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MENTAL HEALTH:
E V I D E N C E F O R AC T I O N
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INVESTING IN
MENTAL HEALTH:
E V I D E N C E F O R AC T I O N
2
CONTENTS
Summary 5
1. Introduction 6
REFERENCES 26
3
4
SUMMARY
Mental health and well-being are fundamental to The report shows that a strong case can be
our collective and individual ability as humans to made for investing in mental health whether to
think, emote, interact with each other, earn a enhance individual and population health and
living and enjoy life. They directly underpin the well-being, protect human rights, improve
core human and social values of independence of economic efficiency, or move towards universal
thought and action, happiness, friendship and health coverage. The report also identifies a
solidarity. On this basis, the promotion, protection number of barriers that continue to influence
and restoration of mental health can be regarded collective values and decision-making including
as a vital concern of individuals, communities and negative cultural attitudes towards mental illness
societies throughout the world. and a predominant emphasis on the creation or
retention of wealth (rather than the promotion of
However, current reality presents a very different societal well-being).
picture. The formation of individual and collective
mental capital especially in the earlier stages of In partnership with all relevant stakeholders,
life is being held back by a range of avoidable governments have a lead role to play in reshaping
risks to mental health, while individuals with the debate about mental health, addressing
mental health problems are shunned, current barriers and shortcomings, and
discriminated against and denied basic rights, responding to the escalating burden of mental
including access to essential care. Accentuated disorders. Key actions that would mark a
by low levels of service availability, the current renewed commitment to promote, protect and
and projected burdens of mental disorders are of restore mental health include: better information,
significant concern not only for public health but awareness and education about mental health
also for economic development and social and illness; improved health and social services
welfare. for persons with mental disorders; and enhanced
legal, social and financial protection for persons,
In this report, potential reasons for this apparent families or communities adversely affected by
contradiction between cherished human values mental disorders.
and observed social actions are explored with a
view to better formulating concrete steps that
governments and other stakeholders can take to
reshape social attitudes and public policy.
5
1. INTRODUCTION
INVESTING IN MENTA L HE A LTH: E VID ENCE FOR ACTION
Mental health or psychological well-being is an While the extent of unmet need is daunting and the
integral part of an individuals capacity to lead challenges of scaling up services are many, it is
a fulfilling life, including the ability to form and vital to recognize that there already exists a range
maintain relationships, to study, work or pursue of preventive and treatment strategies that have
leisure interests, and to make day-to-day been shown to be safe, effective and affordable (5).
decisions about education, employment, housing Thus it is not the case that little or nothing can be
or other choices. Disturbances to a persons done. Rather, much can be done with existing
mental well-being can adversely compromise interventions, but to enable their effective
this capacity and the choices made, leading not deployment will require a major change in social
only to diminished functioning at the individual attitudes and public policy. That is why this report
level but also to broader welfare losses for the in support of WHOs Comprehensive Mental
household and society. Health Action Plan 20132020 (6) calls for
renewed public policy commitment to promote,
Adding up these losses within or across countries protect and restore the mental health of
results in some very large and disconcerting populations.
numbers. For example, mental, neurological and
substance use disorders account for nine out of This report is an update of an earlier WHO report
the 20 leading causes of years lived with disability that also carried the title Investing in mental health
worldwide (more than a quarter of all measured (7), but it now incorporates new evidence and
disability) and 10% of the global burden of disease additional arguments. As in the earlier report,
(which includes deaths as well as disability) (1, 2). the primary aim is to provide national and
A recent analysis by the World Economic Forum international policy-makers, decision-makers
estimated that the cumulative global impact of and funding agencies with a synthesis of
mental disorders in terms of lost economic output the arguments that have been and can be
will amount to US$ 16 trillion over the next 20 advanced in support of renewed action and
years (3). Such an estimate marks mental health investment.
out as a highly significant concern not only
for public health but also for economic Specifically, the report sets out:
development and societal welfare.
