Urging Ministries to Invest in

Mental health

GUIDE
 ABOUT GMHAN

Demonstrating the This guide has been developed by the Financing Mental Health Working Group of the
Global Mental Health Action Network (GMHAN). The GMHAN is an open community

Case for Mental of over 1,000 mental health professionals from 90 countries who share a mission to
improve support of mental health globally. The membership includes individuals from
Health Investment academia, governments, UN agencies, the private sector, and civil society, meaning
the Network is well-positioned in developing robust, informed, and cross-sectoral
to Finance Ministers resources serving a broad range of mental health sector priorities.

The GMHAN works collectively to accelerate political and financial support for
A Guide for Campaigners global mental health through joint communications, advocacy projects, and thought
and Advocates leadership. It is the largest global mental health network of its kind in the world.

April 2021

INTRODUCTION systems include the education sector, social

welfare systems, justice systems, the workplace,
What is this guide for? and numerous additional areas that governments
This guide has the intention of helping all those have responsibility for.
who are or want to influence a finance ministry to
increase investments in mental health. This guide In this multifaceted cross-sectoral context,
will provide language, approaches, and resources finance ministries are uniquely placed to be able
— as opposed to advocacy and campaigning to have a significant, sustained positive impact
strategies — that may be critical in persuading on the mental health of a country or state. While
finance ministries to invest more in mental health ministries are central to protecting and
AUTHORS REVIEWERS health. promoting public health via both provision and
Dr Zachary Burton, Co-Founder, The Sarah Kline, Co-Founder and Interim oversight of health services and advocacy toward
Manic Monologues; Researcher, Stanford CEO, United for Global Mental Health This guide is written for all those seeking to securing and managing public expenditure for
University increase government mental health funding, health, it is the finance ministries that generally
Dr Shekhar Saxena, Professor of the especially those in civil society and therefore control the allocation of this public expenditure
James Sale, Policy and Advocacy Practice of Global Mental Health, Harvard on the outside of government. The authors and of resources broadly speaking — that is,
Manager, United for Global Mental Health T. H. Chan School of Public Health hope that this guide will provide a helpful across the many areas that governments have
framework and overarching guidance, but the responsibility for. Hence, finance ministries
Olivia Rowe, Student, London School of Dr Eliot Brenner, Executive Director, most important component to making the case are the key decision makers in allocating such
Hygiene and Tropical Medicine Klingenstein Philanthropies for investment is always the national and local resources amongst potentially competing needs
context that must be added by the reader — and priorities, and amongst competing sectors.
Priti Sridhar, Chief Development Officer, every finance ministry is different.
Mariwala Health Initiative This said, note that while we shape our language
The authors/GMHAN would be open to working herein toward finance ministries, the same
with local CSOs in case they are interested in arguments and strategies we detail here may also
In addition to our generous reviewers, the authors would like to thank the members of creating a document specific to their country be quite useful and applicable in approaching
the Global Mental Health Action Network’s Financing Mental Health Working Group for any domestic governmental body influencing
continued discussions and input throughout the development of this guide, including Why finance ministries? financial decisions (e.g., legislatures), as well as
special thanks to Mathew Mutiso (Coalition for Action for Preventive Mental Health, The mental health of any population is not private foundations, international donors, non-
Kenya), Ann Lindsay (World Federation for Mental Health, Geneva), Christie Kesner simply a healthcare concern. Mental health is a governmental organizations, and other allocators
(United for Global Mental Health), Bhawesh Jha (Mariwala Health Initiative, India), Yves cross-societal issue fundamental to sustainable of funding.
Zuñiga (Department of Health, Philippines), and Dr Valentina Iemmi (London School of development1 and basic human rights2 —
Economics and Political Science). therefore, a cross-governmental approach is
essential. The most effective mental health

