Five steps to address mental health in Asia and the Pacific and beyond

• Global evidence shows that even during non-emergency settings, one in  five people worldwide are living with mental health disorders

Mental health issues are an increasingly large part of the global burden of diseases and a leading cause of disability. This disturbing trend was made most evident during the Covid-19 pandemic, which contributed both to a sharp rise in mental health disorders and a disruption in critical mental health services.
The most common types of mental health disorders include anxiety and depressive disorders, but many such disorders impact people’s lives, including those involving substance abuse, eating, schizophrenia, as well as psychotic and neurodevelopmental problems.

Mental health disorders 

Global evidence shows that even during non-emergency settings, one in five people worldwide are living with mental health disorders, and over 80% of them are living in low and middle-income countries. The burden of mental health disorders varies across populations, but is experienced most acutely by vulnerable populations, particularly in countries lacking resources, expertise, and infrastructure.
Poverty and poor mental health are intertwined. Poverty increases the risk of mental illness, and those with untreated mental illness are more likely to fall into poverty. Poor mental health has a direct impact on a person’s life by reducing the ability to study and work productively, thereby compromising their overall contribution to economic development.

Sustainable Development Goals 

Despite its inclusion in the Sustainable Development Goals, only 2% of total government health expenditure and 1% of global development assistance for health are dedicated to mental health, according to the World Health Organization’s Mental Health Atlas 2020.
Most mental health-related expenditures in low and middle-income countries have been spent on treatment in hospitals and services at the primary or community care level. Addressing mental health plays a key role in sustainable development and should be linked to efforts to achieve social equity and progress towards universal health coverage.

Primary health care 

Co-morbidities between mental health disorders and rising noncommunicable diseases highlight their common risk factors. Integration of mental health within primary health care is a key strategy to improve access to mental health services, alongside promotion of mental health literacy in schools and workplaces.
Many people do not receive any formal treatment or intervention for their mental health conditions. This unmet need, or treatment gap, for mental health problems and disorders is notably high at 30%-50% for depressive disorders and 50%-70% anxiety disorders.
The most common challenges at low and middle-income countries include lack of awareness, stigma, a lack of services, human resources, and prevention and promotion programmes, as well as limited data and financial barriers.
To address these problems, priorities for global mental health policy should include:
1. Scaling up service provision and access to mental health care via a network of primary and community-based support and timely referral to specialists. This entails prioritizing mental health within public policy and enhancing investment.    
2. Integrating mental health into health system frameworks for non-communicable diseases. Including mental health care in essential services and financial protection schemes of universal health care will ensure its accessibility and affordability to all people.
3. Strengthening public understanding and engagement of people with mental disorders. This will decrease the stigma, improve mental health literacy, and promote help-seeking behaviors.
4. Reducing health workforce shortages. Training of community and allied health workers will build workforce capacity from primary to specialist care.
5. Adopting and supporting digital technology for mental health and enhancing data collection. Measures can include setting up mobile applications, platforms for collection of patient data for monitoring, and teleconsultation to access mental health services.
While mental health issues were exacerbated and accelerated by the pandemic, an increased focus on health by governments offers an opportunity to address this issue as part of sustainable development.
Increasing digital integration for mental health can promote better networks between primary care and specialist health care providers and facilitate interoperability across health information systems.
This requires multisector public–private partnerships within and outside the health system. It will also require engaging the education and social sectors to help increase mental health literacy, promote awareness of mental well-being, and build a productive workforce.
In this way, we can pave the way for mental health security and help countries to better prepare for future mental health emergencies.
(Vasoontara Yiengprugsawan is a Senior Universal Health Coverage Specialist at ADB. Michelle Apostol is a Health Officer at ADB, and Dinesh Arora is a Principal Health Specialist at ADB).