to present key reasons for investing in mental
Yet this concern is not being appropriately health from a range of perspectives, including
addressed or acted upon. Rather, the plight of public health, economic welfare and social
individuals suffering from mental health problems equity (the conceptual case for investment);
is all too often met with indifference or outright
prejudice by the communities and societies they to highlight priorities for investment in mental
live in. This neglect is further reflected in the levels health (the evidence-based case for investment).
of service provision for these vulnerable persons,
which are abysmally low in many parts of the
world. Even among those with very serious mental
disorders such as schizophrenia, only one in 10
persons in low-income countries receives the
treatment and care they need (4).
7
2. MENTAL HEALTH
AND SOCIAL VALUES:
THE CONCEPTUAL CASE FOR INVESTMENT
INVESTING IN MENTA L HE A LTH: E VID ENCE FOR ACTION
9
wor ld he a lth org a niz ation
Although the attainment and preservation of good Table 2 summarizes a number of arguments that
mental health corresponds well to the core human support, and also potentially work against, greater
and social values described above, individual and investment in public mental health from these
collective choices or decisions are influenced by a different perspectives. The table shows that there
range of other factors or values too. For example, are solid arguments from all perspectives in favour
individuals may be prepared to do risky or stressful of greater investment in public mental health, but
work in order to increase their income, or there are also important barriers to consider
governments may prioritize security or economic especially the sociocultural stigma that surrounds
growth over improvements in public health. mental illness (since this can negatively affect
appropriate action by governments) and the fact
Table 1 shows the primary concerns and values that macroeconomic performance often has
that underpin a range of perspectives on how priority over broader measures of societal welfare.
social choices and decisions might be framed:
Public health Promote, prevent, restore and maintain The attributable and avertable
health burden of disease
Economic welfare Maximize individual and social well-being Health as a key component of
economic welfare
Equity Promote fairness in equality of opportunity Health and access to health care
as a human right
Sociocultural Influence of beliefs, customs and attitudes Perceptions or beliefs about the
influence regarding the way societies perceive and causes of illness (stigma)
organize themselves
Political influence Formulate and implement state policies, Market failures in health care
uphold the law and, where necessary, (e.g. incomplete information among
intervene in private markets service users)
10
INVESTING IN MENTA L HE A LTH: E VID ENCE FOR ACTION
Ta ble 2 . Suppor ting a rgu me nts for , a nd pote ntia l ba r r iers ag a inst,
in v estme nt in me nta l he a lth
Public health Mental disorders are a major cause of the Mental disorders are not a leading
overall disease burden; effective strategies cause of mortality in populations
exist to reduce this burden
Economic welfare Mental and physical health are core Other components of welfare
elements of individual welfare are also important (e.g. income,
consumption)
Economic growth Mental disorders reduce labour The impact of mental disorders on
and productivity productivity and economic growth economic growth is not well known
(and often assumed to be negligible)
Equity Access to health is a human right; Persons with a wide range of health
discrimination, neglect and abuse conditions currently lack access to
constitute human rights violations appropriate health care
Sociocultural Social support and solidarity are core Negative perceptions and attitudes
influence characteristics of social groupings about mental illness (stigma)
11
wor ld he a lth org a niz ation
12
INVESTING IN MENTA L HE A LTH: E VID ENCE FOR ACTION
Conclusion
13
3. MENTAL HEALTH
ACTION AND
INNOVATION:
THE EVIDENCE-BASED CASE FOR
INVESTMENT
INVESTING IN MENTA L HE A LTH: E VID ENCE FOR ACTION
The preceding section highlighted reasons why This is not remotely proportionate to the burden
individuals and societies place value or importance they cause, and appears to place a very low
on psychological health and well-being, why these value on the psychological or emotional well-
values do not necessarily lead to action, and why being of populations. The situation is particularly
governments have a responsibility to ensure that bleak in low-income countries where on average
they do. If these reasons are accepted and there is only one psychiatrist for every two million
governments and other key stakeholders are inhabitants (compared to one to every 12 000
prepared to act, policy dialogue within countries inhabitants in high-income countries). Most of
can move on from the question why? to what? the funds that are made available by
and how? (or indeed, how much?). governments are specifically directed to the
operational costs of specialized but increasingly
outdated mental hospitals (that are commonly
What is the current state associated with isolation, human rights violations
of investment? and poor outcomes) (15). This inevitably curbs
the development of more equitable and cost-
Many low- and middle-income countries effective community-based services.
