WPA Working Group on Public Mental Health: objectives and recommended actions

Mental disorder is reported to account for almost a third of global disease burden as measured by years lived with disability (YLDs) ¹ . On the other hand, mental well‐being results in broad positive impacts ² . Effective public mental health interventions exist to treat mental disorder, prevent associated impacts, prevent mental disorder from arising, and promote mental well‐being and resilience ² , ³ .

However, only a minority of those with mental disorder receive treatment, with far lower coverage in low‐ and middle‐income countries (LMICs) ⁴ . There is even less coverage of interventions to prevent associated impacts of mental disorder, and negligible coverage of interventions to prevent mental disorder, or promote mental well‐being and resilience. This implementation gap represents a breach of the right to health, and results in population‐scale suffering and associated economic costs ³ . The gap has further widened during the COVID‐19 pandemic ⁵ , ⁶ , ⁷ .

The United Nations (UN) Sustainable Developmental Goals have set a target of universal coverage by 2030 which includes treatment and prevention of mental disorder and promotion of mental well‐being. The most recent World Health Organization (WHO) Mental Health Atlas highlighted that “global targets can be reached in 2030 only if there is a collective global commitment over the next 10 years across Member States to make massive investments and expanded efforts at the country level relating to mental health policies, laws, programmes and services” ⁴ .

Public mental health involves a population approach to improve coverage, outcomes and coordination of interventions to treat mental disorder, prevent associated impacts, prevent mental disorder from arising, and promote mental well‐being and resilience. This aims to support efficient, equitable and sustainable reduction in mental disorder, promotion of population mental well‐being, and achievement of the UN Sustainable Developmental Goals target of universal coverage by 2030 ³ .

The WPA Action Plan 2020‐2023 promotes public mental health as a guiding principle ⁸ , ⁹ . A Working Group on Public Mental Health has been then established, including experts such as J. Allan, F.K. Baingana, J. Campion, Y. Huang, A. Javed, N. Lamb, S. Levin, C. Lund, M. Marmot, S. Saxena, T. Schulze, E. Sorel, H. Tu, P. Udomratn, and M. van Ommeren (observer).

The Working Group highlighted that pub­lic mental health is not well defined or understood, with some languages having no terms for it. This contributes to lack of action on relevant issues. The Group agreed upon the definition outlined above, which is reported on the Group webpage of the WPA website (www.wpanet.org/public‐mental‐health) and in a recent publication ³ .

The main objective of the Working Group is to improve implementation of public mental health interventions in four ways. The first is to raise awareness, value, acceptance and prioritization of this area in national health policies. The second is to promote national assessments of public mental health unmet need and required actions which can then inform policy development and implementation. The third is to promote public mental health training, including through digital platforms, which can support psychiatrists and other professionals to address the public mental health implementation gap, particularly in LMICs, through identification of required actions by different sectors as well as clarification of a core curriculum, training targets and milestones. Examples of public mental health training are highlighted on the above‐mentioned Group webpage. The fourth way is to support development of integrated public mental health approaches to disease management and prevention including through engagement with primary and general health systems.

Further objectives include: a) work with interested countries in order to facilitate these approaches with identified funding; b) engagement with other organizations on the public mental health agenda – thus far, these have included the Organization for Economic Co‐operation and Development (OECD), the UN International Children's Emergency Fund (UNICEF), and the WHO; c) disseminating work relevant to public mental health through publica­tions, presentations and training, also de­livered online; d) supporting a public mental health approach in other areas of the WPA Action Plan 2020‐2023, including child, adolescent and youth mental health, the management of comorbidities, and partnership with other organizations.

Publications already produced by the Working Group include an editorial on the field as a whole ¹⁰ , articles dealing with the public mental health approach to the COVID‐19 pandemic ¹¹ , ¹² , ¹³ , and papers about required actions to address public mental health implementation failure ³ , ¹⁴ . Members of the Working Group have given and will give presentations at World Congresses of Psychiatry in 2021 and 2022, and will present in a public mental health symposium at the 2022 International Congress of the UK Royal College of Psychiatrists.

In order to achieve consensus on requi­red actions to address the public mental health implementation gap, the members of the Working Group were invited to contribute to a health policy article ³ , which recommends the following six actions: a) making the public mental health case through assessment of unmet need, estimation of impact and associated economic benefits from improved coverage, as well as collaborative advocacy and leadership; b) public mental health practice; c) public mental health train­ing and improving population knowledge; d) improving coverage of public mental health interventions through settings‐based approaches, integrated approaches, digital technology, maximizing existing resources, and focus on high‐return interventions; e) a rights approach, legislation and regulation; f) public mental health research, including that focused on implementation.