Investing in mental health: A panel discussion around the World Bank Annuals

Around the world, financing for mental health is severely lacking. An average of just 2% of government health budgets are allocated to mental health, and in low–income countries, this drops to less than 1%. As Sanjay Wijesekera argued, “efforts to confront and treat mental health problems are woefully underfunded”, particularly for children and caregivers, and universal access to good quality, rights-based support is still far from a reality for much of the world’s population.

As an individual with lived experience of a mental health condition, Charlene Sunkel explained that discussions around access to quality mental health services shouldn’t be isolated to the health sector alone. Instead mental health should be considered in the context of its wider impact on individuals’ lives, and should be addressed across a range of sectors, including education and other social services. Without proper investment, the socio-economic burden associated with mental health conditions can lead to increased poverty, forcing people to depend on social grants and the welfare system, if available. Charlene explained how this in fact places a greater burden on health systems, arguing that “we cannot afford not to invest in mental health…the alternative is so much worse not only for the individual, but at the country level and for the world.”

Ensuring that mental health and psychosocial support is fully integrated into universal health coverage (UHC) is critical to tackling this. As Dr. Ren Minghui emphasised, the core objective of universal health coverage is to protect people from the economic burden of the cost of care. By removing this burden and providing quality services and enhanced financial protection, we can better support individuals, families and societies at large. Increasing financing in mental health is in this way “a true investment” for societies, and should not be viewed as the “burdensome cost” it is often seen to be.

In recent years there has been some progress in financing for mental health around the world. Dr. Faisal Sultan explained how the government of the Islamic Republic of Pakistan is currently working to increase its investment in mental health by modernising health systems and integrating mental health into its UHC plans. He highlighted that as health care systems are decentralised in Pakistan, all action and delivery of care takes place on a provincial level. Because of this, getting provincial entities on board has been a key part of the process. He also emphasised how even when there is appetite in the system, optimising delivery mechanisms is critical to ensuring that care needs are met.

The Dutch government has also long supported the integration of mental health and psychosocial support across global health and international crisis response and preparedness. It has often highlighted how investment from governments and international organisations can help step up progress and how, as Paul Bekker explained, the global community will be “unable to reach SDGs if we do not address mental health and psychosocial wellbeing”. More specifically, the World Bank and the Global Financing Facility can both play a crucial role in increasing finance for mental health and psychosocial support, particularly in countries where greater capacity is sorely needed. Doing so, he explained, will not only help people in need, but also increase the impact of other investments, such as investments in education or strengthening social cohesion.

International organisations also have an important role to play here. UNICEF is currently working to prioritise its investments in child and caregiver mental health and psychosocial wellbeing, and advocacy in this field will be an important element of its work in years to come. Sanjay Wijesekera explained how UNICEF is currently seeking to address gaps and build on strengths, working on implementation, data collection, research and other areas to help step up progress. In particular, the 2021 State of the World’s Children Report examines children and young people’s mental health and wellbeing around the world. It aims to help policymakers understand these issues, and will be critical in supporting UNICEF’s work at the global and Country Office levels.

It was clear from all of our speakers that the World Bank now has a once in a generation opportunity to play a leading role in accelerating progress across the development agenda by ensuring that mental health and psychosocial support is included in its financing packages. The Covid-19 pandemic has already had a profound impact on mental and psychosocial wellbeing around the globe. As we invest in health systems and respond to the growing crisis, we can, and must, use this moment as an opportunity to truly build back better and improve mental health and wellbeing for all.