Dixon Chibanda
Elisha London

The journey of making mental health a development priority

Dr Dixon Chibanda is a psychiatrist and creator of the Friendship Bench, an initiative that has revolutionised mental health care in Zimbabwe. Elisha London is CEO of United for Global Mental Health, a global mental health NGO, which combines advocacy, campaigning and financing expertise. In her work, Elisha draws on her own mental health experiences, having been diagnosed with Post Traumatic Stress Disorder (PTSD) and chronic depression.

For years, we’ve seen first-hand that mental health support and services globally are too sporadic, poorly funded and insufficient to meet the enormous demand for them.

Global aid for health (1995-2015).
Credit: F. J. Charlson J. Dieleman L. Singh H. A. Whiteford

Over three-quarters of people with mental health conditions in low- and middle-income countries receive no support at all, meaning depression has become the leading cause of ill health for all ages and suicide a major killer of young people worldwide. Yet governments, on average, allocate less than 2% of their health spending and donors devote less than 1% of global health aid to mental health.

We’re writing now because it finally feels like some of the voices of people with lived experience of mental health conditions, advocates for their rights and the policy experts supporting them are being heard by decision-makers.

But we see the need to do more – and fast.

Speaking our mind

Driven by people with lived experience of mental health conditions, Speak Your Mind is a global civil society campaign, which is currently in 15 countries (and growing) and launched at the World Health Assembly (WHA) this week, aiming to get the attention of health ministers.

Speak Your Mind’s asks to governments at WHA are: invest, educate and empower societies. Enabled by bigger budgets for mental health, they should run public education campaigns to end the stigma and ignorance surrounding mental health. Leaders should also look to people with lived experience to guide the reform and implementation of policies.

This campaign is building on a wellspring of activity, especially over the past six months but reaching back decades. One such organisation, set up by one of the authors of this post, is the Friendship Bench, a project in Zimbabwe (and soon growing globally), which trains grandmothers in basic mental health counselling techniques. The grandmothers then sit on designated benches outside health centres to help people with mental health needs. Studies prove the effectiveness of the Bench, including a randomised clinical trial, which found that patients with common mental disorders assigned to the Friendship Bench intervention had fewer symptoms than the control group.  

Making space for Mental Health at high level events

On 10 October 2018, World Mental Health Day, the Director-General of the WHO, Dr Tedros Adhanom Ghebreyesus, joined forces with Lady Gaga to write movingly about the 800,000 people who die by suicide every year, showcasing that action is needed.  

As a leading cause of death and suffering worldwide, suicide deserves much more attention from the global community. Suicide mortality rate is the Sustainable Development Goals’ indicator for mental health, alongside the call for promoting mental health and well-being. Suicide prevention is the theme of this year’s World Mental Health Day, which will see campaigners push for closing the huge gap in support for those at risk of suicide and to help end the surrounding stigma.

As last year went on, there was growing global leadership on mental health by both the UN Secretary-General António Guterres and the WHO’s Dr Tedros. The UN Secretary-General announced an initiative to improve the mental health of UN staff. He also called for a collective push by the UN to address mental health, recognising that change requires action across different sectors – not just within health. Dr Tedros focused on mental health in the WHO’s latest General Programme of Work and WHO just announced a new Special Initiative on mental health.

Marking World Mental Health Day last year, the ministerial-level global mental health summit has now become an established fixture. The UK hosted last year, the Dutch will take it on this year and the French in 2020. With a particular focus on mental health and psychosocial support in emergency settings, we hope this year’s ministerial meeting will accelerate progress to both fund and deliver mental health support for those caught up in humanitarian catastrophes, wars and disease outbreaks such as Ebola.

It’s time to act

Throughout these moments, much of the global mental health community has shared the message that while there is a growing conversation around the importance of mental health, not enough is being done to provide tangible support and protect human rights.

Building on the work of advocates committed to improving global mental health, there are a number of important opportunities to enshrine mental health as a vital part of Universal Health Coverage (UHC) throughout the latter half of 2019.

