BRIEF: FINANCING MENTAL HEALTH FOR ALL

With mental health at the forefront of the conversation in the wake of the COVID-19 pandemic, the opportunity for once-in-a-generation change is being presented. The integration of mental health into universal health coverage (UHC) reforms during the run in to 2030 (the target year for the Sustainable Development Goals which include achieving UHC) is being promoted as a key pandemic response, recovery and preparedness element, and as we argued in our previous brief in this series, universal mental health coverage is also a fundamental right. But how much will this cost and how can it be funded? In our latest brief, Financing Mental Health For All, United for Global Mental Health presents new findings that answers these questions and points to how feasible, and desirable, achieving better services with wider coverage for mental healthcare could be.

Currently only 2.1% of government health budgets globally are allocated to mental healthcare. As things stand, huge swathes of the world have next to no access to mental health services; with losses in human capital estimated at US$387.2billion per year for children and adolescents alone, and as much as $6trillion in total between now and 2030 for the general population.

The WHO in 2013, recommended member states increase their current capacity for mental health service coverage by half by 2030. Our research finds that achieving this goal for five major mental health disorders – anxiety, bipolar, depression, epilepsy and psychosis – only requires a year-on-year increase of 20 US cents in global per person mental health investment globally until 2030. For lower middle income and lower income countries, the costs are even lower; from 2 US cents in lower middle income countries to less than half a US cent in low income countries.

This, however, is not UHC. Reaching 90% coverage for those five mental health disorders by 2030 would require an increase in the ratio of global mental health expenditure of 1.9 compared to 2022, and a rise in annual per person spending to US$0.66 and US$2.01 for low-income and lower-middle-income countries respectively for these five mental health disorders. This, compared to spending overall per person on healthcare which in lower-middle income countries is US$95.25, and low income countries US$33.80, should be achievable and is cost effective given the disease burden.

The impact on health outcomes for these five mental health conditions would be enormous. Scaling up investment to increase mental health service coverage by just half of current coverage alongside transitioning from institutional to PHC and community care, as the WHO suggests, is projected to gain nearly 27 million healthy life years; alongside preventing 51.5 million cases of these five common mental health disorders, and averting just under half a million deaths by 2030.

Integration into existing systems is key, particularly into existing ‘physical’ health systems. In low- and middle-income countries for example, integrating mental health initially into existing health development programmes such as HIV and TB, catalysed by finance from mechanisms such as the Global Fund in the fight against HIV and malaria, and transitioning into wider social programmes like education represents a way forward. But mental health is not the sole responsibility of the health sector and health budgets should not shoulder the financial burden alone. Integrating mental health across public services will not only provide effective holistic mental health systems but share the cost across several ministries.

With UHC forming such a big part of pandemic response and recovery discussions on the global stage, there is a special opportunity to reassess how we approach healthcare, and what role mental health plays through UHC. Governments, supported by domestic and international donors, must now commit adequate financing, directed to primary health care and community-based care, and accounting for particularly vulnerable groups such as children and caregivers, to reap those rewards.