Written by GMH@Harvard Ambassador Board Members: Sarah Coleman, Amruta Houde, Bill Kriebel, Anna Bartuska
This year’s World Mental Health Day theme, Move for Mental Health: Let’s Invest, is timelier than ever. Mental health concerns and needs are growing and expected to substantially increase moving forward. Yet, mental health services have been consistently underfunded. During the COVID-19 pandemic, mental health services have been disrupted or halted in 93% of countries worldwide. As the treatment gap continues to widen, significant investment is needed to increase access to care for the most vulnerable worldwide. In the first two articles of this 3-part series, we discussed what it means to invest in mental health broadly (part 1) and how to invest in your own mental health (part 2). But, the question remains, how can we financially invest in mental health? This article emphasizes why the #TimetoInvest is now and offers an introduction to two types of funding mechanisms.
“World Mental Health Day is an opportunity for the world to come together and begin redressing the historic neglect of mental health. We are already seeing the consequences of the COVID-19 pandemic on people’s mental well-being, and this is just the beginning. Unless we make serious commitments to scale up investment in mental health right now, the health, social and economic consequences will be far-reaching.”
-Dr. Tedros Adhanom Ghebreyesus, Director-General of the World Health Organization
Watch WHO’s Big Event for Mental Health Here
The Problem: Why Now?
The greatest cause of disability globally is poor mental health, compounded by poverty, conflict, climate change, systemic racism, economic instability, and most recently, the COVID-19 pandemic. This unprecedented global pandemic has significantly affected many people’s mental health and restricted access to care for those with existing mental health conditions. The mental health impacts of COVID-19 include everything from increased anxiety and fear about the spread of the virus, loss of social networks, stressful experiences of healthcare workers on the frontlines, and a higher risk of substance use. Despite these significant impacts, mental health has not been at the forefront of global health funding. In LMICs, less than 1% of national health budgets are spent on mental health and only 0.4% of health development assistance is spent on mental health, despite the fact that for every US $1 invested in scaled-up treatment for common mental disorders there is a return of US $5 in improved health and productivity according to the WHO. Even more, a recent analysis by the World Health Organization estimated that the cumulative global impact of mental disorders in terms of lost economic output will amount to US $16 trillion over the next 20 years. Such an estimate marks mental health out as a highly significant concern not only for public health but also for economic development and societal welfare (WHO/WEF).
The Solution: Discrete and integrated funding streams
Though mental health funding streams have expanded in the last decade, more investment is urgently needed. Investing in mental health also offers opportunities for return on investment for individuals, families, and communities as individuals can return to meaningful work. We propose a call to action for the global mental health community to invest in expanding two types of funding for global mental health: discrete mental health funding streams and integrated funding streams. To illustrate these two funding streams, we draw upon and cite examples from various leaders in the field of global health, including Partners In Health. Partners In Health (PIH) is a non-profit, global health organization that fights social injustice by bringing the benefits of modern medical science to the most vulnerable communities around the world.
Discrete mental health funding streams provide the opportunity to pilot new models and treatments. Current funding is often predominantly research-focused, which is essential in growing our understanding of mental health conditions and strengthening the toolkit of effective, evidence-based strategies and treatments. Discrete funding can also support implementation of evidence-based practices into routine care delivery. For example, Grand Challenges Canada (GCC) helped support the establishment of a community-based mental health program in Haiti with Partners In Health/Zanmi Lasante which is now a model for national scale and continues to support global mental health projects worldwide today. Private organizations or foundations (such as corporations, pharmaceutical companies, etc.); and individual donors, many of whom often have lived or personal experience and understand the impact of mental health conditions, can also be key partners.
The second type of funding stream is mental health funding integrated with other health conditions as a wedge issue. Given the high comorbidities with mental health and physical conditions, integrated funding streams have the potential to not only improve mental health outcomes but have an impact more broadly, for example, to improve adherence to tuberculosis treatment or to provide psychosocial support to people with cancer. Alternatively, grants to promote HIV treatment can include mental health components around social support or counseling. COVID-19 offers yet another opportunity to incorporate mental health as a wedge issue into funding for health systems strengthening or emergency response initiatives. There are numerous examples of integrated models of mental health care, proving its impact for both the delivery of quality mental health care and as an advocacy tool. Partners In Health sites across the globe have taken this approach in integrating mental care into primary care in Haiti, Rwanda, and Mexico; with care for multi-drug resistant tuberculosis patients in Lesotho and Kazakhstan; with homeless care programs in Liberia and Sierra Leone; with care for non-communicable diseases in Malawi; and with maternal health care systems in Peru. The link between physical health and mental health is clear, and research indicates that integration of services improves patient experience and efficiency of health systems.
Both types of funding streams are needed to address the immense burden of disease globally. However, with any mental health funding, buy-in from service users is needed from onset to ensure that mental health programs reflect the priorities and needs of beneficiaries. Involving individuals with lived experience in developing and driving funding priorities is also essential for ensuring the appropriateness and impact of funded initiatives.
How can you invest in mental health?
World Mental Health Day was on October 10th, but the movement continues. In the spirit of this year’s theme “Move for Mental Health: Let’s Invest” here are a few ways that you can support your own, your community’s, and global mental health:
Share a photo or video of how you are “Moving for Mental Health” on social media and tag #MoveForMentalHealth and @GMHatHarvard.
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