- Mental health is more than the absence of mental disorders.
- Mental health is an integral part of health; indeed, there is no health without mental health.
- Mental health is determined by a range of socioeconomic, biological and environmental factors.
- Cost-effective public health and intersectoral strategies and interventions exist to promote, protect and restore mental health.
Mental health is an integral and essential component of health. The WHO constitution states: “Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.” An important implication of this definition is that mental health is more than just the absence of mental disorders or disabilities.
Mental health is a state of well-being in which an individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and is able to make a contribution to his or her community.
Mental health and well-being are fundamental to our collective and individual ability as humans to think, emote, interact with each other, earn a living and enjoy life. On this basis, the promotion, protection and restoration of mental health can be regarded as a vital concern of individuals, communities and societies throughout the world.
Determinants of mental health
Multiple social, psychological, and biological factors determine the level of mental health of a person at any point of time. For example, persistent socio-economic pressures are recognized risks to mental health for individuals and communities. The clearest evidence is associated with indicators of poverty, including low levels of education.
Poor mental health is also associated with rapid social change, stressful work conditions, gender discrimination, social exclusion, unhealthy lifestyle, risks of violence, physical ill-health and human rights violations.
There are also specific psychological and personality factors that make people vulnerable to mental disorders. Lastly, there are some biological causes of mental disorders including genetic factors which contribute to imbalances in chemicals in the brain.
Mental health promotion and protection
Mental health promotion involves actions to create living conditions and environments that support mental health and allow people to adopt and maintain healthy lifestyles. These include a range of actions to increase the chances of more people experiencing better mental health.
An environment that respects and protects basic civil, political, socio-economic and cultural rights is fundamental to mental health promotion. Without the security and freedom provided by these rights, it is very difficult to maintain a high level of mental health.
National mental health policies should not be solely concerned with mental disorders, but should also recognize and address the broader issues which promote mental health. These include mainstreaming mental health promotion into policies and programmes in governmental and nongovernmental sectors. In addition to the health sector, it is essential to involve the education, labour, justice, transport, environment, housing, and welfare sectors as well.
Promoting mental health depends largely on intersectoral strategies. Specific ways to promote mental health include:
- early childhood interventions (e.g. home visits for pregnant women, pre-school psycho-social activities, combined nutritional and psycho-social help for disadvantaged populations);
- support to children (e.g. skills building programmes, child and youth development programmes);
- socio-economic empowerment of women (e.g. improving access to education and microcredit schemes);
- social support for elderly populations (e.g. befriending initiatives, community and day centres for the aged);
- programmes targeted at vulnerable groups, including minorities, indigenous people, migrants and people affected by conflicts and disasters (e.g. psycho-social interventions after disasters);
- mental health promotional activities in schools (e.g. programmes supporting ecological changes in schools and child-friendly schools);
- mental health interventions at work (e.g. stress prevention programmes);
- housing policies (e.g. housing improvement);
- violence prevention programmes (e.g. reducing availability of alcohol and access to arms);
- community development programmes (e.g. integrated rural development);
- poverty reduction and social protection for the poor;
- anti-discrimination laws and campaigns;
- promotion of the rights, opportunities and care of individuals with mental disorders.
Mental health care and treatment
In the context of national efforts to develop and implement mental health policy, it is vital to not only protect and promote the mental well-being of its citizens, but also address the needs of persons with defined mental disorders.
Knowledge of what to do about the escalating burden of mental disorders has improved substantially over the past decade. There is a growing body of evidence demonstrating both the efficacy and cost-effectiveness of key interventions for priority mental disorders in countries at different levels of economic development. Examples of interventions that are cost-effective, feasible, and affordable include:
- treatment of epilepsy with antiepileptic medicines;
- treatment of depression with psychological treatment and, for moderate to severe cases, (generically produced) antidepressant medicines;
- treatment of psychosis with older antipsychotic medicines and psychosocial support;
- taxation of alcoholic beverages and restriction of their availability and marketing.
A range of effective measures also exists for the prevention of suicide, prevention and treatment of mental disorders in children, prevention and treatment of dementia, and treatment of substance-use disorders. The Mental Health Gap Action Programme (mhGAP) has produced evidence based guidance for non-specialists to enable them to better identify and manage a range of priority mental health conditions.
WHO supports governments in the goal of strengthening and promoting mental health. WHO has evaluated evidence for promoting mental health and is working with governments to disseminate this information and to integrate effective strategies into policies and plans.
In 2013, the World Health Assembly approved a “Comprehensive Mental Health Action Plan for 2013-2020”. The Plan is a commitment by all WHO’s Member States to take specific actions to improve mental health and to contribute to the attainment of a set of global targets.
The Action Plan’s overall goal is to promote mental well-being, prevent mental disorders, provide care, enhance recovery, promote human rights and reduce the mortality, morbidity and disability for persons with mental disorders. It focuses on 4 key objectives to:
- strengthen effective leadership and governance for mental health;
- provide comprehensive, integrated and responsive mental health and social care services in community-based settings;
- implement strategies for promotion and prevention in mental health; and
- strengthen information systems, evidence and research for mental health.
Particular emphasis is given in the Action Plan to the protection and promotion of human rights, the strengthening and empowering of civil society and to the central place of community-based care.
In order to achieve its objectives, the Action Plan proposes and requires clear actions for governments, international partners and for WHO. Ministries of health will need to take a leadership role and WHO will work with them and with international and national partners, including civil society, to implement the plan. As there is no action that fits all countries, each government will need to adapt the Action Plan to its specific national circumstances.
Implementation of the Action Plan will enable persons with mental disorders to:
- find it easier to access mental health and social care services;
- be offered treatment by appropriately skilled health workers in general health care settings; WHO’s Mental Health Gap Action Programme (mhGAP) and its evidence-based tools can facilitate this process;
- participate in the reorganization, delivery and evaluation of services so that care and treatment becomes more responsive to their needs;
- gain greater access to government disability benefits, housing and livelihood programs, and better participate in work and community life and civic affairs.
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