For more information please contact gmhan@unitedgmh.org

Framework presented in this guide HOW TO

1. PROVIDE A QUICK, HIGH-LEVEL SUMMARY As an illustrative example, it may be helpful

As with general approaches to the crafting to see how our own group has approached
of persuasive arguments, key to effective the crafting of such a summary. The following
communication of the urgency and need for example is taken from a Devex op-ed3 published
1. PROVIDE A QUICK, HIGH-LEVEL SUMMARY investment in mental health is the ability to make on October 15, 2020, which was based on a brief4
this case for investment succinctly. This becomes communicated to Ministers of Finance gathered
particularly relevant given that campaigners and at the 2020 Annual Meetings of the International
advocates may be faced with limited time in front Monetary Fund and World Bank, both of which
2. DESCRIBE THE MAGNITUDE OF THE PROBLEM of ministry and general government officials — were written by members of GMHAN.
they must therefore make their case quickly and
effectively, and ideally in a manner that prompts These pieces were written to urge finance
3. DESCRIBE THE RETURN ON INVESTMENT (ROI) ministers and officials to gain interest, and delve ministries across the world to invest in mental
IMPACT OF INVESTMENT into further discussions of approaches to and health — which is to say this is a much more
pathways for such investment. general call to action than would be most
appropriate for a specific national, state, or city
Taking this into account, the first key component government.
4. DESCRIBE CLEAR, EFFECTIVE PATHWAYS FOR INVESTMENT
to communicating the need for mental health
investment effectively is a high-level summary (to After you have read this example, we will
be communicated in anywhere from less than a break down the various components of this
5. MAKE CLEAR WHY NOW IS THE TIME TO ACT minute to a few minutes of time). This summary short summary-level piece in hopes of better
should succeed in simultaneously capturing the illustrating an easy-to-follow, applicable
magnitude of mental health concerns, presenting framework for crafting both written and spoken
6. SUMMARIZE: REVISIT IMPORTANCE, IMPACT, AND clear and actionable pathways for investment appeals for mental health investment.
PATHWAYS FOR INVESTMENT (and attendant ROI/impact of such pathways),
and communicating why investment via such
pathways is of an urgent nature.
TEMPLATE: EXAMPLE FOR CAMPAIGNER USE
Demonstrating the Case for Mental Health Investment to Finance Ministers

The original text of the op-ed summary around the economic cost of mental health
statement (provided in blue): conditions. For example, is there measurable
health-related productivity loss (e.g., how many
“Even before COVID-19, the world was not days were lost due to impaired performance?)?
equipped to respond to the mental health needs Is there measurement or estimation of the cost,
of its populations. Mental health and substance- in terms of GDP equivalent or USD/local currency
use conditions are the global leading cause of amount?
years lived with disability, 1 in 5 of the world’s
children have a mental health condition, and c. What else could be included: Forecasts or
suicide is the second-leading cause of death projections of the disease burden of mental
among those aged 15 to 29. COVID-19 is set to health conditions can also be effective means by
exacerbate this situation. which to demonstrate the (growing) magnitude
of the problem. In our example, we have
“The enormous human cost of mental health alluded to an anticipated increase in mental
ought to itself galvanize government investment. health challenges and attendant burden due
But the unique economic costs — and potential to COVID-19. What challenges are projected for
benefit of investment — combined with the need your specific country setting? If this information
to address the impact of COVID-19 on society, is lacking, general WHO projections on the
only strengthen the case for financing mental composition of global disease burdens due to
health. As finance ministers attend the annual various conditions can be effective, as well.
meetings of the International Monetary Fund and
World Bank this month, now is the perfect time 2. Describe the return on investment
to increase human capital through investment in (both in monetary terms, and in terms of health,
mental health.” societal, individual, etc. returns and benefits):

