October 10 is World Mental Health Day, a World Health Organization (WHO) event to "raise awareness of mental health issues around the world and to mobilize efforts in support of mental health."
Mental health advocates, including the WHO, have been pushing hard to reform mental health care for decades. This year, they stress that a perfect storm of events — from the coronavirus pandemic to economic downturns — has had a major impact on mental health around the world.
According to the WHO World Mental Health report published earlier this year, depression and anxiety rose 25% in the first year of the pandemic, bringing the total number of people living with a mental disorder to nearly 1 billion people.
"What's more, mental health services have been severely disrupted in recent years, and the treatment gap for mental health conditions has widened," a WHO spokesperson told DW.
A special initiative for mental health
So what's being done about it? In 2020, the WHO established the Special Initiative for Mental Health. It is among the WHO's most ambitious mental health programs so far, aiming to increase access to mental health services for 100 million people across 12 nations including Ukraine, Jordan, and Zimbabwe.
"Many countries have very outdated mental health service mandates," Alison Schafer, a technical advisor in the WHO's mental health department, told DW. "We're working with countries to change their approaches so more people have access to support."
Since the initiative began in January 2020, 5 million more people have gained access to mental health and psychosocial support, according to the WHO. Psychosocial support involves building networks around people in need, often through family and local structures.
Schafer said it took two-and-a-half years to set up the initiatives. "But now we expect more and more progress to be made towards expanding mental health services so that more people will be able to access support."
One of the biggest successes so far has been providing mental health and psychosocial support during crises such as the COVID-19 pandemic and for people affected by the conflict in Ukraine and the Philippines.
"We're having the most immediate impact on people here," Schafer said, calling crisis support "key."
Schafer also cited early successes in countries like Paraguay that have enabled consultations with psychiatrists via video calls. During the coronavirus pandemic, video consultations were particularly effective in sustaining community support.
"It sounds quite simple to achieve, but what was missing was the infrastructure," she added.
Big-picture approach to mental health
Schafer said the uniqueness of the WHO's mental health initiative is based on its big-picture approach.
"There is no one way to approach mental health services and support. It requires a bigger perspective than what's been looked at before — not just focusing on singular interventions or groups — but at a whole system of mental and related health care services, which may be offered in health care but also in schools, community organizations, religious groups and businesses," she said.
One goal of the initiative is to focus on providing support to at-risk groups. At-risk groups include, among others, people who experience discrimination or human rights violations, including people who identify as LGBTQ.
"We're already seeing early successes; for example, helping people understand that sexual attraction between people of the same sex is not a mental disorder, but rather they might be at higher risk of mental health conditions because of social stigma and discrimination, and in need of support," Schafer said.
According to Schafer, the success comes from basing mental health support on scientific evidence, on decades of learning, and enhanced rights of people living with mental health conditions and psychosocial disabilities. But the initiative has not been without its challenges.
"Some countries are further ahead in their progress," Schafer said. "The WHO's Special Initiative for Mental Health is working toward facilitating such changes so that expansion of mental health services can be sustained and enhanced even further."
Community-led programs offer lasting mental health support
While the WHO initiative is seeing early successes, the project will end in 2023. What happens with the new mental health support networks after that is not clear.
Renée Eloundou, an anti-discrimination consultant at Berlin-based counseling organization Sources-d'Espoir (sources of hope), is critical of mental health initiatives that have fixed durations.
"The help people need doesn't have an endpoint. The mental instability people find themselves in is very difficult to deal with. It takes time for people to open up and talk. It takes time to establish support networks," Eloundou told DW.
Sources-d'Espoir provides counseling and support for migrant communities in Germany, particularly Black communities.
The link between mental health issues and discrimination, Eloundou said, is striking.
"People [who] experience discrimination often feel ashamed or part of the problem. They feel alienated by government-led structures, which makes them isolated and prone to mental health challenges," she said.
Some 98% of the organization's team is made of Black women who came to Germany as adults. Eloundou emphasized how important it is that psychosocial care gets led by people from the same communities as those they are trying to help.
"Community action is a must. Our team has similar experiences of discrimination, so can easily relate with someone and analyze the signals of mental health difficulties. It helps to build trust around mental health," Eloundou said.
"If you wish to target mental health issues, you need to collaborate with communities and collaborate with experts who have the skills," she added.
"Then you can make a lasting change."
Edited by Carla Bleiker