July 1 is a big day for the World Health Organization. That’s when Tedros Adhanom Ghebreyesus officially becomes the new director-general of this important global health body. In his acceptance speech, Tedros said, “All roads should lead to universal health coverage. I will not rest until we have met this.” Another of his top goals is putting the well-being of women, children, and adolescents at the center of the WHO’s work. I urge him to do that by making mental health a priority.
Why emphasize improving mental health when pressing threats such as Ebola, Zika, tuberculosis, and HIV grab headlines? Because mental health plays a role in almost all of the world’s unfolding health crises.
There’s a clear association between HIV infection and poor mental health due to the direct effect of the HIV virus and opportunistic infections on the brain. What’s more, 30 percent or more of people living with HIV have depression, which compromises the 90-90-90 strategy aimed at ending the HIV epidemic by the year 2020.
Multi-drug-resistant tuberculosis infection is on the increase. Mental disorders are highly prevalent among people on tuberculosis treatment and contribute to the high rate — as much as 30 percent — of people who don’t take the medications needed to stop the disease and prevent its spread.
Among pregnant women, postpartum depression and other mental health issues are associated with poor infant nutrition. In Zimbabwe, where I work, more than 30 percent of women develop depression after giving birth. That often complicates the exclusive breastfeeding program recommended by WHO, particularly among mothers with HIV.
The statistics on the impact of mental health issues are daunting. According to the WHO’s own data, more than 1 in 4 people will develop a mental health issue at some point during their lives. Globally, depression is the leading cause of disability, while suicide kills up to a 1 million people each year and is one of the leading causes of death among people aged 15-29.
In the past, the WHO has not often taken the lead in leveraging addressing mental health issues as a way to prevent and mitigate existing global health challenges. That’s in in spite of overwhelming evidence that mental, neurological, and substance use disorders are among the leading causes of disability. Mental disorders increase the risk of both communicable and non-communicable diseases and contribute to unintentional and intentional injury. And for those with chronic medical conditions such as HIV, hypertension, diabetes, cancer, and other non-communicable diseases, mental disorders hasten the progression of the disease.
All of this, along with over 20 years of rigorous research, has led the global mental health community to rally and emphasize that there is no health without mental health.
As a clinician and researcher in the field of neuropsychiatry for 15 years, I have seen how good mental health forms the cornerstone of social, political, and economic stability and development. For instance, my research work in Zimbabwe has shown that treating mental health issues, particularly common ones such as depression, leads to improvements in poverty, hunger, health, gender equality, and education, all of which are part of the United Nations’s 17 Sustainable Development Goals.
This isn’t unique to Zimbabwe. Studies from both low- and high-income countries consistently show that addressing mental health issues ultimately improves overall health and quality of life, and keeps communities stable.
Despite this knowledge, the resources allocated to mental, neurological, and substance use disorders remain miniscule. Most low- and middle-income countries dedicate less than 1 percent of health budgets to mental health.
That could change if Tedros emerges as a mental health champion. He now has the power to lead the organization away from the existing narrative, which focuses on mental health only in the face of a crisis, such as the suicide of a celebrity, a random act of deliberate destruction, or a school shooting in the U.S. We need a global initiative of the same magnitude as those mounted for HIV or Ebola to combat the global mental health epidemic, which respects no boundaries of race, culture, or socioeconomic status.
It is time to mainstream mental health into our broader efforts to improve health care. Mental health care packages can be integrated into existing primary health care programs, communities, schools, and the workplace. One simple evidence-based strategy, for instance, is to use community health workers through task shifting, which is the delegation of specific tasks to lower level cadres who are supervised by professionals. This approach is gaining traction but needs to be made a priority at a global level.
Tedros needs to be the first WHO director-general who makes mental health a priority 365 days of the year, not just on World Mental Health Day. If we take mental health to the community, much of the rest of WHO’s work will fall into place.
Dixon Chibanda, M.D., is a psychiatrist based in Harare, Zimbabwe, and an Aspen New Voices Fellow.