Transforming mental health for all: a critical role for specialists

The World Mental Health Report: Transforming Mental Health for All  is the World Health Organization (WHO)’s largest review of world mental health in more than 20 years ¹ . At its heart lies a call to change how we promote, protect and care for mental health.

The call to transform mental health and mental health care is not new. Mental health advocates and organizations, including the WHO, have been arguing for services reform for decades. Growth in global activism in recent years has focused political attention on the need for quality mental health care. Most recently, the COVID‐19 pandemic put both the value and vulnerability of mental health under the spotlight and exposed huge gaps in mental health systems all over the world.

Professionals in multiple sectors, the general public and people with lived experience increasingly recognize the importance of mental health, and more policy makers than ever understand – and publicly support – the imperative for improvement. The appetite for change has arguably never been greater. In 2021, all countries recommitted to the Comprehensive Mental Health Action Plan 2013‐2030, which provides a roadmap for improved mental health structured around ten global targets ² .

But this type of expressed commitment can only take us so far. Driving the mental health agenda forward to effect meaningful change also requires institutional commitment – policies, plans and programmes to implement the stated intent – and budgetary commitment, which allocates the necessary funds to act. Both are, on the whole, still lacking. In 2020, only 67 countries reported data on mental health spending to the WHO, and those that did only spent on average 2.1% of their total health budget on mental health ³ .

The shift to community‐based care long advocated by the WHO and others is not happening fast enough, and the wide gap between those needing quality care and those receiving it continues to exist. It has been nearly a decade since countries agreed on the WHO's Comprehensive Mental Health Action Plan, but advances remain few and far between. For most of the world, mental health conditions continue to exact a heavy toll on people's lives, and mental health systems and services remain ill‐equipped to meet people's needs.

The new WHO report outlines three key strategies, or “paths to transformation”, for moving beyond business as usual and accel­erating progress against the Comprehensive Mental Health Action Plan. These focus on shifting attitudes to mental health, addressing risks to mental health in our environment, and strengthening systems that care for mental health.

First, we must deepen the value 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. Second, we must reshape the physical, social and economic characteristics of environments – including homes, schools, workplaces and health services – to better protect mental health and prevent mental health conditions. Third, 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.

In this editorial, I direct my words to the readers of World Psychiatry and so focus on the role of psychiatrists and other mental health specialists in supporting the actions required. These stakeholders have a critical part to play in enabling each path to transformation. Most specialists are clinicians at heart, motivated by providing care to those in need. This remains a key part of their role, especially to care for people who are presenting with complex problems and who are not recovering in non‐specialized care. But, to transform mental health, specialists will have to move beyond being care providers to also serve as advisors, advocates, innovators and educators.

As experts in the field, they can help strengthen institutional and budgetary commitment to mental health through advocacy, by raising awareness of key issues, and advising on and promoting changes in line with the WHO recommendations and the Comprehensive Mental Health Action Plan. They can also help steer policy and practice through research, for example by contributing to the evidence base on which mental health actions have the widest impact for changes. And, as trusted experts, specialists can deepen commitment to mental health across the board by educating policy makers, medical staff and individuals about the intrinsic and instrumental values of mental health.

As mental health leaders, specialists have a major responsibility to strengthen mental health care so that it is respectful, provides dignity, and supports autonomy. Tackling stigma and strengthening rights to eliminate abuse of people with mental disorders within general and mental health services is particularly important. All mental health professionals have a duty to help assure more equitable care for populations who are less likely to seek help or are less likely to be offered quality services, or for whom the risk of missing or misdiagnosing mental disorders is known to be higher than usual. In most countries, these populations include racial and ethnic minorities; lesbian, gay, bisexual, transgender, intersex and queer (LGBTIQ+) persons; migrants and refugees, and persons experiencing poverty and homelessness.

As part of their commitment to person‐centred, human rights‐based care, all mental health professionals are encouraged to join the WHO in advocating for the development of community‐based networks of mental health services and the phasing out of custodial care in psychiatric hospitals as soon as community alternatives become available. At the same time, understanding that the need for mental health care far outstrips supply, mental health specialists should be searching out, adopting and championing innovative tools and technologies that can help scale up care, for example task‐sharing, tele‐mental health and guided self‐help4, 5, 6.

Promoting and facilitating an integrated approach to care is especially important. The evidence is clear that task‐sharing can improve health and social outcomes for people living with mental health conditions, especially in low‐ and middle‐income countries ⁷ . In all cases, task‐sharing relies on mental health specialists leveraging their experience and expertise and supervising, training and mentoring general health workers and community providers to deliver evidence‐based care, including psychological interventions and psychosocial supports.

As well as improving care environments, mental health specialists can and should help advocate for action in other environments like homes, schools and workplaces. They can do this by, for example, sharing evidence on the most detrimental determinants of mental health (such as bullying and gender‐based violence) and supporting the design and delivery of multisectoral initiatives to address these.

The last time the WHO published a world report on mental health, in 2001, it captured the attention of political and health care leaders around the world and provided the momentum for national and international mental health initiatives to advance. It is our hope that the new World Mental Health Report will similarly inspire and inform all stakeholders to reprioritize mental health and to redouble their efforts to transform mental health. Making change happen is everybody's business. But mental health specialists have a central role to play.