In recent years, there has been increasing acknowledgement of the important role mental health plays in achieving global development goals, as illustrated by the inclusion of mental health in the United Nations Sustainable Development Goals (SDGs).
Depression is one of the leading causes of mental disability. Suicide is the fourth leading cause of death among 15-29-year-olds. And people with severe mental health conditions die prematurely – as much as two decades early – due to preventable physical conditions.
Despite progress in some countries, people with mental health conditions, even mild ones, often experience severe human rights violations, discrimination, and stigma. They often lack access to many of the other rights taken for granted by others, including education and health.
Many mental health conditions can be effectively treated at a relatively low cost, yet the gap between people needing care and those with access to care remains substantial. Effective treatment coverage remains extremely low in many countries. In fact, Sri Lanka is among the few developing countries with a fully functional mental hospital. But even Sri Lanka lacks the required number of psychiatrists (and also psychologists) to treat those who require help for mental health conditions.
Granted, it might also not be easy to diagnose certain mental health conditions, as a person may not display any ‘symptoms’ per se to the outside world. He or she might seemingly carry on working normally, hiding the condition until it bursts open, sometimes with tragic consequences. One recent example was the apparent death by suicide of a Peradeniya University undergraduate.
Increased investment is thus required on all fronts: for mental health awareness to increase understanding and reduce stigma; for efforts to increase access to quality mental health care and effective treatments; and for research to identify new treatments and improve existing treatments for all mental disorders.
Quality and affordable care
In 2019, the World Health Organization (WHO) launched the WHO Special Initiative for Mental Health (2019-2023): Universal Health Coverage for Mental Health to ensure access to quality and affordable care for mental health conditions in 12 priority countries for 100 million more people. This year, the WHO launched the World Mental Health Report: Transforming Mental Health for All.
Mental health conditions are increasing worldwide, according to the UN. Mainly because of demographic changes, there has been a 13 percent rise in mental health conditions and substance use disorders in the last decade. Mental health conditions now cause one in five years lived with a disability. Around 20 percent of the world’s children and adolescents have a mental health condition.
Approximately one in five people in post-conflict settings have a mental health condition, including those who have served in combat rules, some of whom suffer from Post Traumatic Stress Disorder (PTSD). However, PTSD can manifest itself in any person who had experienced or witnessed a major traumatic event such as a tsunami, a bombing or a horrific accident.
Mental health conditions can have a substantial effect on all areas of life, such as school or work performance, relationships with family and friends and ability to participate effectively in the community. Although mental health conditions cannot be measured in purely monetary terms, two of the most common mental health conditions, depression and anxiety, cost the global economy around US$ 1 trillion each year as an estimated 12 billion working days are lost each year due to these factors.
Despite these figures, the global median of Government health expenditure that goes to mental health is less than 2 percent, as most countries give priority to physical health and well-being. This has been reduced even further as Governments had to deal with a Covid pandemic for almost three years in a row. Ironically, the pandemic and associated lockdowns have led to an avalanche of mental health conditions among people worldwide.
Covid - 19 pandemic
Whilst the pandemic has, and continues to, take its toll on our mental health, the ability to reconnect through World Mental Health Day 2022 will provide us with an opportunity to re-kindle our efforts to protect and improve mental health.
Many aspects of mental health have been challenged; and already before the pandemic in 2019 an estimated one in eight people globally were living with a mental disorder. At the same time, the services, skills and funding available for mental health remain in short supply, and fall far below what is needed, especially in low and middle income countries.
The Covid-19 pandemic has created a global crisis for mental health, fueling short- and long-term stresses and undermining the mental health of millions. Estimates put the rise in both anxiety and depressive disorders at more than 25 percent during the first year of the pandemic. At the same time, mental health services have been severely disrupted and the treatment gap for mental health conditions has widened.
Growing social and economic inequalities, protracted conflicts, violence and public health emergencies affect whole populations, threatening progress towards improved well-being; a staggering 84 million people worldwide were forcibly displaced during 2021.
Community-based network needed
In the words of the WHO, “We must deepen the value and commitment we give to mental health as individuals, communities and Governments and match that value with more commitment, engagement and investment by all stakeholders, across all sectors. We must strengthen mental health care so that the full spectrum of mental health needs is met through a community-based network of accessible, affordable and quality services and supports.”
Stigma and discrimination continue to be a barrier to social inclusion and access to the right care. It is well-known that people who are fully cured of their mental health conditions are not often re-admitted to their families due to this stigma. No family wants to acknowledge that one of their own has had treatment at a mental health facility, lest the whole family be shunned by relatives and friends.
But we all play our part in increasing awareness about which preventive mental health interventions work (as opposed to curing any subsequent disease) and World Mental Health Day is an opportunity to do that collectively.
