Comprehensive mental health action plan

By Sarah Kline, Co-Founder and CEO of United for Global Mental Health

This week the World Health Assembly is due to approve the updated WHO Comprehensive Mental Health Action Plan (2021-2030). This article summarises what are the new aspects of this plan compared to the old one (2013-2020). For more detailed information and a guide for advocates that lists the changes by subject area please take a look at the Guide for Advocates.

The updated plan includes four new targets, along with updated indicators and new and modified options for implementation. The changes reflect the knowledge developed over the past 8 years since the previous plan was developed and agreed. They also reflect the advocacy by mental health campaigners calling for policy changes at local, national and international level.

Two new targets relate to increasing the integration of mental health in community-based and primary health care services. This, combined with the options for implementation that also emphasise this approach, are an important means for campaigners to press for greater progress to deinstutionalise mental health care.

For example, the recommendation to ”involve people with mental disorders and psychosocial disabilities in the assessment and monitoring of all public and private mental health services including psychiatric hospitals and social care homes,” reflects the work of campaigners in countries such as Argentina. Similarly, the recommendation to undertake capacity building among key stakeholders including policy makers on strategies to promote respect for people’s will and preference in mental health and related services is reflected in the WHO Quality Rights Programme and the work with partners on the ground including in Ghana and Kenya.

The emphasis on integrating mental health and social care into family health and wellbeing programmes reflects the work of the Bernard van Leer Foundation and partners to advocate for the mental health of carers to be given greater priority.

The integration of mental health and social care into disease-specific programmes and services such as those for HIV/AIDS and tuberculosis reflects the current work by a range of advocates to persuade the Global Fund to integrate mental health in its future strategy and programming.

The inclusion of “decriminalize suicide” as an option for implementation is an important step forward and will help strengthen the resolve of campaign groups (including the International Association for Suicide Prevention and UnitedGMH) seeking to end criminalization, reduce stigma and ensure there are sufficient services and suicide for those who need them.

The inclusion of the recommendation to ban of highly hazardous pesticides reflects the success of campaigns by groups such as MANI in Nigeria and the work of Michael Eddleston of Edinburgh University.

The recommendation to promote more responsible media reporting in relation to suicide reflects the work of MIND UK and other groups, including the WHO itself, in light of a number of high-profile suicides and discussion around mental health in the media.

The new target relating to MHPSS in emergencies reflects the strong advocacy of the Dutch government in the past 2 years during and since the Amsterdam summit in 2019. Target 3.3. states, “80% of countries will have a system in place for mental health and psychosocial preparedness for emergencies/disasters, by 2030.” The option for implementation recommends including MHPSS as, “an integral, cross-cutting component in public health emergency responses (for example, to COVID-19, Ebola virus disease) as part of a range of pillars or domains, such as case management, risk communication and community engagement, continuation of services, response coordination, and operations (for instance, staff support).”

The new Global Target 4.2 (the output of global research on mental health doubles, by 2030) reflects the advocacy of Wellcome and others for a stronger evidence base of what works in addressing mental health issues. The option for implementation that recommends ensuring people with mental health conditions and psychosocial disabilities and their organizations contribute to mental health research including setting the research agenda, advising on the research methods and design, and in informing about their lived experience is an important step forward that has been the subject of advocacy by many organisations. It is important to note that the Action Plan emphasises the importance of, “operational research with direct relevance to service development and implementation and the exercise of human rights by persons with mental disorders” which remains the recipient of only a fraction of global research spending. See the report of the International Alliance of Mental Health Research Funders for more information.

While there is a great deal of work to be done to see the WHO Comprehensive Mental Health Action Plan implemented at country level, advocates and campaigners can use the Plan to leverage greater commitments and action by decision makers and use this to drive momentum between now and 2030.

A starting point is for campaigners to write to their Ministries of Health and other relevant government departments to highlight the agreement of the Plan by their government and ask them what actions they intend to take to fulfil the targets they have agreed. The options for implementation provide a starting point for how to persuade policy makers to take actions that will result in meaningful change for millions around the world.