MEMBER BLOG: Finance ministries can catalyze post-COVID-19 mental health action
Dr Zachary Burton, Finance Working Group, Global Mental Health Action Network
Before COVID-19, the world was poorly equipped to address the enormous health, economic, and human capital costs of mental health challenges. During COVID-19, we have already witnessed global, near-ubiquitous disruption and halting of critical mental health services in tandem with a higher demand than ever for these very services. After COVID-19, experts are predicting a “tsunami of psychiatric illness” — an impending mental health crisis whose human, societal, and economic cost will be felt many years beyond the pandemic.
Fortunately, there are proven, cost-effective pathways for investment to avert this metaphorical tsunami — and, there are pathways for investment to ameliorate the existing burden of mental ill-health on individuals, on broader society and health systems, and on local and national economies. Governments must not miss the opportunity to build back better as the world recovers from COVID-19, and must seize the opportunity to integrate mental health (and its tremendous return on investment) into pandemic response as well as sustainable development, priority health areas and primary care, human rights, and economic growth and resilience.
As finance ministers gather for the 2021 Spring Meetings of the International Monetary Fund and World Bank Group, the time to provide critical injection of cross-sectoral investment into mental health at the national scale is now. Due to their role as the key decision makers behind allocation of public expenditure and resources, finance ministries are uniquely positioned to have a significant, sustained positive impact on national mental health for decades to come.
The cost of underinvestment in mental health
Increasingly, the pandemic is causing marked rises in anxiety, depression, burnout (including of critical frontline and mental health workers themselves), loneliness and isolation, substance use, and global disruption of essential mental health care services.
And even prior to the pandemic, the health and societal cost of mental health was vast. Mental health and substance-use conditions are the leading cause of years lived with disability in the world (23% of all YLDs). Nearly 1 billion individuals live with a mental disorder (including over 20% of the working population and 20% of children, at any given time). Suicide is the second-leading cause of death among individuals 15 to 29 years of age.
Yet despite this burden, over 75% of individuals in low- and middle-income countries receive no treatment for their condition, and even in prosperous countries, a majority of individuals may receive no treatment (e.g., in the U.S.A., nearly 50% of individuals with such conditions receive no treatment) — all prior to COVID-19. And COVID-19 is set to significantly exacerbate this dearth of care (and its impact on societies and economies). For example, the World Health Organization reported that as early as October 2020, 93% of countries had reported disruption or complete halting of critical mental health services.
This significant health and societal burden — and the overwhelming lack of treatment — in turn results in tremendous economic burden and loss. Even before the pandemic, 12 billion productive days were being lost each year due to depression and anxiety alone. These productivity losses amounted to losses of US$1 trillion every year. More costly still, broader mental health and substance use conditions resulted in economic losses of US$2.5 trillion to US$8.5 trillion every year — a cost predicted (pre-pandemic) to double by 2030.
Despite the significant disease burden and enormous economic impacts, mental health continues to suffer from substantial underinvestment.
Finance ministries can drive immediate mental health action
As we seek to recover from the pandemic and prepare to face its long-term impacts, finance ministers have the chance to set the stage for decades of sustainable development ahead.
Because mental health is fundamentally cross-societal, a cross-governmental approach is essential in properly addressing mental health needs and alleviating attendant human, societal, and economic burdens. As a key decisionmaker in cross-governmental allocation and prioritization of funds and resources, finance ministries are uniquely positioned in their ability to support mental health systems that effectively involve health services, the education sector, social welfare systems, justice systems, the workplace, and additional areas under the auspices of government responsibility. And fortunately, there are numerous, proven pathways for effective investment in mental health services and programming that ministries can take advantage of for high return on investment and high, cross-societal impact.
National governments currently stand at a pivotal moment in history, a moment that will be remembered for eons to come as to how leadership led the way in recovery from the pandemic — and in lifting nations out of both prevailing and COVID-19-induced mental health impacts to bring about sustained wellbeing, productivity, and prosperity.
The time to act is now.
Acknowledgements: The thesis and arguments presented in this piece are derived from the collaborative efforts, since August 2020, of various members of the Finance Working Group within the Global Mental Health Action Network. The author would like to extend a special thanks to Finance Working Group members James Sale (United for Global Mental Health), Olivia Rowe (London School of Hygiene and Tropical Medicine), Priti Sridhar (Mariwala Health Initiative), Mathew Mutiso (Coalition for Action for Preventive Mental Health, Kenya), Dr Valentina Iemmi (London School of Economics and Political Science), Ann Lindsay (World Federation for Mental Health, Geneva), Christie Kesner (United for Global Mental Health), Bhawesh Jha (Mariwala Health Initiative), and Yves Zuñiga (Department of Health, Philippines). The author also thanks the reviewers of our working group’s expanded guide produced on this topic: Sarah Kline (United for Global Mental Health), Dr Shekhar Saxena (Harvard T. H. Chan School of Public Health), and Dr Eliot Brenner (Klingenstein Philanthropies).