WHO’s message
“We envision a world in which mental health is valued, promoted and protected; where everyone has an equal opportunity to enjoy mental health and to exercise their human rights; and where everyone can access the mental health care they need,” the WHO says in a message to mark Mental Health Day 2022.
WHO will work this year with partners to launch a campaign around the theme of Making Mental Health and Well-Being for All a Global Priority. This will be an opportunity for people with mental health conditions, advocates, governments, employers, employees and other stakeholders to come together to recognise progress in this field and to be vocal about what we need to do to ensure Mental Health and Well-Being becomes a Global Priority for all.
The emphasis on mental health should begin from home and school. Parents and teachers must keep an eye on children who could be subject to mental stress. For example, many children are subject to bullying by fellow students, which could affect their mental and even physical growth. Harsh punishments by teachers (one recent case was a student being hit by a broom by a teacher as she had not contributed money to a school project) can also lead to mental conditions among students.
Exam pressure
Exam pressure has sometimes led to students taking their own lives. In this context, an assurance by the Government that it is rethinking the whole exams-based education system is a step in the right direction. Moreover, both parents and teachers must ensure online safety for students, as it is very easy to fall down the Internet rabbit hole and ruin one’s life.
As already mentioned, ragging, exam pressure, peer pressure and even love affairs at universities (and also teacher training colleges and vocational training colleges) can sometimes lead to disastrous consequences for some students. Ragging has led to many suicides over the years, quite apart from the students who had succumbed to their injuries caused as a result of ragging. But even if you survive the ordeal, ragging can still leave deep wounds in your psyche.
Workplace stress
Workplace stress and anxiety is another factor that is rarely discussed. In fact, the WHO and the International Labour Organization (ILO) have called for concrete action to address mental health concerns in the working population. WHO’s global guidelines on mental health at work recommend actions to tackle risks to mental health such as heavy workloads, negative behaviours, and other factors that create distress at work. For the first time WHO recommends manager training, to build their capacity to prevent stressful work environments and respond to workers in distress.
Work amplifies wider societal issues that negatively affect mental health, including discrimination and inequality. Bullying, sexual violence and psychological violence is a key complaint of workplace harassment that has a negative impact on mental health. Yet discussing or disclosing mental health remains a taboo in work settings globally.
The guidelines also recommend better ways to accommodate the needs of workers with mental health conditions, propose interventions that support their return to work and, for those with severe mental health conditions, provide interventions that facilitate entry into paid employment. Importantly, the guidelines call for interventions aimed at the protection of health, humanitarian, and emergency workers.
New guidelines
“It’s time to focus on the detrimental effect work can have on our mental health,” said Dr. Tedros Adhanom Ghebreyesus, WHO Director-General. “The well-being of the individual is reason enough to act, but poor mental health can also have a debilitating impact on a person’s performance and productivity. These new guidelines can help prevent negative work situations and cultures and offer much-needed mental health protection and support for working people.”
A separate WHO/ILO policy brief explains the WHO guidelines in terms of practical strategies for governments, employers and workers, and their organisations, in the public and private sectors. The aim is to support the prevention of mental health risks, protect and promote mental health at work, and support those with mental health conditions, so they can participate and thrive in the world of work. Investment and leadership will be critical to the implementation of the strategies.
“As people spend a large proportion of their lives in work – a safe and healthy working environment is critical. We need to invest to build a culture of prevention around mental health at work, reshape the work environment to stop stigma and social exclusion, and ensure employees with mental health conditions feel protected and supported,” said Guy Ryder, ILO Director-General.
Mental health of health and care workers
Meanwhile, we have to think of the mental well-being of people who care for our mental and physical health. A new report by the Qatar Foundation, World Innovation Summit for Health (WISH), in collaboration with the World Health Organization (WHO) finds that at least a quarter of health and care workers surveyed reported anxiety, depression and burnout symptoms.
“Our duty of care: A global call to action to protect the mental health of health and care workers” examines the impact of the Covid-19 pandemic on the mental health of the health and care workforce and offers 10 policy actions as a framework for immediate follow-up by employers, organisations and policy-makers. The report found that 23 to 46 percent of health and care workers reported symptoms of anxiety during the Covid-19 pandemic and 20 to 37 percent experienced depressive symptoms.
This report follows landmark decisions at the World Health Assembly and International Labour Conference in 2022 that reaffirmed the obligations of governments and employers to protect the health workforce, ensure their rights and provide them with decent work in a safe and enabling practice environment that upholds their mental health and wellbeing.
Protecting and safeguarding this workforce is also an investment in the continuity of essential public health services to make progress towards universal health coverage and global health security.
Mental health of both children and adults can no longer be pushed aside as it is also essential for physical and overall health. A holistic approach is essential to tackle any lacunae we encounter in addressing mental health and make it a priority for all.