“I believe more than ever that we have the power to help change the world for people with mental illnesses and addictions, and for all those whose lives are affected by these brain illnesses. all of us.”– Patrick J. Kennedy, A Common Struggle (2015)

In this time of a global pandemic, This year World Mental Health Day campaign calls for greater investment in mental health. This focus is timely and justified. Recent estimates suggest that most low- and middle-income countries spend less than $ 2 per person on the treatment and prevention of mental and substance use disorders – and that was before the global novel coronavirus epidemic.

The pandemic has resulted in social isolation, bereavement, financial hardship and disrupted health services – which negatively impact people’s mental well-being. New research also shows that substance use disorders, including opioids, alcohol and smoking, are linked to an increased risk of COVID-19 and serious side effects, including hospitalization and death.

A fundamental overhaul is needed to overcome the false dichotomy between physical and mental health in health services. Parity in mental health must be placed at the heart of human capital development. The social cost mental illness and substance use disorders – which compound the impact of poor physical health – are staggeringly high, for individuals, families, communities and the economy. But the cost of effective treatments is surprisingly low.

Integration of mental and physical health services

Faced with the global economic fallout as the COVID-19 pandemic rages on, governments’ fiscal capacities and international aid coffers are strained. What can be done to answer this year’s World Mental Health Day call?

We must beware of siled approaches to increasing funding for mental health. Rather, Governments can mobilize new resources and leverage existing funding streams by integrating mental health interventions into existing service delivery platforms across sectors.

There are many potential intersectoral entry points that would align funding, service delivery and the needs of the population:

• Experiences in Chile, Colombia, Ghana and the United States demonstrate that national mandates to cover mental disorders and substance use prevent drug use. pre-existing condition clauses refuse health insurance coverage. In Peru, the inclusion of mental health services in all the services offered by the integrated health insurance scheme (SIS) was an important step towards achieving parity in mental health, and to help vulnerable people access these services when needed without incurring high personal expenses. This measure was supplemented by the development of a fee schedule to reimburse health establishments for the services rendered, and a budgetary allocation based on the results over 10 years by the Ministry of the Economy and Finance exclusively to support community-based mental health services.

• Projects funded under the World Bank Group COVID-19 Global Health Emergency Response Program in countries like Bosnia and Herzegovina, Cambodia, Ecuador, India, Lesotho, Liberia, Morocco, Marshall Islands, Mongolia, Nigeria, Sri Lanka and Turkey, support psychosocial interventions to help people cope with the negative psychological effects associated with stressors such as confinement, self-isolation and quarantines, fears of infection, inadequate information, job and financial loss, as well as stigma and discrimination.

• Existing sources of funding for maternal and child health, such as those of the Global Financing Mechanism (GFF) for every woman, every child, can be used to treat maternal depression, especially postnatal depression, and associated growth retardation in children.

• School-based interventions are critically important because 75 percent of mental and substance use disorders start before the age of 25 and suicide is one of the leading causes of death among young people. Social and emotional learning programs as well as physical health promotion, work and study supports, and alcohol and other drug services have a positive impact on healthy development, well-being and school results. The integration of school and clinical services is an effective approach to improve human capital results by investing earlier in life.

• In the same way, integrating mental health into workplace wellness programs can mobilize private companies to invest in health promotion activities such as cognitive behavioral therapies to reduce stress. These programs generate significant benefits for workers, their families and employers, improving productivity and competitiveness, and addressing the stigma surrounding mental disorders.

• Programs in fragile and conflict-affected environments can be leveraged to integrate integration physical and mental health interventions alongside other social services to meet the needs of displaced populations and refugees who have been exposed to high levels of stress. For example, in the Horn of Africa, a World Bank Group-funded project supported counseling services for Somali women and children affected by gender-based and sexual violence as part of a primary care package offered in refugee camps in Kenya and in Ethiopia. Likewise, in Afghanistan and Yemen, psychosocial support services are offered to people who have personally experienced or witnessed traumatic events.

• Pro-health taxes, such as those on tobacco, alcohol and sugary drinks can help broaden the tax base and raise additional government revenue for priority social investments and programs, including mental health services at primary care levels and the community, and reduce the health risks associated with substance abuse disorders. Botswana, Colombia, Moldova, Philippines, and Ukraine provide good examples of the use of this fiscal policy for public resource mobilization and health goals.

• Microcredit programs, such as Increase asset development in Canada, which offers low-interest small business loans, training and mentoring to entrepreneurs with a history of mental health or addiction issues (including former inmates), facilitates reinstatement in the community.

As the saying goes, a crisis should not be wasted. During the COVID-19 pandemic and beyond, renewed efforts and dedicated funding are needed to achieve mental health parity across all sectors. A sustained focus on mental health will contribute to more resilient recovery and develop more equitable societies.