A breakdown of the approach a. We have not specifically addressed ROI

we employed here: or impact in the summary above, aside from
generally alluding to the “potential benefit of
1. Encapsulate the magnitude of the investment.” As with pathways for investment,
problem: the ROI/impact of investment should be tailored
for specific national- to local-level contexts. For
“Even before COVID-19, the world was not further discussion of communicating ROI and
equipped to respond to the mental health needs impact of investment, see Section 3, “DESCRIBE
of its populations. Mental health and substance- THE ROI/IMPACT OF INVESTMENT,” below.
use conditions are the global leading cause of
years lived with disability, 1 in 5 of the world’s 3. Provide proven pathways for investment:
children have a mental health condition, and a. In the example above, we have not provided
suicide is the second-leading cause of death specific examples of pathways to effective and
among those aged 15 to 29. COVID-19 is set to impactful investment in mental health, but, these
exacerbate this situation.” should be included for country- and state-level
applications. For discussion of how to present
a. What we included: Here, we have included such pathways, see Section 4, “DESCRIBE CLEAR,
information on the prevalence of mental health EFFECTIVE PATHWAYS FOR INVESTMENT,” below.
conditions, on the burden of these conditions,
and on the scale of life lost due. We have also 4. Finish the high-level summary by stating
focused on potential impacts of the COVID-19 why now is the time to act.
pandemic here. That is, answer the question of why investment “Even before COVID-19, the
in mental health is terribly urgent and needed for
b. What else could be included: For specific your particular setting and context: world was not equipped to
country- to local-scale settings, as well as
international settings, advocates might also respond to the mental health
consider incorporating some statistics or figures
needs of its populations.”
Demonstrating the Case for Mental Health Investment to Finance Ministers Demonstrating the Case for Mental Health Investment to Finance Ministers

a. What we included: Due to the general, The economic impact of poor mental health of wages. Poor mental health also has broader It has been estimated that 76–85% of those
intentionally broad nature of our call for economic costs to society with issues such as living in low- and middle-income countries with
investment, our justification for the urgency of Given that finance ministries are concerned substance misuse often leading to increased a mental disorder do not receive treatment.10
investment includes both the “magnitude of the about the economic activity of the population rates of crime and incarceration.
problem” wording, described briefly above, an they serve, describing how poor mental Over time, poor mental health and failure to
appeal due to the growing burden of COVID-19 health can affect this is effective in capturing • Globally, close to 1 billion individuals are living address such also carries significant costs for
(the succinct text “COVID-19 is set to exacerbate the attention of decision makers. There are with a mental disorder — it is estimated that in national health systems,11 which are facing
this situation.”) and an appeal due to the many factors that impact the performance of some economies as many as 21% of the working challenges from growing, diversifying, and
specific context in which we sought to appeal economies, and perhaps the best example with population has some form of mental health issue ageing populations, rising prevalence of chronic
to ministries, being the Fall 2020 IMF/World regard to mental health is discussion of the at any given time.5 illnesses, use of expensive technologies, and the
Bank Meetings (communicated with the text “As workforce — such as how poor mental health COVID-19 pandemic.
finance ministers attend the annual meetings of prevents significant portions of the workforce • An estimated 12 billion productive days are
the International Monetary Fund and World Bank from attending work, or, how poor mental health lost each year due to depression and anxiety COVID-19 is causing further concern — for
this month, now is the perfect time to increase negatively impacts work performance. alone.6 As a result, the global economy loses governments, companies, and individuals.
human capital through investment in mental about US$1 trillion every year in productivity due WHO recently released evidence stating that
health.”). It will be best to use data and other evidence that to depression and anxiety — more than cancer, 33% of countries have reported complete
is based on the country or area that the finance diabetes, and respiratory diseases combined.6 or partial disruption across at least 75% of
