Transforming Mental Health For All

In the changing world, mental health is becoming more complex, but critically important to everyone, everywhere. Drawing on the latest evidence available, it is understandably clear that mental health needs and responses are still inadequate, and insufficiently integrated into public health systems.  From the people’s voiced experiences, it reveals that mental health care requires socio-political and cultural efforts to value the urgency of mental health conditions, reshape environments and strengthen health systems in a comprehensive approach. 

Because of poor mental health, millions of people around the world still suffer in silence. Unfortunately, they experience human rights violations, and are adversely affected in their daily lives. In most of the countries, the mental health conditions are highly prevalent, but the needed care and services are poorly experienced. Evidence suggests that about one in eight people in the world live with a mental disorder. Reportedly, the prevalence of mental health disorder varies with age and sex.

Social exclusion 

Again, the experiences of people with poor mental health conditions and their stories of the suffering, stigma, and social exclusion show that we need to create an enabling environment to ensure the critical provision of adequate care and support for the people with mental health conditions at large. A recent WHO report mentions that suicide is a major cause of death among young people. There may be 20 suicide attempts to every one death globally, and yet suicide accounts for more than one in every 100 deaths. There is increasing evidence that transforming mental health essentially requires multi-sectoral promotion and prevention for all. Therefore, reshaping the determinants of mental health requires actions beyond health sector. Moreover, cost-effective promotion and prevention interventions need to consider individual, social and structural determinants of mental health. 

From the service point of view, there is increasing focus on strengthening community-based care for all. By shifting the locus of care for severe mental health conditions away from psychiatric hospitals towards community-based mental health services, the services are becoming more accessible and acceptable than institutional care. Most importantly, these are delivering better outcomes for people with mental health conditions. 

Social protection initiatives are crucial to enable people with mental health conditions, achieve their recovery goals and live a more satisfying and meaningful life. For example, people living with HIV or TB require specific mental health services and care in health and communities. In addition, adolescents and young people are highly vulnerable to mental health issues and psychoactive drug use. Older people, including those living with HIV, are more likely to experience mental health and neurocognitive impairment, as well as social isolation, due to decreased social participation and engagement. Similarly, people affected by TB have a higher risk of mental health conditions, which can negatively impact TB treatment outcomes, health-related quality of life and other health and social outcomes.

According to a national mental health survey report – 2020, there are interesting facts about the situation of mental health in Nepal. The prevalence of mental disorder among adolescents is 5.2 per cent. Similarly, the prevalence of current suicidal thoughts among adolescents is 3.9 per cent while that of lifetime suicidal attempt is 0.7 per cent. Among the adult participants, 10 per cent had any mental disorder in their lifetime, and 4.3 percent currently has any mental disorder.

Like many other countries in Asia, Nepal has given a high priority for mental health needs and services for all. More importantly, mental health is included in the list of basic health services. Further, public health service regulations have expanded the type of mental health services to be included in basic health services and emergency health service package. The national health policy-2019 also articulates the needs for mental health services to be sufficiently integrated into health systems. This also links to government’s strong commitment for achieving Universal Health Coverage (UHC) and health related Sustainable Development Goals (SDGs).

Equitable access

Though mental health is one of the priority agenda in health policy and strategic action plan, there is an emerging need for effective implementation of national mental health strategy and action plan -2020 at local level. The mental health strategy and action plan addresses integration of mental health in primary care and suggests the critical need to strengthen mental health services at the secondary health care level. Some of the implementation challenges for effective implementation of the mental health strategy and action plan include inadequate trained human resources for mental health, limited financial investments, persistent stigma and discrimination, lack of wider public awareness and social advocacy for integrated response to mental health conditions. In order to ensure equitable access to quality mental health for all, provision of participatory, inclusive and rights-based mental health care is critically needed in the federal context. 

While mental health needs of people affected by disasters and disease outbreaks are widely recognised, the capacity enhancement of local governments is crucial in integrating mental health services in local health policies, strategies and plans. Accumulative lessons from the disaster and pandemics such as COVID-19 have shown increasing needs of mental health services for people’s healthy and secured lives. As we know by now, mental health has intrinsic and instrumental value, helping us to connect, function, cope and thrive in different socio-cultural contexts. Undoubtedly, mental health should be a priority development agenda for all. The vicious cycle between poverty and mental ill-health exacerbates the mental health conditions. Strengthening mental health care enhances the capacity of service providers to deliver person-centred and human rights-based care by effectively engaging people with their lived experiences, needs and choices. 

 (Bhandari is a health policy analyst.)