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The need to accelerate efforts around Universal Health Coverage (UHC) has never been clearer. As we come to the end of an extraordinary year with the COVID-19 pandemic, we should not only redouble our efforts to make sure that everyone, everywhere can access the health services they need without suffering financial hardship. But, as a new report lays out, mental health must also be integrated into health systems, especially primary and community-based health services, if we want to ensure the full success of UHC implementation.
A health opportunity, and potential for huge returns
Mental health has for a long time been under-invested. This is an opportunity being missed by national leaders and the international community. Investment in the integration of mental health in health services is a way of righting this balance, both to improve the mental health outcomes of populations - critical in its own right - and to support effective delivery of physical health care.
There is substantial evidence to suggest that, when mental health services are integrated with physical health programmes, the combined physical and mental health treatment contributes to better overall health outcomes. The overall care may also cost less. For instance, integration of mental health interventions has been shown to reduce the incidence of HIV and TB, and improve adherence to treatment. People living with mental health conditions are 4 times more likely to have HIV and people with depression have a 2.6-fold higher risk of contracting TB. A similar relationship exists between mental health and non-communicable diseases. Given the multiple comorbidities between mental health conditions and physical health conditions, mental health is a core component of making UHC a success, and delivering holistic, person-centred, cost-effective care.
Moving beyond health outcomes, there are sound economic reasons to integrate mental health into UHC. Investment in mental health can yield a clearly positive return to economies, generating $5 in terms of productivity and value-of-health benefits for every $1 invested in common mental health conditions. Taking an even wider perspective, given the positive impact of good mental health on human development and economic productivity as a whole, we would argue that it should be explicitly added as an additional component of the World Bank’s Human Capital Index.
A human rights imperative
Finally, but critically, there is a human rights imperative for the full integration of mental health into UHC. It is a tragic fact that people living with mental health conditions can be amongst the most vulnerable in society, enduring incarceration, chaining, coercion and over-medicalisation, stigma and exclusion.
In conjunction with initiatives such as community outreach, by increasing the availability of high-quality, rights- and community-based mental health care, actors can help reduce the opportunity for rights abuses and improve the perception of mental health conditions. An example being the promotion of the understanding that mental health conditions are preventable, manageable and treatable. As such, integration of mental health in UHC in a rights-based way would be a key stepping-stone towards realising the Convention on the Rights of Persons with Disabilities (CRPD) to achieve the rights of people living with mental health conditions, including the right to health, the right to freedom from torture, the right to liberty and security of the person, and other rights.
We have never been more informed on the rewards that integrating mental health in UHC could bring. Success in actually getting this done will be reliant on building genuine political commitment and mobilising domestic and/or catalytic national and international donor financing. We have a number of directive plans and guidelines to steer our efforts, including WHO’s Mental Health Action Plan 2013-2020, the WHO Special Initiative for Mental Health 2019-2023, and such World Bank publications as Moving the Needle. It has also been extremely exciting to see the launch of the new WHO UHC Compendium which brings together evidence, guidance and cost analysis into one go-to platform to inform the development of a comprehensive package suited to national context. The Compendium explicitly incorporates mental health to help decision-makers work out what services their people need and how to provide them.
Mental health is not optional. It is integral to health. And if we do not act now, we risk failing a critical component and contributor to the success of UHC. With a global push towards the 2030 goal of achieving UHC, there is an urgent need for mental health to be included in health sector reforms - now.
For more information, please read the report by United for Global Mental Health No Health without Mental Health: the Urgent Need for Mental Health Integration in Universal Health Coverage.
Dr. Githinji Gitahi, Global Chief Executive Officer for Amref Health Africa. Dr Gitahi is co-Chair of the UHC2030 Steering Committee, a global World Bank and World Health Organization (WHO) initiative for Universal Health Coverage (UHC). He is a member of the Africa COVID19 Response Committee and Board member of the Africa Centres for Disease Control and Prevention (Africa CDC). Dr Gitahi is a reviewer of the United for Global Mental Health report No Health without Mental Health: the Urgent Need for Mental Health Integration in Universal Health Coverage
Dr. Maxim Polyakov, Senior Consultant, Policy, Advocacy and Financing, United for Global Mental Health. United for Global Mental Health brings together the global mental health community with governments, funders and campaigners to help make sure everyone, everywhere has someone to turn to in support of their mental health. The not-for-profit organization was launched at the UN in September 2018. Dr Polyakov is one of the authors of the United for Global Mental Health report No Health without Mental Health: the Urgent Need for Mental Health Integration in Universal Health Coverage
Photo: A mother and child leaving Pursukoon Zindagi’s Wellness Centre, a safe space for counselling established in resource constrained settings.
Credit: Shehzad Noorani