Final note of importance ministry is responsible for, however, it may also specific mental, neurological, and substance
As stated in the Introduction to this guide, “the be useful to give the global context or evidence • Wider mental health and substance use use-related interventions/services. This
most important component to making the case from other similar countries, particularly conditions are the global leading cause of level of disruption was the highest within
for investment is always the national and local when national evidence is scarce or lacking. years lived with disability (22.9% of all YLDs),7 countries in the community transmission
context that must be added by the reader” Furthermore, whenever possible, it is important contributing to economic output losses of stage of COVID-19 (44% disruption).12 Early
— and so, too, is this true of crafting the High- to use the language of finance ministries or US$2.5–$8.5 trillion globally — a figure which is evidence already demonstrates higher rates
level Summary statement to be communicated economists, such as highlighting impacts on projected to nearly double by 2030.8 of distress, depression, and anxiety in affected
succinctly to ministries and government funding national measures of economies like gross populations,13 and what’s more, mental
bodies. The magnitude and nature of mental national product (GDP) or gross national ill health typically rises during economic
health issues, the impact and ROI, the examples income (GNI). These are losses of human capital countries recession. Therefore, mental as well as physical
of successful pathways for investment (e.g., cannot afford, particularly in times of economic resilience in the face of uncertainty is critically
successful programming and initiatives), and the Resources for communicating such can uncertainty. important. Individuals, business, and society as
reasoning for why investment is urgent should all be gleaned from a variety of sources, such a whole need to ensure sufficient investment
be tailored to the national context within which a as academic papers, government reports, Despite this high disease burden and attendant in addressing mental health now and in the
campaigner or advocate employing this guide is global institution reports (such as the World economic impacts, mental health continues to future as we face global uncertainty — some
operating. Health Organization, the International Labour suffer from historic underinvestment. national governments have realised this,
Organization, or the World Bank), and civil society shown leadership, and are acting quickly.14
HOW TO: organizations. Many private sector organizations • Globally, government mental health
2. DESCRIBE THE MAGNITUDE OF THE have also researched the impact of good or poor expenditure is less than 2% of total government
PROBLEM mental health on companies and economies. health expenditure.9 This equates to a global HOW TO:
median annual government mental health 3. DESCRIBE THE ROI/IMPACT OF INVESTMENT
In order to make the case for mental health Below, we have provided some examples of expenditure of just US$2.50 per capita, with
investment, it may be necessary to describe the the sort of global mental health and economic wide geographical variation and disparity — Critical to any successful campaign directed at
current situation and the scale of the mental context, in the form of compelling data and for instance, in low-income countries annual finance ministries is a clear demonstration of
health problem at hand, and demonstrate and figures, that can be conveyed in demonstrating expenditure is just US$0.02 per capita per year.9 favorable return on investment (ROI) in mental
make evident that mental health issues represent the magnitude and extent of the economic The health impacts of poor mental health on the health.
a problem of tremendous magnitude. By burden of mental health. population and the cost of health systems
analysing and communicating the problem, the Campaigners and advocates to finance ministries
solutions that are put forward (such as greater Mental health and economic performance are Although usually the responsibility of the should certainly include information describing
investment by the government) can be seen as interlinked. Mental health issues limit people’s health ministry, it can be beneficial to make ROI in terms of a financial return (for example,
addressing a real problem. This can be done in opportunity to work and earn an income. This fall clear to the finance ministry the health burden communicating a figure such as “there is a
various ways. in productivity results in significant output losses of ill mental health.
for the economy, and reduces local economic
reinvestment normally produced by spending
Demonstrating the Case for Mental Health Investment to Finance Ministers Demonstrating the Case for Mental Health Investment to Finance Ministers

