A.1 The Global Mental Health context
Before COVID-19 emerged, statistics on mental health conditions (including neurological and substance use disorders, suicide risk and associated psychosocial and intellectual disabilities) were already stark:
- Depression affects 264 million people in the world. As many as 450 million people suffer from a mental or behavioural disorder.
- Nearly 1 million people commit suicide every year. Around half of all mental health conditions start by age 14, and suicide is the second leading cause of death in young people aged 15-29.
- Four of the six leading causes of years lived with disability are due to neuropsychiatric disorders (depression, alcohol-use disorders, schizophrenia and bipolar disorder).
- One in four families has at least one member with a mental disorder. Family members are often the primary caregivers of people with mental disorders. The extent of the burden of mental disorders on family members is difficult to assess and quantify and is consequently often ignored. However, it does have a significant impact on the family’s quality of life.
- More than 1 in 5 people living in settings affected by conflict have a mental health condition.
- People with severe mental conditions die 10-20 years earlier than the general population.
- In low- and middle- income countries between 76% and 85% of people with mental health conditions receive no treatment for their condition, despite the evidence that effective interventions can be delivered in any resource context.
- Globally there is less than 1 mental health professional for every 10,000 people.
- Human rights violations against people with severe mental health conditions are widespread in all countries of the world. In addition to the health and social costs, those suffering from mental illnesses are also victims of human rights violations, stigma and discrimination, both inside and outside psychiatric institutions. Of the 139 countries that have mental health plans and policies in place, fewer than half report having these aligned with human rights conventions.
- Source: WHO https://www.who.int/news-room/facts-in-pictures/detail/mental-health
A.2 The Global Mental Health context
- People with mental disorders die 20 years younger than the general population.
- The estimated prevalence of mental disorders in the WHO European Region in 2015 was 110 million, equivalent to 12% of the entire population at any one time. Inclusion of substance use disorders increases that number by 27 million (to 15%), while inclusion of neurological disorders such as dementia, epilepsy and headache disorders increases the total by more than 300 million, to 50%.
- Suicide deaths are strongly related to mental illness, with approximately 90% attributed to mental illness in high-income countries (12). In the WHO European Region, the suicide rate is unacceptably high. In 2015, the age-standardized suicide rate was 14.1 per 100 000 population for both sexes combined, above the global average of 13.6 (12). Moreover, 11 of the top 20
- Countries with the highest estimated suicide rates globally are in the European Region.
- The promotion and protection of physical and mental health require a multisectoral response, which in turn requires a whole-of-government approach. A strategic vision for integrating mental and physical health care and prevention must be linked to and engaged with many constituencies in and beyond the government and in and beyond the health sector, including social care, education and the environment.
- The median value of the MH workforce hides wide variation among countries. For instance, the number of psychiatrists per 100 000 population ranges from 48 per 100 000 in Norway and 24 in Poland to 7 in Bulgaria.
- Substantial differences in terms of the type and location of psychiatric beds: for example, in Azerbaijan, there are 38 mental hospital beds per 100 000 population and 5 beds per 100 000 population in community residential facilities. In France, there are 7 mental hospital beds per 100 000 population and 92 beds per 100 000 population in community residential facilities.
- A strategic vision for integrating mental and physical health care and prevention must be linked to and engaged with many constituencies in and beyond the government and in and beyond the health sector, including social care, education and the environment.
(Sources: WHO Europe – Mental Health: Fact sheet, 2019, SDG MH: Fact sheet 2018)
A.3 MH economics
- The global economy loses more than US$ 1 trillion per year due to depression and anxiety.
- For every US$ 1 put into scaled up treatment for common mental disorders, there is a return
of US$ 4 in improved health and productivity.
- Dramatically disproportionate underfunding: WHO Countries spend on average only 2% of
their health budgets on mental health (….) Despite the massive global economic burden of mental health conditions, spending amounts only to 1% of total health expenditure by governments
in the WHO European Region. Of this spending, 69% was dedicated to government mental
- Extremely weak prevention policies
- The annual direct cost of depression was estimated to be €617 billion overall in the European Union in 2013 (27 Member States), with costs to employers (absenteeism) of €272 billion, to the economy (lost output through lost employment) of €242 billion, to the health sector (treatment of depression) of €63 billion and to the social welfare systems (disability benefits) of €39 billion (22).