme for World Mental Health Day is “Our minds, our rights” and highlights the importance of promoting and protecting everyone’s mental health as a basic universal human right, which includes the quality of care everyone deserves. It also highlights the right to liberty, independence, and inclusion in communities (5).


Protecting and promoting mental health is the overarching goal of the WHO Comprehensive Mental Health Action Plan 2013-2030. For Member States, one of its proposed approaches is to develop, strengthen, sustain and implement national policies, strategies, programmes, laws and regulations pertaining to mental health (6). However, in the World Mental Health Report 2022: Transforming mental health for all, despite Member States’ commitment, the pace of progress has been slow, leading to profound and adverse impacts of mental health conditions on peoples’ lives (7).


The global average for mental health allocations is less than 2% of health care budgets (7). Around half of the world’s population lives in countries where there is only one psychiatrist serving 200 000 or more people (7). There is also limited availability of affordable essential psychotropic medicines, especially in low- and middle-income countries. These gaps are even more accentuated by the differences in the quality of services (7). To address this gap, the WHO Mental Health Gap Action Programme (mhGAP) was established to provide evidence-based guidance for the management of mental, neurological, and substance use disorders in low-resource settings. A set of clinical, health systems, psychosocial and pharmacological interventions are designed to be implemented in primary care settings by health care professionals to address the treatment gap for mental health conditions in underserved populations (8).


Findings from national investment cases for mental health conducted in Bangladesh, Kenya, Nepal, Philippines, Uganda, Uzbekistan and Zimbabwe, which centered on the analysis of nine intervention packages while considering both the societal and economic burden, reveal that prioritizing the reduction of epilepsy and depression yields the most favorable return on investment. However, it's worth noting that each one of these interventions displayed a positive benefit-cost ratio (2,9).


For these reasons, it's crucial for governments to demonstrate consistent political will to invest in provision of mental health services to improve people’s health and well-being. By investing in mental health and raise public awareness, governments can greatly reduce suffering and improve the health, quality of life, functioning and life expectancy of people living with mental health conditions. It can also increase cost coverage and financial protection, and reduce inequities, so less people go untreated due to unavailable or unaffordable services.


By investing in mental health and reducing stigma around mental health conditions, we will also reduce human rights violations. People living with mental health conditions should have equal access to employment, education, housing, and most importantly, equal recognition before the law. With adequate support, individuals facing mental health challenges can actively engage in the workforce and contribute positively to society. It's essential to recognize that mental health is an integral component of overall health and well-being.



References:

1. World Health Organization. Mental Health: Report on the second session of the Expert Committee. Geneva: World Health Organization; 1951.

2. Chisholm, D., Lee, Y. Y., Baral, P. P., Bhagwat, S., Dombrovskiy, V., Grafton, D., Kontsevaya, A., Huque, R., Kalani Okware, K., Kulikov, A., Marahatta, K., Mavunganidze, P., Omar, N., Prasai, D., Putoud, N., Tsoyi, E., & Vergara, J. (2023). Cross-country analysis of national mental health investment case studies in sub-Saharan Africa and Central, South and South-East Asia https://www.frontiersin.org/articles/10.3389/frhs.2023.1214885/fullFrontiers in health services, 3, 1214885. https://doi.org/10.3389/frhs.2023.1214885

3. Corrigan, P. W., Druss, B. G., & Perlick, D. A. (2014). The Impact of Mental Illness Stigma on Seeking and Participating in Mental Health Care. Psychological Science in the Public Interest, 15(2), 37-70. https://doi.org/10.1177/1529100614531398

4. Ma, D., & Funk, M. Human rights violations of people with mental and psychosocial disabilities: an unresolved global crisis. Lancet, 378, 1664–1675. 2011. https://doi.org/10.1016/S0140

5. World Health Organization. World Mental Health Day, 10 October 2023. Accessed on 3 October 2023 from https://www.who.int/campaigns/world-mental-health-day/2023 .

6. World Health Organization. Comprehensive Mental Health Action Plan 2013–2030. Geneva: World Health Organization; 2021. Licence: CC BY-NC-SA 3.0 IGO.

7. World Health Organization. World Mental Health Report: transforming mental health for all. Geneva: World Health Organization; 2022. Licence: CC BY-NC-SA 3.0 IGO.

8. World Health Organization. Mental Health Gap Action Programme (mhGAP). Accessed on 3 October 2023 from https://www.who.int/teams/mental-health-and-substance-use/treatment-care/mental-health-gap-action-programme

9. Prevention and management of mental health conditions in the Philippines. The case for investment. Manila: World Health Organization Regional Office for the Western Pacific; 2021.

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