Transforming Mental Health for All pt.1

 Transforming Mental Health for All pt.1

Data, methods, recommendations, plans, and strategies about mental health, all in one place. This is the proposal that the WHO, World Health Organization, aimed to bring to evaluate this sector worldwide. A casual and informative analysis of the “World Mental Health Report | Transforming Mental Health for All.”

By Duda Matias, AJN communicator in Brazil

Introduction

Hi everyone! I am Duda Matias, a young communicator from AJN, and here I am talking about mental health again. Although the topic may be a bit worn out, it continues to occupy large parts of our lives in all its aspects. Today, the subject is much more discussed than before, stigmas have decreased, treatment has improved, and that’s great! But it’s not enough, there is still a long way to go. And it is precisely with this in mind – assessing global mental health – that the WHO (World Health Organization) created a report: “World Mental Health Report | Transforming Mental Health for All.”

It is a huge document – 256 pages – that has not yet been translated into Portuguese, so my job was to read and simplify the results of this research for you. So, this content is going to be extensive, but remember that the original is much longer 🙂 And to make reading easier, more enjoyable, and practical, this production will be divided into two parts. The first one arrives today, addressing topics of social and individual responsibility in the area of mental health. This text is full of reflections and informational data aiming to alert people about the state of our health and why we can no longer treat it with neglect.

In both parts, there is very important information and strategies that we can adopt as individuals and society to improve our lives and those of others. No one is exempt from having problems, disorders, or mental illnesses, regardless of their social, regional, or personal context.

If you are interested in reading the original document, I especially recommend chapters 4 and 7 – they are the most interesting and direct, with lists of what to do, how we are harmed, the reasons, and problems we may be inclined to have, with data and images. It’s a recommendation! Now, let’s move on to part 1.

A global report to inspire and inform change

Twenty years have passed since the publication of the WHO’s 2001 report, “The World Health Report 2001: Mental Health: new understanding, new hope,” which was a milestone and whose recommendations remain valid to this day.

Much has been accomplished. Interest in and understanding of mental health have increased. Several countries have strengthened their mental health policies and plans. People with developmental impairments due to psychological causes have had their voices amplified. According to the research, the subject has advanced technically. Numerous practices, evidence-based mental health guides, manuals, and other tools are now available for implementation.

Through an assembly composed of the Health Ministers of the 194 Member States, the WHO adopted the Mental Health Action Plan 2013–2030, where all of them, through signatures, committed to meeting global goals to improve mental health – representing a remarkable and official acknowledgment of the importance of mental health. These goals focused on strengthening leadership and governance, community care, promotion and prevention, information systems, and research.

However, the latest analysis from the WHO’s 2020 Mental Health Atlas, which assessed countries’ performance concerning the Action Plan, confirms that progress has been slow. In 2013, 45% of countries reported having mental health policies and plans aligned with human rights instruments. The Action Plan set a target to increase this value to 80% by 2020 (later extended to 2030), but halfway through the plan, this percentage had risen to only 51%. And, when we talk about global care for psychosis, this number drops to less than 29%. In this scenario, countries and communities that have seen real innovation and advances remain isolated from good practices, in a sea of need and neglect, according to the report.

Still, some areas have seen more success: the global age-standardized suicide mortality rate for 2019 fell by 10% since 2013. However, this is far short of the target reduction of 33% projected for 2030. Overall, there is still a long way to go for the world to meet the goals set in the Comprehensive Mental Health Action Plan 2013–2030.

In our current situation, global threats to this issue are more present than ever. Social and economic inequalities continue to grow, conflicts persist, and public health is continuously affected by emerging violence, all of which threaten the progress being made. Now, more than ever, it is essential to improve the mental health care system because the methods previously employed are neither sufficient nor will they be.

The report, along with this text, is a hopeful attempt to inspire and inform the urgent and undeniable transformation we need to ensure that quality mental health care is provided to all. Besides promoting a multisectoral approach, the aim is to reach the entire health sector, including state and municipal governments, ministries, health professionals, and partner institutions in the sector, so that public policies for mental health, as well as the provision of its services, can develop.

Mental Health as a Basic Human Right

Mental health is extremely important for everyone, everywhere.

Mental health is a fundamental part of overall health and well-being and a basic human right. Having good mental health means being more capable of forming relationships, functioning well, handling life’s challenges, and thriving. However, mental health needs are abundant, and the responses are insufficient and inadequate.