return of US$4 for every US$1 invested — i.e., HOW TO: importance of early intervention in mitigating the
a 4x return”). However, campaigners should 4. DESCRIBE CLEAR, EFFECTIVE PATHWAYS FOR At the most fundamental level, campaigners development of more serious disorders later in
also think about and include broad examples INVESTMENT must be able to convincingly and compellingly life, and, in moving an individual more quickly to
on the impact of mental health investment — This is a key section. Any case presented to answer for ministries the question of: “Where recovery.26
for example, health and social outcomes, and finance ministries or similar funding bodies should we put our money?” (With the follow-up
the full impact on individuals’ lives and on their is rendered most effective if campaigners question being, “Why?” which is where conveying 3. Encourage and support programming
communities, businesses, economies, and society and advocates provide ministries/potential the ROI and impact of investment becomes in the workplace: Workplace policies and
at large. Again, such examples will be all the more funders with very tangible, specific pathways for critical.) programming benefit not only the health of
effective if tailored to a campaigner’s specific investment in mental health. employees, but also create significant increases
country or regional setting and situation — and Examples of tangible pathways and in worker productivity (and thus, productivity of
better yet if this ROI and impact is tailored to Below, we provide multiple examples of programming: a given company) as well as increases in overall
specific programmes and interventions brought tangible pathways and options for “most community wellbeing.27
up by the campaigner for Section 4. DESCRIBE impact” interventions and programming that 1. Integrate mental health services into
CLEAR, EFFECTIVE PATHWAYS FOR INVESTMENT. campaigners and advocates may point to when primary care and priority health care
engaging with finance ministries (wherein “best programmes:21 4. Develop specific programmes to meet the
Broadly speaking, investment in mental health buy” denotes “affordable, feasible and cost- needs of marginalised groups:
gives a direct return on investment, as healthy effective intervention strategies”18 — which can a. Integrate mental health services into primary a. For example, create mental health services
individuals are able to actively participate in be quite useful examples to cite in demonstrating care: In a 2008 WHO-Wonca report, former for persons who experience domestic violence,
workplaces, community, and family. significant ROI to government funding bodies WHO Director-General Dr Margaret Chan and which should include services well beyond
such as finance ministries). Professor Chris van Weel wrote that “integrating counselling services (such as temporary housing,
Campaigners can cite recent research, which mental health services into primary care is the employable skill development, and legal services).
found that for every US$1 invested in scaled-up As in other sections, it should be noted that most viable way of ensuring that people have Create mental health services for impoverished
treatment for common mental issues, there is a the most effective approaches should identify access to the mental health care they need.”22 demographics, for unemployed and out-of-
return of around US$4 in improved health and key targets for investment that are specific to Primary care providers, clinics, and health work individuals, for individuals generally
productivity.15 a campaigner’s geographic region (whether workers are an essential potential touch point discriminated against on the basis of race or
national or local) — and accordingly, not all for effective mental health interventions, given ethnicity, gender or religion.
Despite this, most governments spend less examples listed below will necessarily be that up to 60% of individuals visiting primary
than 2% of their budget on mental health.16 appropriate or reasonable in all settings. care clinics have diagnosable mental health b. Create social support for people living
Because this is much lower than the actual needs conditions.22 Finance ministries could facilitate with mental health challenges. These could
of most communities, this dearth of funding Generally, the easier, more direct, and more this by providing adequate budget for employee include providing support in helping individuals
results in high out-of-pocket expenditure on straightforward the pathway for investment, benefits in government organizations. find employment, providing continuation of
mental health services by communities and their the better the advocate’s case for investment education, and providing monetary support for
members. Campaigners can make the case that to target ministries and governmental funding b. Integrate mental health services into persons with long-term mental health support
increasing expenditure on mental health to the bodies. However, we remind the campaigner, and priority health care programmes: Integration needs.
recommended 5–10% of total health expenditure strongly emphasize, that cost-effectiveness is but of mental health interventions into priority
would help in achieving SDG Target 3.8 (Universal one of numerous criteria that must be assessed health areas such as HIV/AIDS, tuberculosis, and c. Important note: It should be noted that any
Health Coverage) by 2030.17 when prioritizing mental health investment. maternal, newborn, and child health has been development of programmes should include
Prioritizing cost-effective interventions is not demonstrated to strengthen prevention and care both service delivery and care provision as well
This general information on ROI aside, and as always fair or equitable — for example, treatment outcomes, improve access to care, and increase as anti-stigma and awareness efforts.
written above, it will be most compelling and of schizophrenia may be deemed less cost cost effectiveness of programming.23,24,25
effective if campaigners are able to cite specific effective due to severity of illness and resultant 5. Invest in non-specialist community-based
facts, figures, and data to convey the ROI, impact, scale of treatment needed, but, withholding such 2. Support interventions for children and programmes to improve access to care:
and full suite of positive outcomes of specific treatment on the basis of cost-effectiveness adolescents: Evidence-based psychosocial a. For example, innovative mental health service
interventions and pathways for investment would not only be deleterious to the health, interventions for children and adolescents delivery models (such as collaborative, low-
according to their national- to local-scale context. wellbeing, and ability to productively engage in such as peer support, crisis counselling, and cost programmes in Kenya, Pakistan, India, and
the workplace and society at large of individuals community referral pathways can be effective Zimbabwe highlighted by WEF28 or community
requiring such treatment, but would be unjust and should be of high priority, given the projects providing pandemic-era mental health
and a violation of basic human rights.19,20
Demonstrating the Case for Mental Health Investment to Finance Ministers

