No health without mental health - why integrating mental health into UHC matters
As we mark a year since global leaders committed to achieve Universal Health Coverage (UHC) by 2030, the world is off track to meet this target. Our new report - No Health without Mental Health: The Urgent Need to Integrate Mental Health in UHC - lays out for the first time in one place the latest evidence on how critical this integration is, and presents recommendations on how the world can achieve it.
UHC means that everyone, everywhere should be able to access the health services they need without suffering financial hardship. But today we are faced with a coverage gap of care and services for common mental health conditions, such as depression and anxiety, of up to 90% in some countries. Even where services are available, they are not necessarily rights-based and cost-effective.
The holistic integration of mental health in UHC is absolutely vital to reverse this situation. As Niall Boyce, Editor of The Lancet Psychiatry said during the webinar to mark the report’s release, “The message is that not just mental health should be part of UHC, but UHC will not be a success without the integration of mental health”. Why? Because integration of mental health in UHC is a way to improve both the mental health outcomes of populations - critical in its own right - but also to support the effective delivery of physical health care. Evidence suggests that when mental health services are integrated with physical health programmes, the combined physical and mental health treatment contributes to better overall health outcomes. The overall care may also cost less, meaning more can be done with the same resources - a crucial consideration for UHC.
As the new report outlines, the integration of mental health in UHC is also a critical stepping-stone towards realising the rights of people living with mental health conditions. These people can be amongst the most vulnerable in society, enduring incarceration, chaining, coercion, institutionalisation, stigma and exclusion. The integration of high-quality, rights-based, evidence-based mental health practices in health systems would reduce the possibilities for these abuses. It would also support the implementation of the Convention on the Rights of Persons with Disabilities (CPRD) to achieve the full range of rights of people living with mental health conditions. Involving those with lived experience is also a central piece of this. Ms Charlene Sunkel, CEO of the Global Mental Health Peer Network stressed during the launch webinar that “We must place people with Lived Experience at the centre of policy and practice, because we can add great value as key partners within the process”.
Combined with the increased urgency due to the impact of COVID-19, which has seen mental health service provision disrupted in more than 90% of countries, decision-makers at international and national levels should spare no effort to ensure the complete integration of mental health in national UHC programmes. Dr Champika Wickramasinghe, the Deputy Director General, NCD, Ministry of Health, Sri Lanka, emphasised the importance of this integration at the primary and community health care level especially: “Integrating mental health into primary care is the most important thing. That way we can ensure everybody has access to mental health services.”
More optimistically, Dr Florence Temu, Country Director, Amref Health Africa Tanzania, highlighted that this can be achieved, but only if the right conditions are in place: “Integration of mental health into UHC is doable. But there needs to be a mindset change and strong leadership to do this”. And Dr Safi Malik, the Director General (Health) at the Ministry of National Health Services Regulations & Coordination, Pakistan, was able to give a recent example of success in this area: “We started integration in 2018, and initially there was not much support from donors. … then the donor community and partners saw the seriousness of the present government in inclusion and provision. ... When we integrated mental health into primary health care, that gave us a good case and traction with funders.”
We have never been more informed on how to achieve successful integration of mental health in UHC, and on the rewards this could bring. As the need for action has never been greater, we are calling on all key stakeholders to move together on this – and move now. The report calls for the following actions:
- international agencies to strengthen the case for integration of rights-based mental health in UHC through policy development and galvanising political will;
- national governments to fully integrate mental health into national health legislation, policies and programmes and commit 5-10% of health budgets to mental health;
- funders to support integration of mental health in UHC by providing catalytic funding, including through priority health programmes in support of the delivery of a rights-based approach;
- the academic community to further strengthen the evidence base for integration and rights-based interventions;
- civil society to advocate for the urgent need to integrate rights-based mental health in UHC, holding national governments and global institutions to account for commitments made.
As Dr Shekhar Saxena, the report co-author said, “If we work together, moving more urgently and with optimism, this is achievable “. Now is the time to build mental health services that are fit for the future: inclusive, rights-based, community-based, and affordable. Because, ultimately, there is no health without mental health.
The report is authored by United for Global Mental Health and Prof Shekhar Saxena and reviewed by a team of experts including Prof Vikram Patel, Prof Sir Graham Thornicroft, Dr Githinji Gitahi, Dr Lola Kola, Ms Charlene Sunkel and a number of Speak Your Mind partner organisations.