How to address the public mental health gaps?

Mental health is a global challenge

The prevalence and cost of mental disorders are likely to increase due to COVID-19

Mental disorders accounted for at least one-fifth of the global disease burden before COVID-19,¹ said Professor Jonathan Campion, London, UK; and this figure was considered to an underestimate by more than a third.² The resulting annual global economic cost by 2030 had been estimated to be 6 trillion US dollars.³

The detrimental effect of the COVID-19 pandemic on mental health and on the risk factors for poor mental health will further increase these prevalence and cost estimates, ¹ added Professor Campion.

Public mental health is key to address the challenges

Only a minority of people with mental disorder receive treatment

Public mental health (PMH) takes a whole population approach to sustainably reduce mental disorder and improve mental well-being through interventions to:

• Treat mental disorder
• Prevent the associated impacts of mental disorder, for instance on physical health, education, employment and the criminal justice system
• Prevent the development of mental disorder
• Promote mental wellbeing⁴

But despite the existence and evidence base for PMH interventions, there is a PMH implementation gap, said Professor Campion.

The public mental health implementation gap results in preventable population-scale suffering

Only a minority of people with mental disorder receive treatment, even in high‑income countries, far fewer receive interventions to prevent associated impacts, and interventions to prevent mental disorder or promote mental wellbeing are negligible.⁴

The result is preventable population-scale suffering to individuals with mental illness and their families, failure to address and manage the associated impacts and high associated costs across different sectors.⁴

COVID-19 has further widened the implementation gap.¹

Actions to address the public mental health implementation gap

Public mental health should be integrated into the response to COVID-19

There is an urgent need to address this PMH implementation failure, which contravenes the right to health,¹ said Professor Campion, and he highlighted the following 12 actions needed to improve PMH as follows:

1. Assessment of need
2. PMH practice with needs assessment, implementation of evidence-based interventions, and evaluation of outcomes and economic savings — PMH will play a key role in economic recovery from COVID-19, said Professor Campion
3. Coordinated advocacy and leadership from all stakeholders to agree on an acceptable level of provision and resourcing with psychiatrists playing a critical role in ensuring the implementation and success of PMH interventions
4. PMH training for a range of professionals making use of online opportunities

Psychiatrists have a crucial role to play to ensure the implementation and success of public mental health interventions

5. Improved population knowledge about mental health
6. Settings-based approaches, for instance at schools, workplaces, and prisons
7. Integrated approaches involving different organizations and sectors facilitated by needs assessment
8. Digital technology for global delivery of interventions and training
9. Maximizing existing resources
10. Special interventions, such as addressing socioeconomic inequalities
11. Use of existing legislation and adopting a rights approach
12. Implementation research on evidence-based interventions