In 1946, the World Health Organisation (WHO)’s first Director-General, Dr Brock Chisholm, declared that “without mental health there can be no true physical health.” Today, the relationship between mental and physical health outcomes is indisputable. The WHO itself defines health as a state of complete physical, mental, and social well-being.

The Sustainable Development Goals (SDG) directly mention mental health: target 3.4 not only argues for addressing the needs of individuals and families already affected by mental disorders and psychosocial disabilities, but also for protection from determinants of mental health, including socioeconomic status, educational attainment, and inequality.

Yet, few countries around the world invest sufficiently in mental health. Upper-middle income countries allocate 2.4% and high income countries allocate 5.1% of their health budgets. But the situation is particularly dire in developing countries where the essential link between mental and physical health is barely evident in national health strategies, health budgets and health systems. Less than 1% of low-income countries’ annual health budgets are allocated to mental health.

“For the first time, mental health has received much needed recognition through its inclusion in the Global Goals,” says Dr Jabulani Nyenwa, Project Director of the UKaid-funded health strengthening program Lafiya. “However, most governments, especially in sub Saharan Africa, are still failing to get the right balance between curative and preventive public health spending, including through spending on mental health.”

The Barriers

This imbalance has implications beyond domestic health systems, as donor agencies work in tandem with governments to create programs that are in line with countries’ national strategies. If countries do not prioritise mental health, considering it a low-impact, longer term strategy, donors will likewise focus elsewhere.

We see this in the UK’s Department for International Development (DFID), whose mental health-focused programs are minimal compared to the spending on reproductive health, family planning, HIV/AIDS and health system strengthening. Similarly, the United States Agency for International Development (USAID)’s Global Health Strategic Framework makes no mention of mental health.

The Impact of COVID-19

Right now, governments around the world have their eyes focused on COVID-19. Countries are battling to slow the spread and save lives, but with every passing day, the pandemic’s mental health and psychosocial implications are becoming clearer. Loss of employment, insufficient living quarters for families, a rise in domestic violence, loss of loved ones, and perpetual fear and uncertainty are all negatively impacting mental health.

Governments will understandably prioritise “reopening economies”, but they must not underestimate the significant mental health implications of this crisis on individuals, families, and entire societies. If not addresses, the increase in cases of mental illness will have a hugely detrimental effect on countries’ ability to rebuild, both socially and economically.

“In the post-COVID era, the quadruple burden of disease from communicable infections, maternal and child health, trauma and non-communicable diseases will be accentuated by unprecedented high levels of mental health issues,” Dr Nyenwa explains. “This must be an important reminder of our global commitment to promoting and investing in impactful mental health programs.”

COVID-19 has highlighted that people’s basic needs must be met, and good mental health is a basic need alongside clean water, food, and housing. Governments and donors can begin to adapt their strategies and focus on the inherent importance to national development of the links between mental and physical health and break down the artificial barriers between them, just as the WHO’s Dr Brock Chisholm sought back in 1946.

To make this possible, the international development sector must work collectively to demonstrate:

• the benefits that arise from investing in mental health, and how this work can boost economic productivity, both due to the decrease in loss of income because of mental health issues and the gain for companies through greater employee productivity;
• that SDG targets set for governments can be met more easily with investment in mental health, without which these countries will struggle to reach their targets;
• that mental health can be measured (despite preconceptions that measurement indicators have not yet been developed), allowing countries who see this as a potential barrier to rethink and begin to address mental health in their national strategies.

There is a long way to go to ensure that mental health becomes a global priority, but governments and agencies can take the necessary steps to ensure that people around the globe lead better lives.