currently allocate less than 2% or even 1%
of the health budget to the treatment and
prevention of mental disorders (see Figure 1) (15).
6%
% of total health spending on menthal health
5.1 %
5%
4%
3%
2.4 %
1.9 %
2%
1%
0.5 %
0
Low-income Lower middle- Upper middle- High-income
countries income countries income countries countries
15
wor ld he a lth org a niz ation
16
INVESTING IN MENTA L HE A LTH: E VID ENCE FOR ACTION
The infringement of basic rights and entitlements activity, an unhealthy diet and, in many cases, the
represents the strongest single reason for side-effects of medication. Along with suicide,
appropriate corrective action by governments and these chronic diseases produce a level of
civil society (including engagement and premature mortality far in excess of that of the
empowerment of organizations of people with general population; even in the relatively affluent
mental disorders as well as families and carers). In context of Nordic countries, this mortality gap has
particular, rigorous and ongoing procedural been estimated at 20 years for men and 15 years
safeguards need to be in place to protect against for women (19).
the overuse and abuse of involuntary admission
and treatment. To this end, the WHO QualityRights Despite (and in no small part due to) low
tool kit sets key human rights and quality standards government health expenditures on mental health,
that need to be met in all inpatient and outpatient the overall economic costs of mental disorders are
mental health and social care facilities (18). also very high. At the household level, these costs
come most directly in the form of reduced
earnings plus additional and sometimes
Public health and catastrophic out-of-pocket expenditure on
health services (often leading to cuts in spending
economic burden
and investment in other areas or giving up
Mental, neurological and substance use disorders household assets and savings). An analysis for
are major contributors to morbidity and premature India, for instance, found that half of the out-of
mortality throughout the world. Over 10% of the pocket expenditures made by households for
global burden of disease, measured in terms of psychiatric disorders came from loans and a
years of healthy life lost, can be attributed to these further 40% from household income or savings
disorders (2); when only years lived with disability (20). The potentially catastrophic impact of private
are counted, the proportion more than doubles to out-of-pocket payments for health services on the
25% of the global burden (1). Not only do these income and savings of households that include a
conditions result in significant levels of disability or person with mental illness has rarely been
impaired functioning but they are highly prevalent. assessed. However, one study in the state of Goa
For instance, more than 650 million people in India found that 15% of women with a common
worldwide are estimated to meet diagnostic mental disorder spent more than 10% of household
criteria for common mental disorders such as income on health-related expenditures (21).
depression and anxiety (1). Almost three quarters
of this burden is in low- and middle-income In terms of the impact on the national economy,
countries. mental disorders are associated with high rates of
unemployment and also under-performance while
The onset or presence of a mental disorder also at work. These both limit labour participation and
increases the risk of disability and premature output (a critical component of economic growth).
mortality from other diseases including A recent study by the World Economic Forum
cardiovascular disease, diabetes, HIV/AIDS and estimated that the cumulative global impact of
other chronic conditions (11) due to neglect of mental disorders in terms of lost economic output
the persons physical health (by themselves, will amount to US$ 16 trillion over the next 20
families or care providers), elevated rates of years, equivalent to more than 1% of global gross
psychoactive substance use, diminished physical domestic product (GDP) over this period (3).
