Mental health still grossly underfunded but there are glimmers of hope

A StrongMinds mental health facilitator (center) speaks with former patients in Uganda. StrongMinds has treated more than 25,000 Ugandan women for depression with group talk therapy. Photo: Kevin Di Salvo

This was originally published on Global Health TV on February 28, 2018.

The problem with mental health and substance abuse in Africa and other developing countries is not that awareness has not been raised about these huge contributors to the global burden of disability.

Annually since 2009, the World Health Organization (WHO) Mental Health Gap Action Programme has been meeting to scale up services for mental, neurological and substance use disorders.

In 2013, the World Health Assembly adopted the WHO’s Mental Health Action Plan 2013-2020, which is designed to provide guidance for national action plans in all resource settings.

And most notably in 2015, world leaders recognized the importance of mental health and substance abuse in the newly minted Sustainable Development Goals. Within Goal 3 (the health goal) of the 17 SDGs, there is a target for mental health and another target for substance abuse. Here are the Goal 3 targets.

So mental health has finally been given a hard-fought and much-deserved seat at the global health table. It just has not been given much money or resources.

As this WHO infographic shows, only 1 percent of the global health workforce works in mental health and the median public expenditure on mental health per person is only $2 in low- and lower-middle income countries. This paper asserts that the amount of development assistance for health is “paltry,” with less than 1 percent specifically earmarked for people with mental disorders.

“Sadly, I don’t see that the funding gap for mental health has changed much from the recent past,” said Sean Mayberry, founder and executive director of StrongMinds, a non-profit organization that treats African women with depression through group talk therapy led by community workers. “The World Bank and WHO made big declarations about prioritizing global mental health in 2016 but they never put any money against it, so we are still in the same spot.”

Yet Mayberry also sees glimmers of hope that resources may be in the early stages of catching up with the rhetoric.

StrongMinds’ own efforts have resulted in more than 25,000 Ugandan women treated for depression with 75% of them depression-free at the end of treatment and 72% depression-free six months after treatment. This was done by cost-effective group talk therapy conducted by trained community health workers.

“Most donors don’t fund mental health because they think mental health interventions are super costly and take forever,” said Mayberry. “These interventions are working and more would be reached if more donors ponied up.”

In Liberia, the Carter Center has trained 230 clinicians in mental health, with 64 specializing in the needs of children and adolescents, said Janice Cooper project lead for the Liberia Mental Health Program. These graduates will provide mental health and psychosocial care in schools, clinics and other youth settings.

The Carter Center also fights against mental health stigma in Liberia by focusing on mental health service users and their families, religious and traditional leaders, journalists, health care workers, and trains law enforcement officers in crisis intervention – an evidence-based intervention also used by law enforcement in the U.S., said Cooper.

The Carter Center says Liberia is “on course to expand mental health care to 70 percent of its population within the next few years.”

The Bill & Melinda Gates Foundation, which has long ignored non-communicable diseases (NCDs), including mental health (see first question here), has just put out a call for funding in its Global Grand Challenges to promote “Strong Minds for Stronger Adolescent and Young Mothers,” the first of its kind that mental health advocates can recall.

A new initiative called citiesRISE brings together international and national leaders in mental health to drive a new level of progress through its networks, experience and expertise at previously unattainable scale. citiesRISE has started working to develop a variety of community-based models and new strategies in Bogota, Chennai, Nairobi, Seattle and Singapore, and is looking for more cities.

In 2014, the Mental Health Atlas, published by WHO, reported very mixed progress in mental health in Africa since its last atlas in 2011:

• There was an increase of 34 percent in the number of psychiatrists in the Africa region and 27% in the Southeast Asia region (which includes Bangladesh, India and Indonesia), although these increases are from abysmally low bases.
• However, the number of nurses working in mental health in these two regions fell by 8 and 6 percent respectively.
• In the Africa region, the number of mental hospital beds fell by 15%, the same drop as with general hospital beds. In the Southeast Asia region, there were increases in both categories.
• The number of admissions to mental hospitals and psychiatric wards of general hospitals increased by 13% in the Africa region and 26% in Southeast Asia region

Mental health legislation is a key component of good mental health system governance, and 63 percent of those countries that responded to the 2014 Mental Health Atlas said they had a stand-alone law for mental health (the rate was 55% in Africa and 60% in Southeast Asia).

Perhaps the most recent country to enact a stand-along mental health law is Liberia, where former President Ellen Johnson Sirleaf signed the bill, which will protect people living with mental health disorders from discrimination and will give access to quality mental health care in all 15 counties, before she left office last month.

It wasn’t that long ago that NCDs got almost no attention at the global level. Yet in September, the United Nations General Assembly will stage its third high-level meeting on the prevention and control of NCDs – although much of this focuses on the more high profile NCDs, like heart and lung disease, cancers and diabetes. Let’s hope that with this event, and others like it, the resources soon start to catch up with the rhetoric.