support, recently provided investment by the U.K. (Convention on the Rights of Persons with
Government29) could help in bridging the mental Disabilities).31 Provide rights to persons with
health treatment gap. mental health issues.

b. As a more detailed example, the accredited c. Important note: It must be ensured that the
social health activist (ASHA) program30 empowers committee undertaking policy and regulatory
community health workers appointed by the work has representatives from various
Government of India’s Health Ministry to work marginalised groups, as well as people who have
on various health issues. These workers are lived experience, to include those with caregiving
usually women in the community who will create responsibilities.
awareness on health and its social determinants
and mobilize the community towards local 9. Strengthen information gathering,
health planning and increased utilization and exploration of evidence-based practice, and
accountability of the existing health services. research for mental health:32
Such a model can be adopted to deliver mental
health services. a. Invest in undertaking research to assess
the extent of mental health issues faced by the
6. Establish technology-based national country.
helplines and/or crisis lines:
a. Integrate counselling services into existing b. Invest in research to document and measure
helplines already in use by the government (e.g., effective local practices that build community
helplines already established for the reporting mental health.
of crimes, informational helplines for child and
maternal health, etc.). c. Important note: It must be ensured that
any such data collection is not stigmatising, and
b. Important note: It must be ensured that protects the confidentiality of any subjects or
there are ethical guidelines issued for usage of participants involved.
such technology (to include both appropriate
privacy measures as well as training of helpline
operators). HOW TO:
5. MAKE CLEAR WHY NOW IS THE TIME TO ACT
7. Integrate mental health services with
emergency and disaster relief: An integral part of communicating the case for
a. Successful integration should involve capacity mental health investment to finance ministries
building of emergency relief committees, is communicating a sense of urgency and of
disaster management bodies, and mental health immediate need for this investment.
professionals in conjunction for the provision
of psychosocial support during emergency and The COVID-19 pandemic has shown us that
disaster situations. when countries perceive a global health issue
as an imminent national threat, they are ready
b. Ensure that monetary relief includes funding and willing to rapidly pivot their policies and
for mental health services. programmes in response, and to scale up
national investments in health.
8. Develop and implement regulations and
policies:
a. Create a National Mental Health Policy that
establishes the philosophy and comprehensive
approach to mental health.

b. Reevaluate any existing Mental Healthcare

Act: Ensure compliance with UN CRPD

.
Demonstrating the Case for Mental Health Investment to Finance Ministers Demonstrating the Case for Mental Health Investment to Finance Ministers