17
wor ld he a lth org a niz ation
Studies from specific countries provide similarly In order to choose specific evidence-based
sobering findings: health care costs and lost interventions for priority disorders that can be
earnings amount to at least US$ 50 billion in readily scaled up and offer good value for money,
Canada and US$ 75 billion in the United Kingdom information is required on cost-effectiveness,
(both equivalent to more than 2.5% of national GDP) affordability and feasibility (see Box 1 for
(22, 23). For childhood mental health problems definitions of these terms).
alone, the lifetime costs to the USA are expected to
exceed US$ 2 trillion as a result of diminished This information is available at the global level i.e.
educational achievement and earnings (24). for countries of different income levels for alcohol
use (as a risk factor for disease), epilepsy,
depression and psychosis (see Appendix 3 for
Cost and cost-effectiveness details). From these interventions, a subset can be
identified that is not only highly cost-effective but
The magnitude of the current and projected also feasible, affordable and appropriate for
burden of mental, neurological and substance- implementation within the constraints of the local
use disorders might be considered a sufficient health system:
reason alone for investment, but only if that
investment can be channelled towards effective Epilepsy:
and affordable solutions. The knowledge base Diagnosis and treatment of epilepsy with first-line
on what to do about the escalating burden of antiepileptic drugs is one of the most cost-
mental disorders has improved substantially effective interventions for noncommunicable
over the past decade, with a growing body of diseases. The treatment is very affordable and can
evidence demonstrating both the efficacy and feasibly be undertaken at the level of primary care.
cost-effectiveness of key interventions for priority
mental disorders in countries at different levels
of economic development.
Affordabilit y is defined in terms of the actual cost of implementing interventions, with US$
0.50 per capita used as a threshold for considering an intervention to be very affordable/low-
cost, and US$ 1 for quite affordable/low-cost.
Feasibilit y is defined by: (i) reach (capacity of the health system to deliver an intervention to the
target population); (ii) technical complexity (technologies needed for an intervention); (iii) capital
intensity (amount of capital required); and (iv) acceptability (including fairness and human rights).
18
INVESTING IN MENTA L HE A LTH: E VID ENCE FOR ACTION
19
wor ld he a lth org a niz ation
B r e a dth
Equitable access and
financial protection (The proportion of the population covered by
(universal health some form of financial protection):
coverage) It is well established that in low- and middle-
income countries there is a sizeable gap in mental
An exercise carried out by the United States health service and financial coverage. For severe
National Institute of Mental Health to identify a mental disorders, the treatment gap is at least
number of grand challenges in global mental 70% (4) and for common mental disorders it is
health found that improved treatment and access even higher.
to care was the single most pressing concern (27).
Indeed, an overarching financing goal of many Heig ht
health systems currently undergoing transition is (The proportion of total costs covered by
the pursuit of universal health coverage, which can prepayment):
be defined in terms of access to key promotive, Private out-of-pocket spending represents a substantial
preventive, curative and rehabilitative health proportion of total mental health expenditure in low- and
interventions for all at an affordable cost, thereby middle-income countries, particularly when the largest
achieving equity in access (28). The concept of element (mental hospital spending) is excluded (29).
universal health coverage can be broken down into Direct out-of-pocket spending is an unfair and
three dimensions (see Figure 2): regressive way of paying for health care because it
penalizes those least able to afford care (28).
D ep th
(The range of services or interventions available In short, current coverage of essential mental health
to members of the pool of insured persons): care can be characterized as inadequate, both in
This can be appropriately assessed by considering terms of access for those in need and in terms of
the cost and cost-effectiveness of services and financial protection or benefit inclusion. Accordingly,
interventions (as discussed above). efforts to scale up community-based public mental
health services can be expected to contribute
strongly to the objective of greater equality in access
because more people in need will be served and with
less reliance on direct out-of-pocket spending.
20
INVESTING IN MENTA L HE A LTH: E VID ENCE FOR ACTION
Include
other Direct costs:
Reduce cost proportion of the
sharing and fees services
costs covered
Extend to
non-covered
Services:
which services are
covered?
