October 10 is World Mental Health Day, a World Health Organization (WHO) event to "raise awareness of mental health issues around the world and to mobilize efforts in support of mental health."
Mental health advocates, including the WHO, have been pushing hard to reform mental health care for decades. This year, they stress that a perfect storm of events from the coronavirus pandemic to economic downturns has a major impact on mental health around the world.
According to the WHO World Mental Health report published in June, depression and anxiety rose by 25% in the first year of the pandemic, bringing the number of people living with a mental disorder to nearly one billion people.
“What’s more, mental health services have been severely disrupted in recent years and the treatment gap for mental health conditions has widened,” a WHO spokesperson told DW.
Special initiative for mental health
So what's being done about it? In 2020, the WHO established the Special Initiative for Mental Health. It is the WHO’s most ambitious mental health programmes so far, aiming to increase access to mental health services for 100 million people across 12 nations, including Ukraine, Jordan, and Zimbabwe.
“Many countries have very outdated mental health service mandates. We’re working with countries to change their approaches so more people have access to support,” Alison Schafer, technical advisor in WHOs Department of Mental Health, told DW.
Since the initiative began in January 2020, five million more people have access to mental health and psychosocial support, according to the WHO. Psychosocial support involves building networks around people in need, often through family and local networks.
“It's taken us two and a half years to set up the initiatives, but now we expect more and more progress to be made towards expanding mental health services so that more people will be able to access support,” Schafer said.
One of the biggest successes so far has been providing mental health and psychosocial support during crises, such as the COVID-19 pandemic, and for conflict-affected people in Ukraine and the Philippines.
“We?re having the most immediate impact on people here. The key has been providing psychosocial support to people going through crises,” Schafer said.
Schafer also cited early successes in countries like Paraguay which have enabled consultations with psychiatrists via video calls. During the coronavirus pandemic, video consultations were particularly effective in sustaining community support.
“It sounds quite simple to achieve, but what was missing was the infrastructure,” she said.
Big picture approach to mental health
Schafer said the uniqueness of WHOs Special initiative for Mental Health is based on its big picture approach.
“There is no one way to approach mental health services and support. It requires a bigger perspective than what's been looked at before, not just focusing on singular interventions or groups, but at a whole system of mental and related health care services, which may be offer in healthcare, but also in schools, community organizations, religious groups, and businesses,” she told DW.
One goal of the initiative is to focus on providing support to at-risk groups. At-risk groups include, among others, people who experience discrimination or human rights violations, including people who identity as LGBTQ.
“We're already seeing early successes, for example helping people understand that that sexual attraction between people of the same sex is not a mental disorder, but rather they might be at higher risk of mental health conditions because of social stigma and discrimination and in need of support,” Schafer said.
According to Schafer, the success comes from basing mental health support on scientific evidence, decades of learning and the rights of persons living with mental health conditions and psychosocial disabilities. But the initiative has not been without its political challenges.
“Some countries are further ahead in their progress,” Schafer said. “WHOs Special Initiative for Mental Health is working towards facilitating such changes so that expansion of mental health services can be sustained and enhanced even further.”
Community-led programs offer lasting mental health support
While the WHO initiative is seeing early successes, the project will end in 2023. What happens to mental health support networks after that is not clear.
Renée Eloundou, anti-discrimination consultant at Berlin-based counselling organization Sources-d’Espoir (sources of hope), is critical of mental health initiatives that have fixed durations.
“The help people need doesn't have an end point. The mental instability people find themselves in is very difficult to deal with. It takes time for people to open up and talk. It takes time to establish support networks,” Eloundou told DW.
Sources-d’Espoir provides counselling and support for migrant communities in Germany, particularly Black communities.
The link between mental health issues and discrimination, Eloundou said, is striking.
“People [who] experience discrimination often feel ashamed or part of the problem. They feel alienated by government-led structures, which makes them isolated and prone to mental health challenges,” she said.
98% of the organization's team is made of Black women who came to Germany as adults. Eloundou emphasized how important it is that psychosocial care is led by people from the same communities as those they are trying to help.
“Community action is a must. Our team have similar experiences of discrimination, so can easily relate with someone and analyze the signals of mental health difficulties. It helps to build trust around mental health,” Eloundou said.
“If you wish to target mental health issues, you need to collaborate with communities and collaborate with experts who have the skills," she added. "Then you can make a lasting change."