WFMH President's Foreword

September 22, 2020

Ingrid Daniels
President WFMH

World Mental Health Day, a programme of the World Federation for Mental Health, annually raises awareness within the global community about the mental health challenges, gaps and priorities through collaborative and unifying voices aimed at taking action, addressing and creating lasting change in a world where we need to restore the dignity of all living with mental health needs.

World Mental Health Day was first observed on 10 October 1992 as an annual activity of the World Federation for Mental Health aimed at promoting mental health advocacy and educating the public on relevant issues. Celebrated on the 10th October, it provides an opportunity to place the spotlight on the mental health challenges experienced in our world today.

The world as we know it has changed dramatically as we experience the unimaginable and unprecedented turmoil caused by the COVID-19 global health pandemic which has impacted on the mental health of millions of people. We could never have imagined that a virus of this nature could wield such devastation across nations. Hard and drastic lockdown measures implemented in many countries to reduce COVID-19 transmissions, infections and deaths saw the enforcement of physical isolations and distancing become a new reality disrupting natural social interactions. Parallel to emotional and health implications large scale socio-economic fallout has been witnessed as markets and economies were destabilised. The overwhelming impact of the virus revealed and exposed the deep inequalities and levels of poverty experienced by many, particularly in lower – and middle income countries, causing further mental distress and vulnerability. Pushed to the foreground was the exposure of many social ills such as; racism, gender-based violence and many others.

The mental health consequences of COVID-19 superseded by an already overburdened mental health landscape in which the number of people living with depression and or anxiety increased by nearly 50% from 416 million to 615 million (WHO, 2016). We know that mental, neurological and substance use disorders exact a high toll on health outcomes, accounting for 13% of the total global burden of disease (WHO, 2012). One person in every four will be affected by a mental disorder at some stage of their lives. The treatment gap remains large with 50% of people with mental disorders in high income countries and 85% of persons in low-and middle income countries having no access to treatment (WHO, 2012). Fragile health systems have not been able to address or cope with the large treatments gaps and need for mental health care. We have observed how delicate health systems are further stretched and challenged by the increase in demand for mental health interventions as a result of the pandemic.
Sadly, the global denial and failure to invest in mental health over many years has resulted in a shameful situation in which access to treatment has limited individuals' rights to wellness and health which has been exacerbated by the COVID-19 crisis. The inadequate response to invest and increase access to mental health has resulted in gross failure to ensure that every global citizen can live fully integrated lives. Mental health continues to be misunderstood, ignored, stigmatised, underfunded and overlooked. COVID-19 has in many respects been an equalizer and has placed at the forefront the critical need for good mental health interventions, responses and support during this time.

Taking our current reality and context into account the theme for World Mental Health Day could not have come at a more appropriate time as a call to action becomes critical.

Mental Health for All
Greater Investment – Greater Access

The United Nations (2020) states that, "Good mental health is critical to the functioning of society at the best of times. It must be front and centre of every country's response to and recovery from the COVID-19 pandemic. The mental health and wellbeing of whole societies have been severely impacted by this crisis and are a priority to be addressed urgently" (UN, Policy Brief, 2020).

The World Economic Forum (2018) noted that mental health disorders are on the rise in every country in the world and could cost the global economy up to $16 trillion between 2010 and 2030 if a collective failure to respond is not addressed. We are faced with an international mental health crisis and have been forewarned over the last two decades of this imminent catastrophe. Yet little movement has been seen in shifting the mental health investment agenda despite the global return on investment analysis and economic benefits. According to WHO's "Mental Health Atlas 2014" survey, governments spend on average 3% of their health budgets on mental health, ranging from less than 1% in low-income countries to 5% in high-income countries. The value of investment needed over the period 2016–30 for scaling up treatment, primarily psychosocial counselling and antidepressant medication, amounted to US$ 147 billion (Chisholm, et al, 2016).

Yet the returns far outweigh the costs. The WHO (2019) states that for every US$ 1 put into scaled up treatment for common mental disorders, there is a return of US$ 4 in improved health and productivity. "Despite hundreds of millions of people around the world living with mental disorders, mental health has remained in the shadows," said Jim Yong Kim, President of the World Bank Group. Despite a growth in mental health awareness and case made mental health investment has been stagnant across the globe. It is clear that greater movement and action needs to be seen within countries to increase access to mental health for all.

World Mental Health Day is simply not a one day event and provides us with the opportunity and advantage to hold the attention of governments, donors, policy-makers and all stakeholders to ensure action for greater investment in mental health.

This year the call to action "greater investment in mental health" has to be headed and cannot be ignored in the current COVID-19 pandemic environment. It is unquestionable that mental health is a human right and thus, now more than ever, it's time for mental health for all. Quality and accessible mental health care is an undeniable right and part of the foundation for universal health coverage. Every nation – every voice needs to move and call for greater investment in mental health. Our key activations over the next few weeks through our coordinated efforts and activities with our collaborating partners will ensure that this year we will have the greatest impact in shifting the investment in mental health agenda.

Our call is a simple one – let us hold hands and unify our voices in moving the mental health investment agenda for increased focus and access to mental health and thereby making mental health a reality for all – everyone, everywhere.

The Lancet Commission on Global Mental Health and Sustainable Development (2018) note that the sustainable development goals are not achievable without making significant improvements to treating, preventing and promoting mental health. They identify mental health as a humanitarian and development priority, providing evidence that mental health is indeed at the centre of sustainable development.
We can thus conclude that there can be no sustainable development without mental health. There is still time to limit the worse impact and consequences of inaction by being bold and investing in the mental health of all.

"The ultimate measure of a man is not where he stands in moments of comfort and convenience but where he stands in times of challenge and controversy."
Martin Luther King Jr.

The time for action in now.

Mental Health for All
Greater Investment – Greater Access

Dr Ingrid Daniels
President WFMH