Horyou is proud to support the global efforts to ensure healthy lives and promote wellbeing for all at all ages (SDG3). As part of our commitment to the Sustainable Development Goals, we invite Dr. Alexey Kulikov from the United Nations Interagency Task Force on Noncommunicable Diseases, based at the World Health Organization, as a guest writer.
According to the World Health Organization (WHO), mental health disorders account for 30% of the non-fatal disease burden and 10% of the overall disease burden, worldwide. Mental health disorders include depression, anxiety, bipolar affective disorder, schizophrenia and other psychoses, dementia, and developmental disorders, including autism (1).
Growing ageing populations have resulted in a 30% increase in the global prevalence of mental health disorders since 1990 (2). The heavy burden of mental disorders and small proportion of national budgets earmarked for mental health (less than US$2 per person per year in low and middle-income countries) has resulted in a substantial gap between the need and availability of mental health disorders and treatments (1). Half of all mental health conditions start by 14 years of age but most cases go undetected and untreated due to the lack of mental health care available in many countries. Mental health is an integral part of an individual’s capacity to lead a fulfilling and productive life, and persons with untreated mental disorders experience an average of 10-20 years reduction in life expectancy (3).
The high burden of mental disorders is not just of public health concern but has growing economic implications, too. Common mental disorders alone cost the global economy US$ 1 trillion per year, resulting in increased health and welfare expenditures as well as reduced economic productivity (4). Persons with mental health conditions are more likely to exit the labor force, miss days of work or perform at a reduced capacity while at work.
The United Nations Development Programme (UNDP), Pan-American Health Organization (PAHO), the Ministry of Health of Jamaica and RTI International developed a pilot Mental Health Investment Case in Jamaica in 2018. The investment case modeled clinical interventions selected by Jamaica’s Ministry of Health to scale up treatment of mental health conditions such as depression, anxiety, and psychoses disorders. The selected scale-up of interventions was projected to cost approximately 16 billion JMD in the next 15 years but also to lead to large economic productivity and social benefit gains valued at approximately 60 billion JMD over the same period (5). The take-away point from this study in Jamaica is that the benefits of mental health treatment significantly outweighed the costs by 375%.
The need to address social and economic challenges posed by mental disorders was highlighted during the High-level Meeting of the UN General Assembly on the Prevention and Control of Noncommunicable diseases (NCDs) in 2018 (6). Together, UNDP along with WHO’s Department of Mental Health and Substance Abuse, and the WHO Secretariat for the United Nations Interagency Task Force for the Prevention and Control of Non-communicable Diseases (UNIATF) is developing the methodology for mental health investment cases to enable national governments to develop national mental health investment cases to strengthen their responses to mental health disorders and promote health and well-being.
Capitalizing on UNIATF’s experience in development of national NCD investment cases, mental health investment cases will assist national governments in estimating the “hidden” cost of mental disorders resulting from labor force reductions, presenteeism and absenteeism. Based on empirical, nationally owned data and WHO and UNDP tools, analyses from mental health investment cases will identify the leading behavioral, social and environmental risk factors in a country and propose concrete national policies and relevant clinical interventions to combat mental health disorders. From these analyses, an estimation of the return on investments (ROIs) of scaled-up action for the treatment and prevention of mental disorders will be calculated. These ROIs will compare the monetary value of health impacts and economic outcomes of scaled-up interventions with the cost of these interventions. As in the case of NCD Investment Cases, ROIs will allow ministries of health to make compelling economic arguments for taking multi-sectoral and holistic action to promote, protect and restore mental health.
By Alexey Kulikov, Jenna Patterson, Mark Humphrey Van Ommeren,Dudley Tarlton and Nicholas Banatvala
1. World Health Organization, 2014. Mental health atlas. Available at https://apps.who.int/iris/
2. World Health Organization, 2019. Investing in Mental Health for Sustainable Development. Available athttps://apps.who.int/iris/
3. Firth, J. et al., 2019. A blueprint for protecting physical health in people with mental illness.. Lancet Psychiatry.
4. Chisholm, D. et al., 2016. Scaling-up treatment of depression and anxiety: a global return on investment analysis. Lancet Psychiatry.
5. Scaling up treatment for depression, anxiety and psychosis in Jamaica: A return on investment analysis, 2018. RTI International.
6. United Nations General Assembly resolution 73/2. Political declaration of the third high-level meeting of the General Assembly on the prevention and control of non-communicable diseases. A/RES/73/2 (10 October 2018) from undocs.org/en/A/RES/73/2