Are we doing enough to ensure mental health worldwide?
There is no public health without mental health
Von Ambassador Tania Dussey-Cavassini
Surely, you have come across this tagline when listening to statements by Member States at the World Health Assembly or when reading about the issue in various articles. Last January 2017, Tania Dussey-Cavassini was invited to take part in a panel conversation at the Open Forum in Davos on “Mental Health Matters”. She shares her views on a topic that is utterly difficult and very sensitive.
Overcoming Torture 1.0, USAID Funded project “ACOPLE: Community-Based Treatment Services for Afro-Colombian Victims of Torture” (Photo: Heartland Alliance International – Project ACOPLE (Colombia) / Gloria Carolina Barrera Mejía, flickr, CC BY-NC-ND 2.0)
Isaac Newton once said: “I can calculate the movement of stars but not the madness of men”. There lies my first provocative thought: how does one describe mental health? The World Health Organization (WHO) defines Mental Health as the state of well-being in which every individual realizes her or his own potential, can cope with normal stresses of life, can work productively and fruitfully is able to make a contribution to her or his community. (WHO, Mental Health, August 2014) There are four important elements in this definition that need to be reunited in order to fulfill the state of mental health.
In his book, “Saving normal”, Dr. Allen Frances wrote a fascinating account on the explosion of psychiatric disorders in the United States of America, and the problem of increasing medicalization of normality. More specifically, how over-diagnostics have led to unnecessary and harmful medications. (Frances 2013)
Disturbing facts and figures
Still. According to WHO, the facts and figures on mental health problems worldwide are disturbing: 20% of the world’s children and adolescents have mental disorders or problems. Mental and substance use disorders are the leading cause of disability worldwide. 800’000 people commit suicide every day of which 75% occur in low- and middle-income countries. Wars and disasters have a major impact on psychological well-being. Mental disorders are often the cause of unintentional or intentional injuries. Stigma and discrimination prevent people from seeking mental health care. Human rights violations of people with mental disability are routinely reported. There are great disparities in the distribution of skilled human resources for mental health. Finally, the financial resources invested in mental health treatment and prevention remain modest.
In Switzerland, one out of five suffers from mental health disorder in her or his life-time. According to a recent report published by the Swiss Health Observatory, 30% of the population declares having depressive symptoms (anxiety, sleep deprivation). Depression is the most common chronic disease. There are an average of two to three suicides per day in Switzerland: in 2014, 754 men and 275 women died through non-assisted suicides. According to the World Economic Forum, mental health disorders are estimated to cost the Swiss economy around CHF 19 billion, equivalent to 3.2% of GDP per year in lost productivity, healthcare and social spending.
Mental Health Action Plan Flyer (WHO)
In the WHO European region, average spending on mental health account for 5.9% of the health budget. Western high income countries have high proportion of health spending committed to mental health (about 10% in The Netherlands, The UK or Scandinavian countries, i.e. 1% of GDP). These countries can afford complex systems including mental health specialists in primary care, community teams, hospital beds and specialist services such as liaison psychiatry, forensic care and eating disorders. Multidisciplinary staff is available, including psychiatrists, nurses, psychologists, social workers and occupational therapists. In middle income countries, typical spend amounts to 2-4% of the health budget. The services are very basic, relying on policlinics or large mental hospitals in basic conditions. Family doctors are not engaged in mental health care and there is a heavy reliance on medication. In many of these countries very few, if any psychologists and social worker are active in mental health.
The importance of mental health recognized at international level
In 2013, the 66th World Health Assembly adopted a Comprehensive Mental Health Global Action Plan 2013-2020 that calls for changes by governments. Switzerland strongly supported the adoption of this plan. The specific inclusion of mental health as well as the prevention and treatment of substance abuse in the Sustainable Development Goal 3, adopted in September 2015 by all UN Member States is another important step likely to have a positive impact in public health measures. Most recently, Switzerland played a key role in putting dementia on the agenda of the Governing Bodies of WHO, and in the work that led to the adoption last May 2017 in Geneva, of the Global Action Plan on the public response to dementia by the 70th World Health Assembly.
These Action Plans and political commitments should serve as a greater incentive to encourage high income countries in supporting programs that aim at enhancing the state of mental health worldwide.
Switzerland through the Swiss Agency for Development and Cooperation already provides psycho-social support to victims of gender based violence and to orphans and vulnerable children in some African countries, as well as support to mental health reform in Eastern European and Balkan countries. Switzerland trains mental health professionals along the priorities defined in the Comprehensive Mental Health Action Plan, and puts a strong emphasis on community based services.
But, are we doing enough? Official Development Assistance for Health amounted USD 35 billion in 2015. According to www.healthdata.org only 1.4 % was dedicated to preventing Non Communicable Diseases. How much did we invest in promoting mental health worldwide?
Mental health disorders worldwide represent:
- HIGH public health and economic burden
- HIGH stigma, and a major factor in
- HIGH human rights violations,
- LOW priority and spending, leading to
- LARGE treatment gap
How can we continue to claim that there is no public health without mental health, if we do not include the latter in our actions?
WEF, Davos Open Forum 2017
Frances, Allen: Saving normal, HarperCollins Publishers, 2013
Swiss Health Observatory, Mental Health in Switzerland, December 2016, http://www.obsan.admin.ch/fr/publications/la-sante-psychique-en-suisse-2
WHO, Mental Health,
UN Sustainable Development Goal 3, September 2015, https://sustainabledevelopment.un.org/sdg3
WHO: Mental health included in the UN Sustainable Development Goals, September 2015
WHO: Development of a draft global action plan on the public health response to dementia
Tania Dussey-Cavassini is Ambassador for Global Health, Vice-Director General of the Swiss Federal Office of Public Health.