World Bank, WHO Unite to Include MH in International Development

The long push to bring mental health to greater prominence on the world’s agenda took a major step forward at a joint conference in Washington, D.C., on the global economic effects of depression and anxiety when the World Bank Group (WBG) and the World Health Organization (WHO) combined to issue a report in April that promised to make mental health a global development priority.

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“Two of the most common forms of mental disorders, anxiety and depression, are prevalent and disabling, and they respond to a range of treatments that are safe and effective,” said the report, titled “Out of the Shadows.” “Yet, owing to stigma and inadequate funding, these disorders are not being treated in most primary care and community settings.”

“Mental illnesses are responsible for great costs in all societies, but $1 spent on mental health provides a return on investment of $4,” said psychiatrist Shekhar Saxena, M.D., director of the Department of Mental Health and Substance Abuse at WHO. “That should serve as a good example to convince development agencies of its value.”

Saxena and numerous others spoke at several forums held at George Washington University to mark publication of the report. They agreed that world bodies and governments must prioritize mental health in development agencies alongside improving nutrition and general health and alleviating poverty.

Integrating mental health into primary care by collaborating with nonspecialist care managers has demonstrated value, but there are other possibilities as well. Building local capacity and linking mental health with prior development goals would be a good start, said Saxena. For instance, screening and treatment of postpartum depression could be incorporated into existing mother and child health systems.

It is important to show that mental illness can be treated, said Kaz De Jong, Ph.D., head of the staff care unit for Medicins Sans Frontieres. He noted that the response to the AIDS crisis demonstrated that advancing research and finding treatments can significantly improve conditions for patients and lessen stigma.

“Let us not pathologize and overtreat entire populations,” cautioned De Jong. “We should incorporate more about vulnerabilities in our work and less about the signs and symptoms of mental illness by improving culturally based diagnostics and measurements and moving away from linear, causal thinking and diagnoses.”

Moving beyond symptom-based approaches to mental health care would boost resilience at both the individual and population levels, agreed Murali Doralswamy, M.D., a professor of psychiatry and behavioral sciences at Duke University and chair of the World Economic Forum’s Global Agenda Council for Brain Research.

“Symptom-based approaches can work, but they are not perfect, and we don’t understand the biology of the disorders well enough yet,” said Doralswamy. “We need to understand the biology of illness but also the biology of resilience. And we need to do a better job of rehabilitation, both to get people back into the workplace and to end the perception that people with mental illness lack useful skills.”

“[F]ailure to address mental health will impede general health goals and risk other social and economic development,” wrote former APA President Paul Summergrad, M.D., a professor of psychiatry at Tufts University, in an editorial in the Lancet coinciding with the WBG/WHO report. Summergrad supports expansion of demonstration projects in countries with limited medical infrastructures, creation of sustainable funding mechanisms, and campaigns to destigmatize mental disorders and secure basic rights to care for patients.

“It’s very important to engage stakeholders outside the usual mental health circles and get mental health integrated into the United Nations’ Sustainable Development Goals,” said Saxena. “Now we have to translate that into action.” ■