Achieving equality, inclusiveness, and cultural sensitivity in mental health (EDIT)

In this era marked by unprecedented global challenges, mental health remains a key issue affecting individuals across diverse ages, cultures and backgrounds. According to the latest World Mental Health Report ¹ , 970 million people (13% of the global population) live with a mental health disorder, including 248 million youth.

Though high‐income countries exhibit a slightly higher prevalence of mental disorders (15.1%) relative to low‐income countries (11.6%), more than four out of five individuals with a mental disorder (82%) live in low‐ and middle‐income countries (LMICs), due to their larger population size.

Historically, mental health care has been marked by disparities, with certain populations facing stigma, discrimination, and limited access to services. Compared to the general population, ethnic and sexual minorities are often more likely to be affected by mental disorders, but less likely to use mental health services ² . Gender inequalities also exist, and are often driven by societal expectations and cultural norms. While depressive and anxiety disorders are more prevalent among women, men are more prone to substance use disorders ³ . Societal pressure related to body image, unequal workplace opportunities, and gender violence exposes women to higher risk of eating disorders, occupational stress, and trauma‐related disorders. On the other hand, men may face more barriers in accessing mental health treatment due to societal pressures that discourage them from seeking help.

Across the world, mental disorders are a leading cause of disability, exerting a huge impact on individuals’ and families’ daily life and functioning. The life expectancy for people with severe mental disorders is drastically reduced ⁴ . Nevertheless, only 2% of global health expenditures are allocated to mental health. Indeed, the treatment gap for mental disorders is above 50% in all countries in the world, and can reach 80‐90% in LMICs ⁵ .

Societal attitudes toward mental health can foster stigma and discrimination that in turn prevent individuals from seeking help. Help‐seeking can also be discouraged by a lack of awareness of the signs and symptoms of mental disorders and of available effective treatments, by cultural beliefs and practices, by language barriers, and, ultimately, by personal barriers, such as fear of treatment and stigma superimposed on insufficient motivation ⁶ .

People with mental disorders are more likely to experience various forms of social and health inequality. Unemployment is high in this population ⁷ , resulting in financial and housing insecurity. Unhealthy behaviors – such as excessive alcohol consumption, smoking, poor nutrition and sleep, and sedentariness – are also common among people with mental disorders and expose them to a higher risk of physical diseases ⁸ .

Considering these socioeconomic and cultural implications, the WPA Action Plan 2023‐2026 ⁹ , ¹⁰ , ¹¹ advocates for a more comprehensive and inclusive approach to mental health.

In order to reaffirm the WPA's commitment to promoting good mental health and well‐being for all individuals and communities around the world, the Action Plan introduced the EDIT initiative.

The EDIT acronym stands for:

• Equality across genders, ages and ethnicities. The WPA aims to ensure that mental health care is accessible to all, by reducing disparities based on factors such as ethnicity, age, gender, sexual orientation, geographical location, and socio‐economic status. By promoting research, education, and policy changes, the WPA seeks to create a world where mental health is a universal right. At the same time, the WPA emphasizes the need for a culturally competent psychiatry able to recognize and address the unique challenges faced by different populations and communities.

• Developmental stages from childhood to adulthood and beyond. The WPA recognizes the dynamic nature of mental health, which changes across the lifespan, and therefore encourages a life‐course approach to health and mental health ¹² . There is a need to train psychiatrists specialized in dealing with the unique manifestations of mental disorders at different stages of life. Furthermore, since about 40% of mental disorders are established by the age of 14 years, early prevention and interventions should be prioritized ¹³ .

• Inclusion of under‐represented groups. The WPA is committed to foster diversity and inclusivity in all its activities. The viewpoint of marginalized groups and people with lived experience should be considered in every phase, from research to clinical treatment.

• Transcultural awareness and perspectives. As cultural belief systems, values and practices shape the clinical expression and personal experience of mental disorders, the research questions and the provision of mental health care in contemporary multicultural societies pose enormous challenges. The WPA underscores the need for culturally sensitive approaches that acknowledge and respect this diversity. This involves not only understanding the cultural context of mental health, but also adapting research questions and treatment approaches to be culturally sensitive. In this sense, the WPA aims to foster collaboration between researchers and mental health professionals from different cultural backgrounds to expand the breadth and depth of knowledge, and promote a culture of understanding, acceptance and trust.

To achieve these goals, effective communication plays a fundamental role. By enhancing dialogue and promoting mental health literacy and awareness, the WPA aims to destigmatize mental health issues and create a more open and understanding society. The WPA recognizes the need for improved communication not only within the psychiatric community, but also with stakeholders, people with lived experiences, and the general public. To meet this need, several new communication initiatives are encouraged, harnessing the great potential of digital technologies.

One platform under creation, called the Specialist Corner, is aimed at updating clinicians about the latest findings and enabling them to discern and adopt best practices. The platform will consist of a series of short, easily‐digestible webinars on major mental disorders, covering the state‐of‐the‐art treatments and best practices for daily psychiatric work, including aetiology, symptoms, comorbidities with physical diseases, and rehabilitation strategies from the gender, developmental stage, and cultural perspectives. Moreover, follow‐up webinars will feature prevention, healthy lifestyles, caregiver and family, digital psychiatry, and human rights/ethics perspectives from experts in these fields. Reader‐friendly educational materials from the webinars will be developed for patients, their families, clinical staff, and the general public.

Another platform on the WPA website, the Healthy Lifestyles Hub, is a library of resources accessible to psychiatrists worldwide, with the purpose of demonstrating how mental health can be improved through the adoption of healthy lifestyles. Videos on physical activity and good nutrition have been developed for easy use in clinical practice. Furthermore, engaging both patients and psychiatric staff in joint sessions of physical activity will strengthen connections, cohesion and collaboration, improve mutual understanding, and reduce hierarchical divisions.

Without breaking the language barriers, however, it will be impossible to ensure the accessibility of these resources to psychiatrists worldwide. For this reason, the WPA is committed to making the materials available in as many local languages as possible, through the engagement of Member Societies and of young, enthusiastic psychiatrists.

In conclusion, the WPA Action Plan 2023‐2026 acknowledges the interplays between all aspects of human experience and mental health, and aspires to address the diverse needs of individuals across the lifespan and from various cultural backgrounds. The WPA continuously tries to strengthen ties with other international organizations in the fields of psychiatry, neurology, and public mental health, including service users and family carers organizations.

Through collaborative efforts in research, education, clinical practice, advocacy, and policy changes, according to the United Nations Sustainable Development Goals, the WPA seeks to shape a world where actions to improve mental health are universally accessible, culturally sensitive, and inclusive ¹³ .