James Donaldson on Mental Health – One Billion People Worldwide are Living with Mental Health Disorders

By Disha Shetty

Over a billion people across the world are living with mental health disorders, a slight but significant increase over the numbers from the last time the data was collected in 2000, with anxiety and depression being the most prevalent conditions.

In low-income countries, fewer than 10% of affected individuals receive care, compared to over 50% in higher-income nations, according to the latest data released Tuesday by the World Health Organization (WHO).

These key findings are contained in two WHO reports, ‘World Mental Health Today’ and ‘Mental Health Atlas 2024’.

Mental health disorders are prevalent across all countries and communities, affecting people across age and income groups, the reports found. The prevalence of mental health disorders is also rising. While there are some signs of progress, greater investment and action is needed globally to scale up mental health services, experts said during the report’s release.

“Transforming mental health services is one of the most pressing public health challenges,” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General. “Investing in mental health means investing in people, communities, and economies — an investment no country can afford to neglect. Every government and every leader has a responsibility to act with urgency and to ensure that mental health care is treated not as a privilege, but as a basic right for all.”

Apart from being the second biggest cause of long-term disability, after back pain, and contributing to loss of healthy life, mental health disorders are also driving up healthcare costs for affected people and families.

Women are disproportionately affected

While the prevalence of mental health disorders can vary by sex, women are disproportionately impacted.

“Since depression and anxiety are by far the most common mental health conditions, and since these are more common among women, the overall picture is that women have more mental health conditions,” said Dr Mark Van Ommeren, head of WHO’s Department of NCDs and Mental Health.

Anxiety, depression and eating disorders are the most common mental health disorders among women. ADHD and substance use is more common among men.

One extreme outcome of mental health disorders is death by suicide. There were an estimated 727,000 deaths by suicide in 2021 alone, making it a leading cause of death in young people across all countries and socioeconomic contexts.

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While the United Nations Sustainable Development Goals (SDGs) aimed to cut down these deaths by a third before 2030, on the current trajectory, only a 12% reduction is likely to be achieved by that deadline.

The number one billion too has made an appearance for the first time. Ommeren said that the last time the data was reported was in 2000 when the number of people affected by mental health disorders was less than a billion.

“One would expect an increase, but there’s actually a bigger increase than the increase in the world population,” Ommeren said.

The reports also made it clear that the economic impacts of mental health disorders are staggering. Much of this is indirect cost in the form of lost productivity. For instance, depression and anxiety alone cost the global economy an estimated US$1 trillion each year, according to WHO data.

Investment continues to lag, workforce gap remains

While many countries did improve their mental health services post-pandemic, including taking actions like strengthening their mental health policies, laws and planning, it has not been not enough.

Investment has also stagnated. Median government spending on mental health remains at only  2% of total health budgets — unchanged since 2017. There is a huge spending of disparity between low-income countries and high-income countries.

While high-income countries spend up to $65 per person on mental health, low-income countries spend as little as $0.04.

“We see, for example, high-income countries spending a little less than 5% of their health budgets on mental health, whereas in low lower-income countries, it’s more like 1% so a threefold difference. And if you start looking at the actual dollar amounts, then the differences become much starker,” said Dr Daniel Chisholm, mental health specialist at WHO’s Department of NCDs and Mental Health.

There is no ideal amount to spend, experts said, but if low-income countries too spend about 5% of their overall health budget on mental health disorders, that is likely to go a long way.

Reform in how mental health services are being provided is also progressing very slowly.

Less than 10% of countries have fully transitioned to community-based care models recommended by WHO and other experts, with most countries still in the early stages of transition. Most of the inpatient care continues to rely heavily on psychiatric hospitals, with nearly half of admissions occurring involuntarily and over 20% lasting longer than a year.

Silver lining

WHO has been pushing countries to expand primary healthcare and integrate mental health services into primary care. Latest data suggests that 71% of countries are now meeting at least three of the five WHO criteria for doing so. However, data gaps remain; only 22 countries provided sufficient data to estimate service coverage for psychosis.

Most of the countries now report having functional mental health promotion initiatives such as early childhood development, school-based mental health and suicide prevention programmes. Over 80% of countries offer mental health and psychosocial support as part of emergency responses, up from 39% in 2020.

Outpatient mental health services and telehealth are also becoming more available, though access remains uneven.

While there is an extreme shortage of mental health workforce in low-and middle-income countries with the global median number of mental health workers at 13 per 100 000 people, small improvements have been registered.

“We see pretty modest but definitely some positive signs of increased availability of specialized mental health workers, like psychiatrists, of course, psychologists, nurses who work in mental health space, social workers,” Chisholm said. “So that’s a slightly more encouraging sign, rather than the stagnation in the estimated expenditure levels,” he added.

The latest data thus shows that countries remain far off track to achieve the targets set in WHO’s Comprehensive Mental Health Action Plan for the years 2013-2030.

“We need urgent systemic transformation of mental health systems worldwide, and this includes sustained investment in mental health workforce and services, a decisive shift toward community-based, person-centered care as part of universal health coverage, legal and policy reforms that uphold rights and dignity,” said Dr Dévora Kestel, director at WHO’s Department of NCDs and Mental Health.

The reports include data from 144 countries, are an attempt to provide policy makers with the most up-to-date global data on the prevalence, burden, and economic cost of mental health conditions. They are meant to inform national strategies and shape global dialogue ahead of the United Nations High-Level meeting on NCDs and promotion of mental health set to take place in New York on 25 September.