Addressing mental health through primary care and community engagement in the WHO South-East Asia Region
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World Health Organization. Regional Office for South-East Asia
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Twenty years after WHO published its landmark World Health Report 2001: Mental Health – new understanding, new hope,1 the recommendations made then remain valid today.Many advances have been made since but there is still a long way to go. The recentlylaunched World Mental Health Report 2022: Transforming Mental Health for all2 argues for a transformation that is possible and required to ensure better mental health for all, with the underlying premise that ‘there is no health without mental health’. The Sixty-sixth World Health Assembly adopted the WHO Comprehensive Mental Health Action Plan 2013−2020 in May 2013. In 2019, the Action Plan was extended until 2030 by the Seventy-second World Health Assembly.3 To achieve the Action Plan’s objectives, we need to transform our attitudes, actions and approaches to promote and protect mental health and ensure that services reach all those in need, closer to where they live and without incurring financial hardship. Improving mental health of populations leads to increased economic productivity and greater social development.Currently there are almost 1 billion people living with different mental health disorders around the world. In the South-East Asia Region, 13.2% of the population live with mental health conditions.4 Yet, treatment gaps continue to be very high. Key challenges include lack of investment, scarcity of human resources, stigma, inadequate prevention and promotion programmes, paucity of data and lack of mental health services in primary care settings.There have been many Executive Board and World Health Assembly Decisions and resolutions on mental health during the last two decades. A list of these and the texts areavailable in the WHO MiNDbank5 database. There have been several important resolutions promulgated by the WHO Regional Committee for SE Asia related to mental health. Among these are SEA/RC59/R8 on alcohol consumption control – Policy options; SEA/RC65/R5 onnoncommunicable diseases, mental health and neurological disorders; SEA/RC65/R8 on comprehensive and coordinated efforts for the management of autism spectrum disorders (ASD) and developmental disabilities; and SEA Regional Action Plan to implement the Global Strategy to reduce harmful use of alcohol (2014–2025) (SEA/RC67/R4).WHO has also published various technical and policy documents and action plans on this issue. These include the Mental Health Atlas 2020, mhGAP Guidelines, LIVE LIFE, Quality Rights and EQUIP to help Member States transform mental health policies and services, in line with the principle of universal health coverage to strengthen acceptable, accessible and equitable primary mental health-care services. The paths to transformation specified in the World Mental Health Report 2022 include the required shifts to drive the agenda of mental health forward, including a focus on primary care, renewed community engagement, more priority for prevention andpromotion, adoption of whole-of-society and whole-of-government approaches, multistakeholder initiatives, and a shift from a biomedical to a holistic bio−psycho−social approach to services along with greater utilization of non-specialized workers.The UN Convention on the Rights of Persons with Disabilities (UNCRPD), adopted in 2006 and having come into force in 2008, has been ratified by all Member States of the SEA Region.6It identifies the rights and freedoms of persons with disabilities and binds countries to promote, protect and ensure those rights.This Working Paper was presented to the High-Level Preparatory Meeting for its review and deliberation. The HLP Meeting reviewed the paper and made the followingrecommendations.Actions by Member States(1) Integrate mental health into primary health care as a key strategy to reduce the treatment gap in countries.(2) Ensure that MHPSS is a key component of the emergency response.(3) Increase mental health budgets and orient funds towards community-based mental health networks and integration of mental health into PHC.Actions by WHO(1) Support countries in strengthening the delivery of mental health services in non specialized settings through task-sharing, capacity-building and technical support. (2) Provide technical support to strengthen MHPSS to address psychosocial needs during emergencies. (3) Engage with relevant stakeholders to identify modalities of financing for mental health. This Working Paper and the HLP Meeting recommendations are submitted to the Seventy-fifth Session of the WHO Regional Committee for South-East Asia for its consideration and decision, if any.