The Lancet Commission on Global Mental Health and Sustainable Development

I.    Background

II.   The Need to Reframe Mental Health Patel

III.  Taking a dimensional approach

Vikram Patel, recipient of the GA's Presidential Citation for Lifetime Achievement Award, sharing highlights of the Lancet Commission's landmark report in his keynote address at our Coming Together for Action 2018 conference in Denver.  

 

Background

On World Mental Health Day (October 10, 2018), the Lancet Commission on Global Mental Health and Sustainable Development outlined a blueprint for reducing the global burden of mental health problems.  The Commission's report builds on more than a decade of work, beginning with the original Lancet series in 2007, aimed at making mental health a global priority. 

The report relies on scientific evidence to raise awareness of critical issues in mental health globally and to urge investment in reframing the global mental health agenda to emphasize prevention and early intervention, closing the treatment gap, improving quality of care, and addressing the wide range of conditions that affect mental health and well-being.  

Sustainable Development Goals

Central to the Commission's report is a call to reframe mental health in the context of the Sustainable Development Goals (SDGs).  The 17 SDGs provide an opportunity for broadening the global mental health agenda to include entire populations.  Virtually all of the SDGs related to mental health, however Goal #3 -- Good Health and Well-Being -- is specifically applicable to mental health and to the Commission's call to reframe the agenda.  Implementing a population approach to mental health will require a coordinated, multisectorial approach. 

The Foundational Pillars 

The Commission grounded its agenda in 4 basic principles:

  1. Mental health is a global good and relevant to sustainable development in all countries
  2. Mental health problems exist along a continuum from mild, time-limited distress to chronic, progressive, and severely disabling conditions
  3. Each individual's mental health is a product of social and environmental conditions, especially in the early years, interacting with genetic, neurodevelopmental, and psychological processes and affecting biological pathways in the brain
  4. Mental health is a fundamental human right for everyone.  A rights-based approach is necessary to protect the rights of people with mental disorders and those at risk of developing disorders, and to stimulate an environment that promotes mental health for all.   

The Need to Reframe Mental Health

The perception of mental health by the general public matters.  When mental health is associated with chronic and severely disabling conditions, it shapes the types of services available and whether people seek treatment.   The Commission argues that mental health must be reframed to address some of the common barriers to seeking treatment and receiving appropriate care for mental health conditions.    

What are the barriers?  

  • Stigma
Stigma of mental health problems can cause people to avoid seeking help when they need it.  Stigma can damage self-esteem.  It can also lead to discrimination and social exclusion at school, in the workplace and in the community.  As a result, individuals with milder disorders may not seek treatment until their disorder becomes worse.  The failure to access care may also widen disparities in mental health. 

  • Treatment Gap 

As it currently exists in high income countries, the mental health system is plagued by a number of structural barriers, the result of which is a significant treatment gap.  Where services do exist, quality is often poor or not responsive to the needs of individuals with mental health problems.  In low- and middle-income countries (LMICs), services are even more scarce.  

  • Access to care
Several factors may have the effect of limiting access to care.  In many communities, access to care is exacerbated by a shortage of practitioners and appropriate, and sometimes nonexistent, services.  Social factors, including attitudes about mental health and psychiatric treatment, may determine whether a person seeks help for a mental health problem.  The lack of integration of mental health and physical health services can also be a barrier to seeking help. 

  • Prevention and Early Intervention

Although the majority of people who experience mental health problems do not have serious mental health disorders, the mental health system historically has prioritized acute care over prevention and early intervention.  The relationship of social factors, like poverty, income inequality, climate and environment threats, rapid urbanization, conflict and displacement, pandemics and growing economic and political uncertainties, to mental health provides opportunities for the implementation of broad strategies that benefit the entire population, as well as strategies targeted to individuals with high risk.   Prevention and early intervention is especially important in working with children and youth.  

In offering a "fresh perspective on global mental health and sustainable development," the Commission proposes three key principles to guide the reframing of mental health:  

  • An approach to understanding and responding to mental health problems that looks at mental health along a continuum, from health promotion to recovery. 
  • Convergence of the findings of the social and biological determinants of mental health problems.
  • Recognition that mental health is a fundamental human right, in particular for those who have already developed mental health problems and those at risk of developing problems.   

 Taking a dimensional approach to mental health  

Mental health is a state of well-being in which an individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and is able to make a contribution to his or her community.  - World Health Organization

Dimensions of Mental Health

 

 

 

 

 

 

 

 

 

Mental health is more than clinical services

The Commission calls for a dimensional approach to mental health that ranges from positive mental health to psychosocial disability.  The approach recognizes that mental health occurs along a continuum from well-being to more serious disorders.  This principle balances the focus on treatment, rehabilitation, care, and recovery with an equal  emphasis on the promotion of mental health and the prevention of mental disorder.  Interventions that begin early in life are particularly important in preventing more serious disorders.     

The social determinants of mental health matter

The Commission says that knowledge from diverse disciplinary traditions have converged to advance knowledge and to create understanding of the diverse determinants that may affect mental health.  A convergent approach should help in the development of theories and frameworks to guide interventions.    

Mental health is a human right