Accordingly, we have provided some examples There is also a lack of development aid for mental disasters such as Hurricane Katrina suggests the community services, ensuring coverage for
below that any campaigner or advocate should health. For example, in 2015, development aid to impact of COVID-19 on bereavement, fearing mental health conditions in health insurance
feel free to use in communicating the urgent mental health totalled US$132 million, just 0.4% for loved ones’ well-being, and lacking access packages, and building the human resource
need for investment, and in making clear to of total development aid to health.35 to medical care and medications could lead to capacity to deliver quality mental health and
finance ministries that now is the time to act. adverse impacts on public mental health for up social care in the community.” 44
With an estimated 75% of individuals with a to 12 years into the future.41
a. The prevalence and burden of mental illness mental disorder in lower- and middle-income g. Examples of countries investing in
is growing countries (LMICs) receiving no treatment at all Immediate action is needed to address the rising mental health
for their disorder, scaling up access through prevalence of mental health conditions and to
In addition to affecting one in four of us over a increased mental health financing for LMICs is of support individuals to recover from COVID-19 in a A campaigner could include examples of other
lifetime, mental health conditions represent a utmost urgency.36 way that prevents potential longer-term negative countries making ambitious investments in
growing burden of disease. If we don’t intervene impacts on mental health. mental health as a means to further motivate
now, this burden may continue to rise. d. COVID-19 has significantly affected investment by their own government.
mental health e. The relationship of COVID-19, global poverty,
WHO reports a 13% rise in mental health and mental health New Zealand announced its first-ever wellbeing
conditions and substance use disorders since As Dr Tedros Adhanom Ghebreyesus, Director- budget in 2019, which included nearly NZ$500
2017.33 General of the World Health Organization, In addition to the direct psychosocial impacts of million of investment in mental health services
highlighted: the COVID-19 pandemic, we also expect to see and suicide prevention services, as well as
b. Mental illness represents a substantial, indirect impacts on global mental health from the commitments to tackle wider determinants of
growing cost to the global economy “COVID-19 has interrupted essential mental wider economic fallout. mental health such as homelessness and child
health services around the world just when poverty.45
Adequately financing mental health services and they’re needed most. World leaders must move Under the baseline scenario, COVID-19 could
programmes now could save millions to billions fast and decisively to invest more in life-saving push an additional 176 million into poverty, Indonesia reported total government
of dollars — or more — in the future. mental health programmes — during the most of whom will be concentrated in countries expenditure on mental health as 6% of total
pandemic and beyond.” 37 already struggling with high poverty rates in government health expenditure in 2017.46 They
Mental ill-health represents a significant South Asia and Sub-Saharan Africa.42 We know also reported that care and treatment of persons
economic burden, with depression and anxiety The COVID-19 pandemic has presented that mental illness and poverty interact in a with major mental disorders was included within
alone estimated to cost the global economy US$1 unprecedented challenges to all aspects of global vicious cycle, and this increase in poverty will national health insurance or reimbursement
trillion every year.33 life. By disrupting critical mental health services therefore likely have a significant impact on the schemes and that fully insured persons would
in 93% of countries worldwide and exacerbating global burden of mental illness. pay nothing at the point of service.
c. Allocation of economic resources for mental the already-growing burden of mental illness,
health has been severely limited the pandemic has shown us that investment in However, investing in mental health interventions This investment surpasses the standard set by
mental health is needed now more than ever now could help break the bidirectional the Lancet Commission on Global Mental Health,
Outlining how poorly mental health has been before.37 relationship between poverty and mental illness whereby lower- and middle-income countries
financed historically can help make the case that and improve people’s economic and social should be spending at least 5% of their health
significant investment is needed immediately if The pandemic and its impact on known wellbeing.43 services budget on mental health.47
we are to have any hope of meeting the targets risk factors for mental ill-health (such as
set out in the WHO Mental Health Action Plan. bereavement, isolation, and loss of income) is f. COVID-19 presents an opportunity to “build The U.K. National Health Service (NHS) Long Term
triggering new mental health conditions and back better” Plan48 commits to grow investment in mental
exacerbating existing ones. We have seen high health services faster than the NHS budget
The WHO Mental Health Action Plan 2013–2030 — and growing — rates of anxiety, depression, As Dévora Kestel, Director of the Department overall, which represents at least a further £2.3
was adopted unanimously at the World Health post-traumatic stress disorder, and psychological of Mental Health and Substance Use at WHO, billion a year by 2023–2024. The NHS in England
Assembly in 2013. However, only 53% of distress amongst the general population argued: is already meeting the goal set by the Lancet
countries globally have resourced policies for worldwide through the COVID-19 pandemic.38,39 Commission on Global Mental Health,47 whereby
this, with wide disparity — for example, only 27% “The scaling-up and reorganization of mental high-income countries should be spending at
of African countries have resourced policies.34 The mental health impact arising from the health services that is now needed on a global least 10% of their health services budget on
pandemic is expected to be long-lasting, with scale is an opportunity to build a mental health mental health.
Overall, less than 2% of global median experts predicting a “tsunami of psychiatric system that is fit for the future.
government health expenditure goes to mental illness” to come.40 Extrapolating from previous
health.33 This means developing and funding national
plans that shift care away from institutions to
Demonstrating the Case for Mental Health Investment to Finance Ministers

In consecutive years, the NHS in England has statement such as, “We would like xx amount of
increased local funding for mental health by funding for xx prevention program, which will
at least as much as the overall increase in the result in xx ROI and include xx impacts.”
money available to local clinical commissioning
groups. This is called the mental health TEMPLATE EXAMPLE
investment standard.49 FOR CAMPAIGNER AND ADVOCATE USE

