10 October, World Mental Health Day – Addressing mental health is not only a moral imperative – it is the only way to achieve sustainable development
The COVID-19 pandemic has had a widespread and profound impact on mental health. The stress brought by socioeconomic inequalities and the effects of quarantine and lockdown has led to the development or deterioration of mental health disorders – Photo by Verne Ho on Unsplash
By José Peres – Mental health disorders are complex and can take many forms. A mental disorder can be defined as a syndrome characterized by clinically significant disturbance in an individual’s cognition, emotion regulation, or behavior that reflects a dysfunction in the psychological, biological, or developmental processes underlying mental functioning. Mental disorders are usually associated with significant distress or disability in social, occupational, or other essential activities.[1]
Mental disorders remain widely under-reported. Data prior to the pandemic suggests that, globally, more than one in ten persons live with a mental illness.[2] These mental health conditions often contribute to poor health outcomes, discrimination, stigma, human rights violations, and premature death. More than 80% of people experiencing mental health conditions, including individuals experiencing neurological and substance use disorders, are without any form of quality, affordable mental health care.[3]
The European political context
One of the main actors driving mental health into the European and global political agenda is, undoubtedly, the World Health Organization (WHO).
In January 2005, the Office of the European Region of the WHO convened a conference of European Health Ministers in Helsinki to discuss the issue of mental health problems across the region. The outcome of the meeting was the endorsement of a Declaration, recognizing that mental health and mental well-being are fundamental to the quality of life and productivity of individuals, families, communities, and nations, enabling people to experience life as meaningful and be creative and active citizens.[4]
Building on this commitment, the WHO Regional Office for Europe developed the European Mental Health Action Plan for 2013-2020.[5] This Plan was adopted by all countries in the European region. Its objectives covered promotion and prevention, human rights, services, and partnerships. Its priorities included introducing health promotion programs for vulnerable groups, improving the competence of primary care to identify, diagnose and treat people with mental disorders, and implementing community-based service models sensitive to each country’s culture and resources.[6]
As a result, most Member States have significantly advanced their national strategies and initiatives during this period. Most countries updated their policies and laws, improved their approaches to children and adolescent mental health, and updated and implemented better national suicide prevention plans.
Significant advances have also been made in the accessibility, availability, and affordability of mental health services. [7]
The European Commission has also been very active in this field[8]. As an example, the European Commission launched the Pact for Mental Health and Well-being in 2008, and in 2016 completed the European Framework on Mental Health and Well-being.
The COVID-19 pandemic and the economic recession have negatively affected many people’s mental health, resulting in an increase in suicidal ideation and substance use disorders – Street photo; 7-11 Gas Station, Salem, Oregon, USA, by Verne Ho on Unsplash
The second pandemic
The COVID-19 pandemic has had a widespread and profound impact on mental health. The stress brought by socioeconomic inequalities and the effects of quarantine and lockdown has led to the development or deterioration of mental health disorders, causing an increase in demand for essential mental health services. These services were severely disrupted, with a drop in the number of outpatients visits and a shift towards online psychiatric care.[9]
To address the impact of the pandemic on mental health and service delivery systems, Ministers of Health and representatives of the Member States of the WHO in the European Region have gathered this summer in Athens.[10] The event’s primary objectives were to allow health experts to share experiences and practices, propose future solutions for strengthening mental health and well-being, and improving universal health coverage for access to mental health services. The Summit was also instrumental in consolidating consensus on the implementation of a new Framework for Action for the forthcoming years.
Building better
In September 2021, Member States unanimously endorsed the European Framework for Action on Mental Health for 2021-2025. This new strategy aims to address the pre-existing and new challenges exacerbated by the pandemic.[11]
The Plan urges Member States to reiterate their political commitment to and leadership in promoting mental health as a priority for public health systems.
It calls upon them to provide adequate funding and promote governance structures, policy frameworks, and regulations that ensure quality mental health services in a way that moves towards universal health coverage.
