Copenhagen, 10 October 2023
In a region where as many as 1 in 7 people live with a mental health condition, too few get any form of care or support. In fact, many people continue to experience discrimination for seeking mental health support – it can lead to the loss of their job or home; while physical health problems may be wrongly attributed to a person’s psychiatric diagnosis.
Although mental health has climbed higher on the health agenda regionally in recent years, it is increasingly difficult to access mental health care, in part because of a worrying decline in mental health workers. From 2017 to 2020, the number declined from 50 per 100 000 population to around 45. This means longer waiting times and a more burnout-prone mental health workforce.
Successive crises over the past three years – COVID-19, the war in Ukraine, a rising cost of living, multiple natural disasters and extreme weather events – have made it all the clearer that current approaches to protecting mental health do not serve people’s needs and preferences. Far too many vulnerable people fall through the gaps.
It is time for the WHO European Region to invest in and design better mental health systems at this time of permacrisis.
The WHO Regional Office for Europe is calling on its 53 Member States to:
- rethink what mental health systems look like;
- listen to the people who operate in those systems, especially health workers and people with lived experience, in shaping the implementation of mental health policies;
- invest mental health budgets better, across a variety of types of mental health support.
Rethink
Mental health systems encompass both health care and community-based support. WHO has long advocated for a transition to community-based mental health care, but it is important to recognize that what we view as a “community” has changed.
Rapid urbanization in many countries has blurred or erased traditional community spaces. For many people, public spaces are increasingly digital, disconnected from physical spaces but interconnected by shared interests or knowledge.
While digital technologies hold great promise for increasing access to mental health support, these technologies offer new challenges as well, directly impacting our mental health (such as increasing addictive behaviours) while also introducing new potential gaps in access (the so-called digital divide).
The WHO European Region has to embrace this changing definition of community, which also means acknowledging that mental health goes well beyond the health sector. Education, housing, law, industry, employment, transport, arts and culture, sports – these and many other sectors play a role in population mental health and well-being, whether they know it or not. This is why it can be difficult to produce enduring change in mental health systems, because initiatives have been patchwork, often located solely within the health sector, rather than involving all sectors.
In short, countries must rethink mental health systems as comprehensive webs of all kinds of support. They must enable these sectors to communicate their roles and capacities in the protection and promotion of mental health and well-being, as well as support the implementation of these efforts.
Listen
Is having a mental health policy a guarantee for change? Although there are more mental health policies and plans in the European Region than ever before, unfortunately, their implementation remains poorly assessed in terms of process, outcomes and impact. Many policies do not have evaluation indicators built into them or are not built together with the people whom they will ultimately impact.
Although most countries do report involving people living with mental health conditions and their families and carers in designing or updating policies, the limited buy-in of such individuals continues to be a barrier to implementing these policies. This suggests that involvement is generally not meaningful participation or genuine co-creation. There must be an authentic effort by governments and policy-makers to harness the rich expertise of people with lived experience to ensure that policies are built and implemented with their beneficiaries in mind.
Quite simply, governments have to listen – and keep listening – to those on the ground, if policies are to have an impact.
Invest
It is encouraging that countries are investing in mental health systems more than in the past. However, in most European Region Member States, the average share of the total health budget assigned to mental health is still only about 3.6%. Worse still, globally, large mental hospitals continue to receive the lion’s share, despite not being regarded as effective for recovery.
The historical approach to budgeting for mental health must end. Rather than allocating resources based on past budgets, as is done currently in many countries, we must allocate funding flexibly based on people’s current needs. It is not enough to merely invest more, but to invest better.
Better financing would mean a focus on recovery and not on disease. It would give equal weight to preventative and promotion interventions as to treatment, care and rehabilitation. It would also break the vicious circle of stigma and prejudice that continues to be perpetuated by decades of poor financing, obsolete services, poor therapeutic outcomes and enduring beliefs that mental health conditions are unbeatable.
In sum, countries must invest better if we want mental health systems to work as they are intended – towards long-term recovery and well-being.
If not now, when?
The permacrisis of recent years, and decades of poor investment, have taught us much about what mental health systems are, as well as what they can and should be. We simply cannot wait for the next crisis to tell us once again what we already know: that mental health is vital across the entire life-cycle and that our systems for protecting and enhancing it can, and should, be better.
We have no time to lose in investing strategically in protecting mental health as a foundation for individual and societal well-being.