Making Person-centered Mental Health Care a Reality

Reflections from the 2022 WHO Mental Health Forum

One in every eight people lives with a diagnosable mental illness, and nearly three-quarters do not receive the mental health services that they need. This global burden contributes to one in every 100 deaths resulting from suicide. In 2019, one-tenth of all disability adjusted life years were due to mental health disorders, and approximately 12 billion work days a year are lost due to depression and anxiety.

Despite these shocking statistics, mental health continues to be neglected within the global health arena. Almost universally, other health conditions are prioritized over mental health. Countries dedicate less than 2 percent of their health care budgets to mental health, and community-based, person-centered mental health care is consistently underfunded, though it has great potential to meet people where they are. Funder agencies also deprioritize mental health, which further diminishes its visibility as a critical public health issue.

JSI was pleased to participate in the WHO Mental Health Forum 2022. Over the course of the two-day virtual meeting, government, academia, private sector, and civil society representatives expressed urgency for global investments in mental health to overcome challenges that have arisen during the COVID-19 pandemic. The meeting included the following highlights.

Ending Stigma and Discrimination in Mental Health

At the Launch of The Lancet Commission on Ending Stigma and Discrimination in Mental Health, participants were reminded that: 1) mental health is not important to the individual and to the family only; it is a global health good; 2) the presence or absence of mental health is not binary; it occurs along a continuum across the life course; 3) mental health is a fundamental human right that affects our ability to access all other human rights; and 4) there are important social and environmental factors that serve as drivers, protectors, and risk factors of mental health. The Lancet Commission, developed in collaboration with people with lived experience, calls for ending all forms of stigma and discrimination against people with mental health conditions, which many describe as worse than the condition itself. In addition to exacerbating social exclusion, stigma and discrimination reduce access to needed care and diminish educational and employment opportunities. An overview of 216 systematic reviews examining anti-stigma interventions demonstrated that the most effective way to reduce stigma and discrimination is through culturally appropriate social contact between people who do and do not have lived experience with mental health conditions. The Lancet Commission had an explicit call to all media organizations to remove content that portrays people with mental health conditions as dangerous. It instead suggests that media organizations reduce stigma through accurate, responsible, and nuanced portrayals of individuals living with mental health conditions.

WHO’s World Mental Health Report: Putting people at the center of mental health programs

In the overview of the new report, WHO urged supporting mental health programs that are people-centered, recovery-oriented, and human-rights based. Person-centered care can have lasting benefits for individuals, families, communities, and systems. Its application to mental health can enhance trust, improve access to and quality of mental health services, and strengthen health literacy and decision-making skills to promote independence. To achieve this type of care, we must cater to the spectrum of mental health needs, including integrating mental health services into primary health care, and community-based and social services outside the health sector. This is a priority within JSI’s person-centered care framework.

The report further elaborates on community-based services needed to fully support person-centered mental health care. These include:

• Engaging individuals, families, and communities as active participants, rather than passive recipients of mental health care.
• Adopting people’s own perspectives and priorities and responding to these in humane and holistic ways.
• Respecting people’s cultural understanding of mental health.
• Ensuring that mental health care providers engage in meaningful conversations about people’s needs and concerns.
• Encouraging a more holistic approach to identify and manage people’s health needs rather than focusing on a particular pathology or disease.
• Organizing high-quality, supportive community-based health care around the needs and expectations of people, not diseases.

Below is a model of a comprehensive network of interconnected formal services that, with enough resources, can be achieved.

Beyond the health care setting, other sectors have important roles, including detection and mental health interventions in schools and within the justice system. Providing housing and employment opportunities benefit mental health, too.

WHO Mental Health Gap Action Programme: The Way Forward

The WHO Mental Health Forum called on member states and other stakeholders to:

• Deepen value and commitment by intensifying engagement and investments in mental health, and prioritizing mental and physical health equally.
• Reshape environments including the physical, social, and economic characteristics of homes, schools, workplaces, services, and communities for strengthened mental health.
• Make person-centered mental health affordable and accessible to all by investing in community-based networks of services, diversifying care options, and engaging people with lived experience.

JSI’s Commitment to Person-centered Mental Health Care

To support population health and well-being, we must find creative ways to prioritize mental health, even when funding is scarce and it is not a priority within the global public health sphere. The adage is true: there can be no health without mental health. JSI is personally committed to the following—

• Designing holistic and integrated programs: We will ensure that service integration considers the mental health needs of respective populations and builds integrated approaches including bidirectional links between mental health and other clinical services. We will promote care that is focused on meeting the needs and expectations of people, not diseases. We will also seek opportunities to integrate mental health literacy into our clinical and community training programs.
• Strengthening systems to incorporate mental health: Within our broader health systems strengthening activities, we will collaborate with funders, governments, and others to consider developing systems that collect disaggregated data on mental health as a foundational step to advocate for increased attention and resources. We will encourage use of task-sharing models that will make mental health services more accessible in places where mental health specialists are scarce and build a primary health care service force that provides high-quality mental health care. We will also advocate for mental health inclusion within universal health care and improved resources and governance.
• Increasing demand from clients and strengthening mental health within communities: We will strengthen community networks to fulfill people’s right to mental health. We will also seek opportunities to integrate care competency into client-level training, including skills to care for themselves and each other. Most of all, we will advocate for holistic, person-centered care.

By Jessica Posner