Chapter 3 of the Report discusses the current global state of mental health, and the situation “isn’t good for anyone,” as the prevalence of mental disorders is enormous in all countries. Here are some of the data obtained from the report:

One in every eight people in the world has a mental disorder, which varies by sex and age. But in both, anxiety disorders and depression are the most common. Globally, there are 20 suicide attempts for every 1 death, and 1 suicide for every 100 deaths. This is the leading cause of death among young people.

Mental illnesses severely impair the quality of life. Schizophrenia, which occurs in 1 in every 200 adults, is one of the biggest concerns in this regard, and in its acute cases, it is the most harmful of all mental disorders. People with schizophrenia or other severe mental illnesses have a life expectancy 10 to 20 years shorter than the general population.

Note¹: A mental disorder is a serious health condition that requires specific interventions for treatment and management. These conditions affect a person’s cognitive, emotional, or behavioral functioning, resulting in significant difficulties in coping with everyday demands. A variety of disorders, such as anxiety, depression, schizophrenia, bipolar disorder, obsessive-compulsive disorder (OCD), and post-traumatic stress disorder (PTSD), can manifest with varying degrees of severity.

They can be influenced by a combination of genetic, biological, environmental, and social factors and can also be triggered by stressful events, trauma, or adverse life experiences. They may cause symptoms such as mood changes, irrational thoughts, compulsive behaviors, concentration difficulties, insomnia, among others.

Note²: Schizophrenia is a mental disorder characterized by a loss of contact with reality (psychosis), hallucinations (commonly hearing voices), false beliefs (delusions), abnormal thinking and behavior, reduced emotional expression, decreased motivation, a decline in mental function (cognition), and problems in daily performance, including in professional, social, relational, and self-care areas.

In general, the economic consequences of mental illnesses are enormous. Productivity losses and other indirect costs to society often exceed healthcare costs – it is estimated that around 12 billion working days are lost due to anxiety and depression. Within these terms, schizophrenia is the most costly mental disorder per person for society. However, depressive and anxiety disorders are more prevalent, albeit cheaper, and therefore contribute mostly to national and global costs – as per the report.

Worldwide, mental health systems have significant gaps and imbalances in information, research, governance, resources, and services. Other areas of health are considered more relevant in this regard, leading to neglect of physical, mental, and social well-being.

On average, countries allocate less than 2% of their health budgets to mental health. Over 70% of mental health expenditures in middle-income countries still go to psychiatric hospitals – which do not represent the appropriate type of treatment, as they do not focus on rehabilitation. About half of the world’s population lives in countries where there is only one psychiatrist to serve 200,000 or more people. And the availability of essential psychotropic medications at affordable prices is limited, especially in low-income countries. Most people diagnosed with mental illnesses do not receive any treatment. In all countries, gaps in service coverage are exacerbated by variability in the quality of care.

Brazil, despite being one of the countries with the highest number of anxious individuals in the world – according to the National Health Council – offers open and community-based mental health support services through the Psychosocial Care Network (RAPS), led by the Unified Health System (SUS). These services are strategically composed of various methodologies, actions, and equipment for each type of situation, including:

– Basic Health Units (UBSs);

– Psychosocial Care Centers (CAPS);

– Therapeutic Residential Services (SRT);

– Welcoming Units (UAs);

– Multiprofessional Teams for Specialized Mental Health Care (AMENT);

– Street Clinic Teams;

– Specialized Ambulatory Services;

– Specialized Reference Units in General Hospitals;

– Psychiatric Specialized Hospitals;

– Mental Health Beds in Hospitals.

Several factors prevent people from seeking help for mental health, including poor service quality, low levels of mental health literacy, as well as stigma and discrimination. In many places, there are not even services to address this issue, and if they exist, they are often inaccessible. Generally, people choose to endure mental suffering without relief rather than risk the discrimination and exclusion that come with accessing mental health services.

Unfortunately, many of us have thought this way, even involuntarily. We are taught to “be strong,”keep busy,” to say it was “just a bad day” when we need help and support. The tendency is to isolate ourselves and try to forget what bothers us instead of seeking help – when we have that possibility – which is not a reality for most Brazilians. Regarding psychiatric medications, there are even more deeply ingrained stigmas and prejudices, as it is said that those who go to a psychiatrist “are crazy.”

That said, can you perceive any advances in mental health that have already been made? In your perspective, does everyone need access to mental health? What is the true importance of emphasizing this issue so much? Do we have the power to change anything, given the magnitude of this challenge?

Well, dear readers, these are the questions I want to leave for you to reflect more deeply on the topic. In the next text – part two – we will address all these questions in a more detailed and practical way. I hope to see you there!

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