Population: who is covered?
In practical terms, there are several critical issues S erv ice d eliv ery
that need to be addressed in order to move closer Specialized secondary care should be available for
to the goal of universal coverage in mental health. referral cases and mental health care should be
These are: integrated into primary health care, maternal and
reproductive health care, internal medicine and
Fin a n cing / in sur a n ce paediatrics, and emergency medicine, so that the
A defined set of mental health conditions and majority of persons with mental health needs can
interventions should be explicitly recognized and enjoy local access to treatment and care.
included in the essential list or package of health
benefits offered to all citizens by governments, H u m a n r esources
whether as part of the national tax-based health Clinical tasks should be shared with nonspecialists
service or under the provisions of social or private so that the provision of essential care and support
insurance schemes (see Box 2 for an example is not thwarted by the absence of specialist mental
from Chile). health providers.
21
wor ld he a lth org a niz ation
As part of a broader process of health reform, in 2005 the Chilean parliament passed the
Regime of Explicit Guarantees in Health Law which provides universal coverage for all citizens
with regard to a package of medical benefits consisting of a prioritized list of diagnoses and
treatments for 56 health conditions. This list of conditions (which is still growing) includes
depression, alcohol/drug dependence and schizophrenia. The regime is enforceable by law and
includes a set of guarantees concerning access, quality and financial protection such as
maximum waiting times, co-payments, and the mandatory offering of the benefits package by
both private and public providers (30).
There is a strong international consensus that the Furthermore, the study found that the cost of
shortage of financial and human resources for additional community-based workers and a mental
mental health requires a policy to integrate mental health counsellor at primary level can be offset by
health care into general health care. Such a reduction in the number of other specialist and
integration provides opportunities for reducing the nonspecialist health personnel (32).
stigma of mental health problems, which in itself is
a major barrier to accessing care. A recent report Adequate training, supervision and support are of
presents the justification for, and advantages of, course paramount to the success of such an
providing mental health services in primary care, approach. This means that sufficient financial or
and describes how a range of health systems have other incentives need to be put in place to ensure
successfully undertaken this transformation (31). sustainability of the approach. In addition,
treatment guidance and training materials need to
Because of the current shortage of specialist be geared towards nonspecialists; this has been
mental health personnel a well-established achieved with the development and roll-out of
barrier to scaling up mental health services a key WHOs mhGAP Intervention Guide (5).
proposal to improve access to treatment is by
task-sharing with nonspecialist health workers.
There is an emerging evidence base that Conclusion
demonstrates how task-sharing with nonspecialist
health workers can improve access to care. A By putting together an overall picture of these
study carried out for KwaZulu-Natal province in different criteria, as shown in Box 3, one sees a
South Africa, for example, concluded that a task- compelling case for urgent action and investment.
sharing approach to the integration of mental
health into primary health care can substantially
reduce the number of health-care providers who
would otherwise be needed to provide this care.
22
INVESTING IN MENTA L HE A LTH: E VID ENCE FOR ACTION
Individuals with mental health problems (together with their families) are commonly
subjected to stigma, discrimination and victimization.
Well-formulated and properly enforced policies and laws that are oriented to human rights
prevent abuse and protect rights.
G
lobally, more than 25% of all years lived with disability and over 10% of the total burden of
disease is attributable to mental, neurological and substance use disorders.
Left unaddressed, lost economic output due to these disorders will increase significantly from
the already enormous levels.
F
easible, affordable and cost-effective measures are available for preventing and treating
mental, neurological and substance use disorders.
M
ost persons with mental ill-health do not have adequate access to the essential mental
health care they need; those who do use the services end up paying much of the bill.
Integration of mental health care into publicly-funded primary care and task-sharing with non-
specialist health-care providers are appropriate and viable strategies for enhancing access.
