#MHForAll Webinar: World Mental Health Day activities and campaigns
Chair: Niall Boyce, Lancet Psychiatry
Speakers:
Ingrid Daniels, World Federation For Mental Health
Alison Brunier, WHO
Taha Sabri, Speak Your Mind Campaign, Pakistan
Eleni Misganaw, Mental Health Service Users' Association Ethiopia
Key points on what speakers hope will come from World Mental Health Day:
Eleni Misganaw: I hope that the involvement of people with lived experience will shine out and policy makers, stakeholder, researcher and everyone in the field will start involving lived experience and doing it meaningfully. I also hope this will lead to more money for the sector.
Alison Brunier: I hope that everybody that gets involved in World Mental Health Day has a better understanding of what they can do to support their own mental health. Also I hope that government, civil society, business leaders all go away and commit to action to invest in mental health.
Ingrid Daniels: We want to see an increase in budget spend, for mental health across the world, and an increase in community based mental health initiatives that includes the voice of lived experience. I also hope that this combined effort and dialogue doesn’t stop, we must continue this pressure to see the desired outcomes - otherwise the treatment gap will get even wider.
Taha Sabri: As a service user, physician, and advocate, I truly believe that by holding hands and working together we can achieve impact. I hope this momentum continues and grows until the world cries with one voice that we must move for mental health and invest.
Niall Boyce:
Welcome back to the MH For All Webinar series, thank you to those who have been with us since we set up this series, back in April. You will have noticed we have rebranded, to move away from just focusing on COVID-19 and mental health, to now broaden the focus to mental health and it’s many intersections. This week’s webinar is looking at the biggest day in the global mental health calendar; World Mental Health Day (WMHD).
This year the theme for World Mental Health Day is Mental Health For All: Greater Investment - Greater Access.
The first question is for Ingrid; what made you decide that this year’s theme for WMHD would be greater investment and greater access?
Ingrid Daniels
The World Federation for Mental Health decided on Mental Health For All: Greater Investment - Greater Access because of the current global mental health landscape.
Close to one billion people around the world are living with a mental health disorder. Poor mental health and substance abuse has a huge toll on health outcomes. The context in which theme was chosen, is that there is currently a massive treatment gap when it comes to mental health; in high income countries 50% of people don't have access to the mental health services they need and deserve, and this statistic jumps to 85% in low and middle income countries. The average global spend on mental health is 2% of health budgets. For every one dollar spent on mental health there is a four dollar return on the investment.
On top of this, we have seen a significant number of people having their mental health affected by COVID-19.
Spending money on mental health shouldn't be seen as an expense, rather an investment to close the treatment gap, and ensure everyone everywhere has access to mental health care.
Niall Boyce
It is not only the ethical duty to help people who are in mental distress but also the enlightened self interest argument of receiving return for every dollar that you invest. Alison what are the best arguments for investment in mental health?
Alison Brunier
There has been chronic underinvestment in this area for several decades now, and we are still nowhere near the level of investment that is needed.
Continuing on from Ingrid; the loss of productivity is huge. One trillion dollarswill be lost in lost productivity due to depression and other mental health conditions .
However, there are extremely easy and cost effective solutions that can easily treat many common mental health disorders effectively and efficiently. Generalists and community health workers can be trained to treat mental health disorders cheaply. The WHO’s mhGAP programme has guidance on this.
We must not forget about neurological disorders such as dementia and behavioural disorders for example autism. Caregivers can also be easily and cost effectively trained to improve the quality of life for people living with these conditions.
A question we often get asked is why should mental health be prioritised?
We know from other humanitarian emergencies that when emergencies hit, people’s mental health suffers. Stress and anxiety has been exacerbated by the pandemic, plus there is a huge concern that people who already have mental health conditions may be unable to get treatment in the same way as before. In some countries there have been great adaptations, and solutions have been found in telemedicine and other ways of finding care. But there is still a very real risk that there will be more people with new mental health difficulties and people with existing conditions may get worse.
