Mental health must be meaningfully integrated into UHC systems

Saving millions of lives: putting mental health at the heart of UHC

By Muhammad Ali Hasnain, Senior Officer, United for Global Mental Health

When the First Lady of Ukraine, Olena Zelenska, took the stage at the 75th World Health Assembly (WHA) on 23 May 2022, she rallied the international community to support her people’s “battle” for their mental health:

“Following what Ukrainians have experienced during the occupation, at the front, in bomb shelters, under shelling… they need rehabilitation in the same way as those who are physically wounded.

“Yes, war is a tragedy. But we must find an opportunity to do good even in the midst of the horrors of war. Let us use this period as an opportunity to integrate psychological support into all areas of our peaceful life. I hope for your support.”

The speech was one of many at the assembly that called for mental health to be prioritised. And it was deeply heartening to see mental health discussed openly at the WHA under the auspices of Universal Health Coverage (UHC) – the concept that everyone, everywhere should be able to access the good-quality health (including mental health) services they need without suffering financial hardship.

Going one step further

Delegations from across the globe, including from the US, Canada, Sweden, Denmark, Peru, Israel, and the Maldives, put their weight behind the importance of mental health and its integration into health systems through UHC. It is a timely call in light of the many humanitarian crises around the world, and the impacts of the Covid-19 pandemic.

Our new brief “What Can We Achieve if We Meaningfully Integrate Mental Health into UHC” goes one step further. It highlights both the need for, and the substantial mental and physical health benefits of, integrating mental health into UHC.

Today the treatment gap for common mental health conditions can be as high as 90% in low-income countries. And as most of the delegations at the WHA noted in their statements during the session on mental health and non-communicable diseases (NCDs), most often it is the poorest and most marginalised people who lack access to services. This is largely because the already underfunded mental health sector sees most of its funding (66% as per the WHO’s Mental Health Atlas 2020) go to expensive mental hospitals over primary, community and secondary care.

Using new research, the brief highlights the massive impact addressing this treatment gap for mental health conditions through UHC could have. For example, by achieving universal treatment coverage (90% plus) for five common mental health and neurological conditions – anxiety, depression, psychosis, bi-polar disorder and epilepsy – by 2050:

• over 1.4 billion prevalent cases of these conditions could be averted
• over 500 million healthy life years could be gained around 6 million deaths averted.

The brief was developed by UnitedGMH with the expert support of Professor Shekhar Saxena of Harvard University, Professor Sir Graham Thornicroft of King’s College London, Mark Van Ommeren of the WHO and Paul Bolton of USAID.

The physical health-mental health connection

The connection between mental and physical health has long been acknowledged and our new brief breaks down the evidence behind this. It makes the case that the meaningful integration of mental health in the prevention and treatment of HIV and TB, to take one example, could significantly reduce the prevalence of these diseases. The brief also touches upon some of the key principles and recommendations behind the integration of mental health into UHC, which could turn these projected benefits into a reality.

One key change we need to make is a shift from tertiary (specialised hospital/institutional) care to primary and community-based care. We also need to ensure that integrating mental health goes beyond the health sector to include vital sectors such as education, employment, social welfare and housing. These sectors can play a vital role mental health promotion and prevention.

To help implement these and other recommendations there are links to the many resources and documents developed by the WHO, the World Bank and others. These include the WHO UHC Compendium and the soon-to-be-launched WHO World Mental Health Report 2022.

Use the momentum

The Danish delegation at the WHA 2022 session on non-communicable diseases and mental health said it best:

“We need to use the momentum generated around mental health to invest in mental health promotion, treatment and care to the same level as physical health.”

Integrating mental health into UHC meaningfully in this way is the need of the hour. There is so much to be gained by doing so.