23
4. SUMMARY OF KEY
FINDINGS
INVESTING IN MENTA L HE A LTH: E VID ENCE FOR ACTION
This report set out to describe the place of mental Mental health action
health as a valued source of human capital or well- and innovation
being in society, and to assess its suitability as a
target for greater investment and action. The main J udged against core criteria for priorities in
points can be summarized as follows: health (i.e. human rights, public health,
economic efficiency and social equity) there is
a compelling evidence-based case for investing
Mental health and in mental health. For each year of inaction and
social values underinvestment, the health, social and
economic burden will continue to rise. Doing
From a range of different analytical perspectives, nothing is therefore not a viable option.
there are sound arguments that support greater
attention to and investment in mental health, M
ental health can be considered a focus of
including the protection of human rights, renewed investment not just in terms of human
improved health and well-being, reduced social development and dignity but also in terms of
inequalities, and enhanced economic social and economic development.
productivity and efficiency.
N
egative cultural attitudes towards mental
illness persist and governments tend to
emphasize the creation or retention of wealth
rather than the promotion of societal well-
being. This situation can be countered by
presenting a stronger and more unified voice
and insisting that the health and human rights
of persons with mental health problems can
and should be appropriately protected.
A
s the ultimate guardians of population health,
governments in partnership with other key
stakeholders have a lead role to play in the
enactment of national mental health action
plans, including: the provision of better
information, awareness and education about
mental health and illness; improved services;
and enhanced legal, social and financial
protection for persons, families or communities
adversely affected by mental disorders.
25
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27
wor ld he a lth org a niz ation
Appendix 1. 3.
(Macro)economic growth perspective: The
Six perspectives on the overarching concern for society from this
value base for individual perspective is to improve the standard of living
or collective decision- in a country by increasing economic output
making through more efficient production. Ill-health can
affect economic growth through its negative
impact on the supply (and quality) of human
1.
Public health perspective: The defining goal capital or labour. Countries devote an
from this perspective is to protect, improve and increasing share of their national product or
optimize individual and population health, income to health care (which could otherwise
where to use WHOs definition health is be put to potentially more productive use).
defined as a state of complete physical, mental Economic growth is typically measured with
and social well-being and not merely the reference to a countrys gross domestic
absence of disease or infirmity. Historically, the product (GDP). However, GDP is only a partial
main focus from this perspective was measure of economic welfare (and was not
premature mortality (and the infectious designed to measure this broader concept),
diseases that contribute most to it); as a since it does not include consumption that is
consequence of increased/longer survival, as not marketed, or the value of leisure or the
well as greater exposure to unhealthy lifestyles, value of health itself. There has been recent
diseases of a chronic, disabling and interest in developing alternative measures to
noncommunicable nature are increasing, GDP or income for assessing a countrys
thereby prompting a major change in terms of success or progress, including the concept
public health priorities and policies. (and various indices) of gross national
happiness.
2.
(Micro)economic welfare perspective:
Welfare economic theory posits that, subject Equity perspective: In contrast to the notion of
4.
to constraints such as income and time, maximizing societal utility, the ethical
individuals or populations seek to maximize perspective derives from concerns over
utility (a term used to describe pleasure or fairness in equality of opportunity (i.e. each
economic welfare), which they do by person should be able to achieve a fair share of
consuming goods and services and by the opportunities available in society). Such
spending time with family and friends or in entitlements are enshrined in international
other forms of leisure. Health contributes to human rights instruments such as the Universal
individual utility or social welfare, not only Declaration of Human Rights, which declares
because people prefer to be more healthy that all human beings are born free and equal in
rather than less healthy but also because dignity and rights (including the right to health).
being healthy enables them to better enjoy Individuals with health problems who are
consumption or leisure activities. Thus health prevented from accessing appropriate care and
has an intrinsic value but also supports the support as a result of poverty or
capability of an individual or community to discrimination, for instance experience a
undertake desired activities or functions. violation of the right to health.
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INVESTING IN MENTA L HE A LTH: E VID ENCE FOR ACTION
5.