Niall Boyce
I would like to turn to Taha now - what is the Speak Your Mind Campaign in Pakistan doing for World Mental Health Day?
Taha Sabri
COVID-19 has meant that mental health is now on the policy maker’s agenda - we have to see the opportunities in times of crisis; now is the opportunity for mental health.
In Pakistan we have created a coalition for mental health, a group of different organisations all working on the same campaign. We have recently brought on board the Federal Ministry of Health and we have also brought in the planning commission plus media houses, educational institutions, PR firms, marketing firms, and businesses to make the case for mental health.
Together we are very excited to participate in the 24 hour virtual march which is being conducted by the Speak Your Mind campaign on the 9th October and will feature an hour of online campaigning from 19 countries plus five thematic hours including youth mental health, inclusion and mental health, LGBTIQ+ mental health, and humanitarian crises and mental health.
For this march we will have speeches from the minister of health, and the special assistant to the prime minister on health along with the WHO country lead and various health experts, survivors, celebrities. We are really hoping this will have a huge impact on mental health access and investment in Pakistan.
Niall Boyce
It sounds like a huge amount of work - getting a lot of people on board, it really is a very multilateral effort! Eleni - What does greater investment and greater access look like for you in Ethiopia?
Eleni Misganaw
For me as a service user living in a low income country such as Ethiopia, access to mental health services is a basic human rights issue; not only in the number of mental health services available but also ensuring good quality services is a priority. The mental health sector is very similar to the landscape that Ingrid mentioned earlier, with poor access for 85% of the population, and services confined to major towns.
Access also means having less expensive services - most of us spend out of pocket for our mental health support as we don’t have good insurance policies or strong social security.
Access to service and investment in mental health has to address both supply and demand perspectives. There is also a limited number of professionals and very few treatment options; overall I would say that Ethiopia has very poor access to mental health services. Demand for mental health services is also hampered by stigma and discrimination.
Mental health is 0.9% of the health budget, but as Ingrid said - investing more in mental health should not be seen as an expense, but instead a return. Investment should not just be focused on treatment but also prevention.
Niall Boyce
What progress has been made in Ethiopia?
Eleni Misganaw
We have seen huge amounts of progress over the past ten years; a decade ago we had only one specialist mental health hospital. We have been gradually widening the access of services to integrate them into primary health centres. Plus we have seen more and more political will to focus on mental health; the mental health case team is well organised within the ministry of health, which wasn't the case less than 5 years ago. The health act is currently being re-drafted with mental health issues being included.
Niall Boyce
What is the World Federation doing for WMHD, and how can people get involved?
Ingrid Daniels
We are collaborating and working very closely as three global partners; World Federation for Mental Health, the WHO and United for Global Mental Health.
We have launched our Mental health for all; greater investment, greater access toolkit which is downloadable for everyone via our website. We also have launched our press statement and a patron for this campaign, Princess Iman Afzan Al Sultan Abdullah of Malaysia calling for greater investment in mental health; it is not only governments who should be investing in mental health but all of us have a role to play in closing the treatment gap.
We are doing the virtual global campaign powered by the youth sector of World Federation For Mental Health; we are now gearing up for the big global mental health festival taking place from 9th-11th October, as well as a global virtual forum with many presentations from around the world. There is also a virtual art exhibition #ArtForAll.
The one advantage that COVID-19 has presented to us is it has removed barriers to make it easier to work together across the world.
Niall Boyce
Alison, following on from Ingrid - what are the WHO doing for WMHD this year?
Alison Brunier
I have worked on many mental health campaigns over the years but none quite like this one - and I mean that in a good way!
At the WHO we are working on the first online global advocacy event specifically focussed on mental health, called the Big Event for Mental Health. This event will be on the 10th October, 4pm CET, running for three hours, and open to all. It will feature the Director General of the WHO - Dr Tedros - as well as world leaders, heads of state, mental health activists, celebrities, and lived experience advocates. We will also be sharing real stories illustrating the range of work that WHO is involved in through mental health care and prevention, as well as substance and alcohol use.
