“Mental health is a basic human right. And it is crucial to personal, community and socio-economic development.”
World Health Organisation
Each year, on 10th October, the world celebrates Mental Health Day and this year’s theme focuses on making mental health and wellbeing a global priority for all.
This, however, has its fair share of challenges.
Relatively few people around the globe are able to access and afford quality mental health care, which includes those in high income countries – where it is reported that between 35-50% of people with depression reported receiving inadequate care.
For low income countries; the numbers are even higher, with about 80% of people with mental health conditions reporting that they did not receive any treatment at all.
An integral part of making mental health a priority for all includes having conversations around what is not working and what we need to do to make it work.
Why are mental health services not accessible to all?
‘The Impact of COVID on mental health may last longer than the pandemic itself.’
United Nations Secretary General, António Guterres, 2019.
The pandemic’s long-term impacts were not predicted by experts. Add wars, financial crises, displacements, and climate change to the mix, and it’s understandable why our wellbeing continues to deteriorate.
Sadly, these are only a handful of the factors contributing to the level of mental health decline currently being experienced around the world, and each one only seeks to worsen the lack of mental health diagnosis, treatment and support available.
There are so many drivers to consider, but let’s start by having a look at three key reasons why mental health care is not as accessible as it should be.
1) Skills and funding for mental health services are in short supply
The World Health Organisation reports that there are insufficient numbers of specialised and general health workers in low-income and moderate-income countries, such that more than 50% of the population in these nations will depend on the services of one psychiatrist.
In addition, in the UK, data suggests we are behind our target to train and recruit 50,000 more nurses into the NHS by 2024. And, when you combine that with the loss of current staff (due to retirement, career changes etc.), the NHS is becoming increasingly short-staffed and overworked.
The statistics for mental health care providers trained in use of psychosocial interventions (such as cognitive behavioural therapy) is even more worrying, with far fewer numbers.
2) Notable treatment gap between those in need of mental health services and what is actually available
This second reason is the natural consequence of the first. The lack of funding and adequate trained personnel to offer support will affect the nature of treatment available.
The COVID pandemic increased the severity of the situation due to the disruption of health services experienced, while having to deal with the fallout of the spread. Treatment for other conditions that were considered “less urgent” was sidelined, and mental health conditions sadly became one of those casualties.
It is important to note that reports show a sharp rise in anxiety and depression disorders (of around 25% increase) during the pandemic (especially during ‘lock-down’ phases); an additional consequence of the pandemic that we were not prepared for.
Lastly, low availability and affordability of medication for mental health disorders, and the restricted use of medication owing to the lack of qualified health workers to administer prescriptions, has also affected the provision of mental health interventions in some countries.
3) Ill-preparedness of the health systems
As mentioned above, the COVID pandemic exposed the fact that the health systems in many countries across the globe were not prepared to deal with any sort of disruption from the status quo.
The wellbeing levels of health, social care and frontline workers has also been majorly affected during this time, as there was little if any support available to them during the crisis.
“1 in 5 healthcare workers admit to feeling burnt out every single day”
Nursing Times, 2022
Furthermore, employers were not aware of how grave the effects of the pandemic would be on its employees, not forgetting that many lost their jobs with others getting pay cuts or no pay at all. This greatly affected the mental health and wellbeing of the workforce, but also presented an opportunity for employers and staff to rethink employee wellbeing.
What do we recommend?
The need for mental health intervention is undeniable and urgent. Although there are a huge amount of changes that are needed (more than we can do justice to in this one article), there are some key things to consider – both from a societal and individual point of view.
It must always come down to taking action – no matter how small.
As a result, we’ve compiled a list of three crucial actions that could prove useful in the fight to make mental health a commitment for everyone.
1) Mental health services are an essential component of health care and should be treated with parity of esteem
“Parity of esteem is about tackling and ending the stigma and prejudice within the NHS which stops people with serious mental health problems getting treated with the same vigour as if they had a physical illness such as, say, diabetes”
NHS, 2014
Starting around the 1950s, many countries experienced the closing of psychiatric hospitals with the aim to move the provision of care into community-based services. Although the success and benefits of this deinstitutionalisation process is often debated, we need to look at how we can integrate the care of mental health into general health care settings via maternity, sexual, reproductive, and child health, HIV/AIDS, and chronic noncommunicable disease programmes, ensuring that mental health treatments are accessible to all, particularly vulnerable groups.
To have parity of esteem between mental and physical health care, mental health needs to be fully understood – across the board – by all medical professionals, and the funding of mental health services prioritised; considering the prevalence of conditions when deciding upon the provision of funding.
An action here: if you are a medical professional reading this – regardless of your speciality – make it a priority to educate yourself about all things mental health and how mental ill health may present itself within the work you do.
Consider: how can the work I do better support the mental health of my patients and what needs to change in order for us to do that?
We are acutely aware that medical staff are already under so much pressure, however, change must also happen from the inside. Even if it’s teeny tiny small changes – it can start with you.
2) Raising awareness around all things mental health
From working in the field of mental health, it’s very easy to think that we all have a hugely improved understanding of mental health. Many use the term ‘mental health’ freely in their conversations and you often see these words floating around social media; something that was far less common a few years ago.
However, running Mental Health First Aid and Suicide First Aid training courses has taught me that there is still so much for us to learn as a society. We have a long way to go until we fully understand mental health and how we can better support those around us.
Building this awareness is also critical in addressing the stigma and discrimination that continue to present barriers to accessing appropriate mental health care.
This includes promoting healthy and inclusive workplace cultures. There is a desperate need to train all managers and HR professionals in mental health awareness – leaders and decision makers play a crucial role in improving the quality of the workplace.
An action here: How could you improve your understanding of mental health, both within the workplace and society-at-large? Everyone must contribute to promoting mental health awareness, because the poor mental health of one affects us all.
Consider: If you are a leader within an organisation, consider how aware and emotionally intelligent your management team are? Do they have the skills and knowledge to understand and support mental ill health at work? Do they know how to spot signs of poor mental health in their team members? Would they know how to respond?
3) Governments and key stakeholders within society need to do more
It is no secret that a country’s health system requires the backing of its government in order to survive. The same is true for mental health interventions.
As a consequence, governments and other big players in this world must work together to implement preventive measures that minimise the risk of mental illness. This is against the backdrop of research indicating that preventative mental health interventions work and may be accomplished through both broad and targeted evidence-based interventions.
An action here: education and training in all things mental health must start at a young age. Understanding mental health and wellbeing must be part of the school curriculum and considering 50% of mental health problems are established by age 14 and 75% by age 24, schools and universities are in a prime position to make a difference.
Consider: Are you in a position to influence what training and education children and young adults receive? If so, what can you do?
We may be biased, but we believe that Mental Health First Aid and Suicide First Aid training must be a mandatory requirement for every single person who plays an integral role in the life of those under 25-years-old.
Where do we go from here?
The difficulties associated with poor mental health are numerous, and the solutions indicated above are only a few of many available. However, the most important thing to remember is that supporting and maintaining a strong sense of mental health across our society, as a whole, has intrinsic and instrumental worth and is essential to both our own and others’ state of wellbeing.
We must recognise that we all have a role to play in pushing the ‘Mental Health and Wellbeing for All’ agenda and ensuring that mental health becomes a priority for everyone, no matter who they are or where they live.
Every little change makes a difference, so take a moment to reflect on this article and understand what role you can play in the improvement of mental health support and provision? What training can you do? Can you become an ambassador for mental health and wellbeing at work? Do you have any influence over decisions within schools, universities or within the government?
Change starts with us all. Change starts with you.
What will you do today to help support a better tomorrow?