Sociocultural perspective: This perspective 2.
Risk and uncertainty: There are a number of
reveals how beliefs, customs and social concerns regarding paying for or insuring against
attitudes shape the way societies perceive, mental illness, particularly in the case of chronic
organize and further themselves (through, for conditions such as schizophrenia or bipolar
instance, sociocultural norms governing affective disorder. First, uninsured persons or
kinship, reciprocity and spirituality). In many households face potentially ruinous costs
cultures, entrenched beliefs about the causes associated with health care expenses and lack of
of mental illness (e.g. evil spirits or sorcery) income from paid work. Second, persons who
engender negative attitudes and practices seek to mitigate this risk by buying private health
towards persons with mental illnesses. insurance may find themselves excluded or
restricted from receiving the services they need
6. Political perspective: The role of government is (because insurance companies remove or limit
to formulate and implement state policies. At entitlements). Other relevant services such as
least in democratic or republican forms of social care, special educational needs or housing
government, policies are usually considered to may also not be covered by insurance or may
be made in the national interest, to address be subject to separate charges.
issues where private markets have failed, and
to reflect the demands or wishes of the Negative spill-over effects: Persons with mental,
3.
electorate (thereby echoing prevailing social neurological or substance use disorders are often
attitudes and values). How decisions actually the victims of abuse and violence by others, but
get made varies considerably, however. State can also pose a risk of violence or harm to others
representatives are subjected to lobbying by (e.g. by a person suffering a psychotic episode or
special interest/advocacy groups which exert behaving aggressively when under the influence
influence on final public policies or choices. of alcohol or illicit drugs). Such spill-over effects or
externalized costs justify some form of public
intervention. Spill-over effects often extend
Appendix 2. beyond the immediate victims of violence, abuse
Market failures with or crime to contact with criminal justice services.
respect to mental health In the case of drug-use disorders, the harm may
and health care be to other peoples health (e.g. HIV transmission
via use of shared needles). Mental disorders can
1. Information failures: Many people with mental also have adverse impacts on physical health (e.g.
illness lack insight into, or even recognition of, the impact of perinatal depression on infant
their health condition, needs or rights. This results development). Furthermore, mental illness affects
in a lower level of demand or help-seeking than family members and friends who often provide
the person may need. The result is an under- informal care and support as a complement to, or
supply of services that only collective action can replacement for, formal provision of health or
redress. The stigma attached to a mental disorder social care. Informal caregivers may derive
another form of information failure produces a satisfaction from doing this but many also
further impediment to the demand for services. experience welfare losses themselves in the form
The stigma that surrounds mental ill-health also of exhaustion, stress and reduced opportunities
has a negative influence on the political for work or leisure activities.
processes that determine priority-setting and
resource allocation in health.
29
wor ld he a lth org a niz ation
Appendix 3.
Identifying interventions that are cost-effective,
affordable and feasible
Notes: a
Source of data: Chisholm and Saxena, 2012 (25).
KEY: Cost-effectiveness:
+++ (very cost-effective; cost per healthy year of life gained < average income per person).
++ (quite cost-effective; cost per healthy year of life gained < 3 times average income per person).
+ (less cost-effective; cost per healthy year of life gained > 3 times average income per person).
Affordability:
+++ (very affordable; implementation cost < US$ 0.50 per person).
++ (quite affordable; implementation cost < US$ 1 per person).
+ (less affordable; implementation cost > US$ 1 per person).
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INVESTING IN MENTA L HE A LTH: E VID ENCE FOR ACTION
31
wor ld he a lth org a niz ation
32
Mental health and well-being are fundamental to our collective
and individual ability as humans to think, emote, interact
with each other, earn a living and enjoy life. Yet currently the
formation of individual and collective mental capital especially
in the earlier stages of life is being held back by a range
of avoidable risks to mental health, while individuals with
mental health problems are shunned, discriminated against
and denied basic rights, including access to essential care.
www.who.int/mental_health/en/