United for Global Mental Health will be launching an Anthem, bringing together artists from around the world.
Niall Boyce
Taha, what have you done to move towards greater investment and access - does all this campaigning make a difference?
Taha Sabri
This is the first truly global advocacy mental health campaign. Every year people across the world celebrate and campaign on World Mental Health Day, but this is the first time this is a truly coordinated response. Convincing media houses, businesses and ministers is a lot easier when you can say that you are working in a global campaign, supported by WHO and the World Federation for Mental Health.
This would all be very difficult without a global umbrella to support us, giving us moral support, structural support, and campaign support. If I tell a policy maker that this campaign is being listened to by the UN instead of a local tv channel then we definitely get more support.
Niall Boyce
And now let's bring it back to the local picture; Eleni, what is planned in Ethiopia for WMHD?
Eleni Misganaw
World Mental Health Day is an important landmark. We (the Ethiopia Mental Health Service Users' Association) have been selected to co-chair an event with the Ministry of Health. This recognition is an important thing; service user involvement is a new phenomenon, especially for countries such as Ethiopia. We are being asked for our perspective on the best mental health services, opportunities and experiences, drawing on ideas from other countries and other service users, such as advocates from the Global mental Health Peer Network.
We are also running social campaigns where we will share our lived experiences of stigma and how poor access and low investment has affected us in Ethiopia. This will be available online open for everyone.
Audience question: What role do you envision for experts by experience in policy, advocacy and care provision?
Eleni: Service users are of course experts by experience, not only from advocacy but also in designing policies and improving service delivery. Their involvement should be a priority at all levels, sometimes we tend to involve experts by experience at some levels but it needs to be a meaningful participation, not only in giving inputs to policy, frameworks strategies and research but also setting funding and research priorities.
Alison: I wholeheartedly agree, this is very much part of the WHO’s thinking; The WHO runs a Quality Rights Programme which puts people with lived experience at the heart of the work that is being done on country level. We really strive to ensure that service users opinions and needs are really considered. With regards to WMHD more specifically we do have many voices of people with lived experience in the Big Event.
Audience question: what can people do to be part of the March for Mental health?
Taha: Everyone can contribute
Watch: the March For Mental Health https://marchformentalhealth.com/
Move: Join the virtual march, use the social media filter, and be a part of this global movement!
Share: talk to people about mental health, tell people about the march and activities. Use the hashtag #MoveForMentalHealth
Ingrid: Get involved on social media, write letters to your government, get as much media exposure as possible. Also remember that the voice of people with lived experience is far more powerful than anything else; small forums can start the dialogue and grow the movement, and also do engage in the campaign platforms that are provided. World Federation for Mental Health has established a global virtual hall, where people can donate money to ‘build the hall”, these donations then go towards small organisations working on mental health to help with their work.
Niall: There is a lot of discussion around mental health stigma and how it is time to talk, but however much you push that, if there are not the services to support then people, then they will not be able to get better, even if we eliminate stigma.
Our final question for all panellists - what do you hope will come out of the day?
Eleni Misganaw: I hope that the involvement of people with lived experience will shine out and policy makers, stakeholder, researcher and everyone in the field will start involving lived experience and doing it meaningfully. I also hope this will lead to more money for the sector.
Alison Brunier: I hope that everybody that gets involved in WMHD has a better understanding of what they can do to support their own mental health. Also I hope that government, civil society, business leaders all go away and commit to action to invest in mental health.
Ingrid Daniels: We want to see an increase in budget spend, for mental health across the world, and an increase in community based mental health initiatives that includes the voice of lived experience. I also hope that this combined effort and dialogue doesn’t stop, we must continue this pressure to see the desired outcomes - otherwise the treatment gap will get even wider.
Taha Sabri: As a service user, physician, and advocate, I truly believe that by holding hands and working together we can achieve impact. I hope this momentum continues and grows until the world cries with one voice that we must move for mental health and invest.