The UN Secretary General has stressed the need to ensure mental health is a key component of Universal Health Coverage (UHC). This has real significance in a year when UHC is the main focus of the World Health Assembly and a high level event at UNGA, which will include a negotiated statement and speeches by heads of state outlining their commitments to achieve UHC. Honing in on the UHC promise to look at specific diseases, the Global Fund replenishment in October must also include mental health if prevention and treatment, especially of HIV/AIDs and TB, is to be effective.

Mental health has frequently been left out of health plans – this is not acceptable. Mental and physical health should be treated equally by policy makers, just as they are equally valued by us all.

Participants at the Speak Your Mind planning meeting in Johannesburg, January 2019

Top featured image: A woman stands outside the Women’s Centre in Balukhali camp, which provides a safe space for Rohingya women and adolescent girls to seek psycho-social counselling, among other services and support. Cox’s Bazar, Bangladesh. Photo credit:  UN Women/Allison Joyce.

 

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Comments

5 Responses to “The journey of making mental health a development priority”
  1. Kate

    Thanks for drawing attention to this… I was just discussing the very same issue this week with my colleague recently back from Liberia where so many people have had deeply traumatic wartime experiences, often as children exposed to horrific violence and displacement. There have been some recent efforts (post-Ebola) to invest in mental health in Liberia but it’s clearly still vastly underfunded. Of course the underfunding of mental health services globally is entirely unsurprising given that even in wealthy countries mental health has been a cinderella service for decades, and given also that many other diseases are a lot easier to treat/prevent. Do policy makers forced to make choices about which health services to invest in have the evidence they need, to support investments in mental health?

    I love the idea of the grandmothers project, giving people in communities skills in talking therapy. Having recently trained as a mental health volunteer in the UK myself, I am experiencing at first hand how the power of simply listening and not judging can help someone greatly.

  2. Thank you so much for highlighting Mental Health as a development priority. My colleagues and I (at TEAR Australia) have been working on research, advocacy , awareness raising and calls to action on this for awhile. Recently we conducted 2 participatory research studies on the lived experience of people with psychosocial disability in low and middle income countries in Afghanistan, India and Nepal. This research highlighted the very important role that development agencies can have in supporting inclusion and promoting wellbeing for all.
    https://doi.org/10.5463/dcid.v29i2.746
    DOI: 10.4103/INTV.INTV_39_18
    Some of our collaborators from CBM have written about the importance of inclusion of people with psychosocial disability in development programs too.

  3. Geoff

    I am rather concerned at the discourse on mental health as a development issue. The idea that people in poverty around the world would feel sad, depressed, anxious, fearful or despairing to name just a few possible emotional responses to the injustice and oppression they experience is a normal ethical response. But to label this as a mental illness is quite frankly offensive. It is saying that it is not what happened to you but instead it is saying what is wrong with you. You are depressed because you have something wrong with your brain. This is not to say that mental illness does not exist, but it is saying that the western psychological notion of mental illness is just that, it’s a theory, that has for a long time been pushed back on by those not from the US and others. As well as many in the west, though it is clearly up against the interests of big pharma. Pushing western based notions of mental health as a development issue is just another form of colonization. The best way to ‘treat’ these rational emotional responses of people in poverty and those who are experiencing injustice is to work to support them to not be in poverty and to realize justice and their rights.
    Pretty disappointed that this post was on the fp2p blog given the big fuss made about making it more inclusive of the voices of people living in the countries where Oxfam work.

    If you want to read more on this, check out Crazy Like Us: the globalization of the American Psyche by Ethan Watters

    • Hi, I absolutely get your reservations and this is a hot button issue in the “global mental health” community and academia! By now, the consensus appears to be that rather than pathologizing the effects of poverty, systemic oppression, and ongoing violence, global mental health movements and leaders acknowledge the role politics play in mental health and strive to highlight the effects and push for solutions. At the same time, helping individuals cope better with their struggles and trauma can help them become active leaders and advocates for and in their communities, which can also create political pressure and create change.
      It’s great that you brought this up, because it’s definitely a debate that must be ongoing and very self-critical.

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