To assist in the implementation of this Framework, on September 30, the WHO Regional Office for Europe launched a new pan-European Coalition on Mental Health.[12] This new coalition will gather national leaders, professionals, members of civil society, representatives of international organizations, and other mental health experts to transform European mental health services, promote mental health, and prevent mental illnesses across the life course. Many actions will support these priorities, including leadership-building and advocacy initiatives, mental health literacy programs, and a mental health data lab.[13]
“In any given moment, we have two options: to step forward into growth or to step back into safety.” The COVID pandemic showed us how vital mental health services truly are. This pandemic is a unique opportunity to advance mental health as a public health priority and build back better. Build in a way that is affordable, available, and resilient, without leaving no one behind.
References
[1] American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596
[i2i] Saloni Dattani, Hannah Ritchie and Max Roser (2021) – “Mental Health”. Published online at OurWorldInData.org. Retrieved from: ‘https://ourworldindata.org/mental-health’ [Online Resource]
[3] World Health Organization. (2019). The WHO special initiative for mental health (2019-2023): universal health coverage for mental health. World Health Organization. https://apps.who.int/iris/handle/10665/310981. License: CC BY-NC-SA 3.0 IGO
[4] WHO European Ministerial Conference on Mental Health (1st : 2005 : Helsinki, Finland) & World Health Organization. Regional Office for Europe. (2005). Mental health declaration for Europe : facing the challenges, building solutions : First WHO European Ministerial Conference on Mental Health, Helsinki, Finland 12-15 January 2005. Copenhagen : WHO Regional Office for Europe. https://apps.who.int/iris/handle/10665/107625
[5] World Health Organization. Regional Office for Europe. (2015). The European Mental Health Action Plan 2013–2020. World Health Organization. Regional Office for Europe. https://apps.who.int/iris/handle/10665/175672
[6] Muijen, M. (2016). Implementing the mental health action plan – experiences and challenges. European Psychiatry, 33(S1), S9-S10. doi:10.1016/j.eurpsy.2016.01.797
[7] Regional Committee for Europe, 71st session. (2021). Seventy-first Regional Committee for Europe: virtual session, 13–15 September 2021: final reports on implementation of 1. The European Mental Health Action Plan (2013–2020) and 2. The WHO European Declaration and Action Plan on the Health of Children and Young People with Intellectual Disabilities and their Families (2011–2020). World Health Organization. Regional Office for Europe. https://apps.who.int/iris/handle/10665/343172
[8] Muijen, M., & McCulloch, A. (2019). Reform of mental health services in Eastern Europe and former Soviet republics: progress and challenges since 2005. BJPsych international, 16(1), 6–9. https://doi.org/10.1192/bji.2017.34
[9] Rojnic Kuzman, M., Vahip, S., Fiorillo, A., Beezhold, J., Pinto da Costa, M., Skugarevsky, O., . . . Goorwod, P. (2021). Mental health services during the first wave of the COVID-19 pandemic in Europe: Results from the EPA Ambassadors Survey and implications for clinical practice. European Psychiatry, 64(1), E41. doi:10.1192/j.eurpsy.2021.2215
[10] World Health Organization. Regional Office for Europe. (2021). Summit on actions required to address the impact of the COVID-19 pandemic on mental health and service delivery systems in the WHO European Region https://www.euro.who.int/en/media-centre/events/events/2021/07/summit-on-actions-required-to-address-the-impact-of-the-covid-19-pandemic-on-mental-health-and-service-delivery-systems-in-the-who-european-region
[11] World Health Organization. Regional Office for Europe. (2021). WHO European Framework for Action on Mental Health 2021–2025 https://www.euro.who.int/en/health-topics/noncommunicable-diseases/mental-health/publications/2021/who-european-framework-for-action-on-mental-health-20212025
[12] World Health Organization. Regional Office for Europe. (2021). The Pan-European Mental Health Coalition. https://www.euro.who.int/en/health-topics/health-policy/european-programme-of-work/flagship-initiatives/the-pan-european-mental-health-coalition
[13] World Health Organization. Regional Office for Europe. (2021). Launch of the Pan-European Mental Health Coalition. https://www.euro.who.int/en/media-centre/events/events/2021/09/launch-of-the-pan-european-mental-health-coalition
