"No health without mental health" and what has COVID-19 got to do with it?
By Shekhar Saxena, Maxim Polyakov, James Sale
Yesterday we had the pleasure of co-hosting a webinar entitled: No health without mental health: integrating mental health into health systems. It was part of the series that we at United for Global Mental Health co-host with the Lancet Psychiatry, Mental Health Innovation Network, and MHPSS.net.
Together with our stellar panel of speakers (Githinji Gitahi, Devora Kestel, Akwasi Osei and Peter Yaro), we explored various facets of a key question: is COVID-19 an opportunity or a barrier to integrating mental health into health systems?
The short answer is: it’s an opportunity for those who know how to seize the moment.
Of course, the challenges that COVID-19 poses - and the tragedy it has wrought - are all too real. We have all seen the immense additional pressure on health (and mental health) systems that has resulted due to COVID-19; and there is a real risk that we will see a diversion of health funding away from mental health, all within a constricting fiscal space that leaves governments little room for manoeuvre.
However, the rewards of being able to integrate mental health into a health system built on the principles of universal health coverage (UHC) are huge. Even before COVID-19, we knew that mental health provision was nowhere near sufficient to cover the underlying need; and we also knew that health systems where mental health is an integral component are better prepared to deal with challenges than systems where mental health was delivered in isolation, as Devora Kestel, the Director of the Department of Mental Health and Substance Use, WHO, pointed out. Ultimately, integrating mental health as part of UHC is our best chance of making services accessible to all who need them, during normal times, and also during times of crisis (such as the current pandemic).
So, what can we do to overcome the challenges? First, “we need to see health as an investment, not a cost”, as Githinji Gitahi, the Global CEO, AMREF Health Africa and Co-chair of UHC2030, pointed out. There is no health without mental health, and without health, there cannot be a healthy economy. This is a bitter lesson that we are learning today. Thus, we must encourage inclusion of mental health within the health benefits package that governments are financing.
Second, we need to work to ensure there is political will to drive integration of mental health and UHC: for instance, by creating a basis for it in law, and by holding governments to account for their election promises. Civil society has a key role to play in this, bringing to bear as it does a degree of moral accountability to the government.
Third, we need to involve all of society. Creating a good mental health should be seen as a collective responsibility: of individuals, of the community, of government, and of civil society. The voice of lived experience should be heard and amplified.
We discussed the very interesting example of Ghana in this regard.
The President of Ghana has said that the pandemic has shown gaps in Ghana’s healthcare generally, and specifically in mental health. As a result, the sector is undergoing an ambitious and rapid transformation. New hospitals are being built, including psychiatric hospitals. There are plans to train every health worker in mhGAP and mental health first aid, and expand the role of community mental health care. Finally, there are discussions on introducing a “mental health levy” to finance a broader mental health programme in a self-sufficient and sustainable manner. “The key point is that, even if the current funding for mental health is doubled or even tripled, this will still not be enough. So we want to put in place a new sustainable financing mechanism”, said Akwasi Osei, the CEO of the Mental Health Authority of Ghana.
At the same time, Ghanaian civil society organisations are acting as a critical friend to the government: to help keep on track the ambitious transformation, but also to ensure that what is being proposed is realistic, and can rapidly answer the real and urgent need of people on the ground. “The hospitals are the icing on the cake”, said Peter Yaro, Executive Director, BasicNeeds Ghana. “But we should not lose sight of in the meantime are the more realistic, doable and cost-effective initiatives [such as those at community level].”
We believe that the issues raised at the global level as well as the experience from Ghana shared by our panellists will be of use to the attendees in findings ways to integrate mental health within health systems of their countries.
We warmly thank all our panellists for such a robust and dynamic discussion, and wish them all the best in their crucial work at this important time.