h. We need to be prepared for future The text below provides an example of how one
global challenges might approach communicating the case for
mental health investment to finance ministries.
COVID-19 will not be the last adverse event to Note that this example is very general, in that it
impact global mental health. If we act now, we does not target any single national context, but
can build a more resilient and mentally healthy is rather presented as a global call for mental
society that is better prepared to tackle future health investment from finance ministries.
global challenges.
Accordingly, the campaigner or advocate using
For example, with projected environmental this guide should be sure to include examples
modifications, upheavals, and climate disasters of the magnitude of mental health challenges
expected as a result of climate change, we can that are specific to their national or local context,
expect an increased number of threats to our examples of returns on investment and impacts
mental health and wellbeing in the future.50 of investment that are tailored to their national
This includes both the immediate mental health context, pathways for investment and examples
impacts of extreme weather events as well of effective programming that are specific to
as longer-term indirect impacts such as mass their national setting, and any additional points
climate-related migration. of evidence or motivation for investment by their
local finance ministry or fund-granting body.
HOW TO: EXAMPLE:
6. SUMMARIZE: REVISIT IMPORTANCE, IMPACT, THE CASE FOR INVESTMENT IN MENTAL HEALTH
AND PATHWAYS FOR INVESTMENT
SUMMARY
Campaigners should succinctly wrap up their Even before COVID-19, the world was poorly
presentations of the case for mental health equipped to address the enormous and growing
investment to finance ministries. In many ways, health, economic, and human capital costs of
the final summary section is similar to the mental health challenges.
introductory High-Level Summary (the 30-second-
or-so “pitch” of the project) given by an advocate Before COVID-19, 12 billion productive days were
or campaigner. Repetition is highly effective in being lost every year due to depression and
both conveying and convincing a target party of a anxiety alone, resulting in productivity losses of
given point. US$1 trillion each year. Pre-pandemic, economic
losses of US$2.5 trillion to US$8.5 trillion occurred
Overall, this summary should incorporate key due to broader mental health and substance
points of the above five sections. This final
summary should likely include final short words
use conditions every year — a cost predicted to “The scaling-up and
double by 2030. COVID-19 is set to significantly
on the importance and impact of investment, exacerbate this cost to societies and economies — reorganization of mental
with a particular focus on ending with some for example, not only did 93% of countries report
immediate, meaningful pathways for investment disruption or complete halting of critical mental health services that is now
in mental health by the specific ministry. That is,
campaigners should end with and emphasize a
health services as early as October 2020, but the
uncertainty, stress, and forced isolation brought
needed on a global scale
clear call to action (a clear “ask” of the ministry).
For example, the campaigner might end with a
on by the pandemic is itself giving rise to a marked is an opportunity to build
a mental health system
that is fit for the future.”
Demonstrating the Case for Mental Health Investment to Finance Ministers Demonstrating the Case for Mental Health Investment to Finance Ministers

rise in anxiety, depression, burnout (including These enormous health, human, and societal THE RETURN ON INVESTMENT (ROI)/IMPACT OF outcomes, access to care, and cost effectiveness
of critical frontline workers), and myriad mental costs alone are losses no country can afford. INVESTMENT for both priority programmes and mental health
health challenges. But, to exacerbate the situation, mental health In purely economic terms, the return on interventions.
conditions also carry tremendous economic costs, investment in mental health is tremendous.
Fortunately, finance ministries are uniquely losses to productivity, and significant detrimental Previous workers have demonstrated that for Workplace policies and programming should
positioned to harness numerous proven impacts in the workplace. Before the pandemic, every US$1 invested in treatment for common be harnessed as highly beneficial not only to
pathways for investment in effective mental depression and anxiety alone were resulting in mental health issues, there is a return of US$4 in employee mental health, but as a significant
health programming and services, as well as to a loss of 12 billion productive days every year, improved health and productivity. mechanism for increasing worker productivity and
benefit from significant returns on investment and translating to annual economic losses of US$1 overall productivity of the worker’s employer and
invaluable impacts to individuals, communities, trillion. And, this significant economic return only local economy at large.
and local and national economies brought about scratches the surface of the myriad meaningful
by transformative investment in mental health. In Broader mental health and substance use health, social, and economic benefits of such Programmes focused on marginalized groups and
the wake of COVID-19, finance ministries have the conditions were resulting in economic losses of investment, and only begins to illustrate the on non-specialist, community-based solutions
chance to take on a crucial role in ensuring that US$2.5 trillion to US$8.5 trillion every year — a full impact that investment has on individual’s can be particularly effective, low-cost pathways to
societies and nations rebuild better — in a manner figure which, before the pandemic, the World lives, their communities, their businesses and realizing significant mental health outcomes.
that harnesses the powerful complementary Economic Forum and Harvard T. H. Chan School local economies, and society at large. What’s
impacts of investment in mental health as of Public Health forecast to double by 2030. more, such investment will be fundamental in Numerous additional effective pathways for
integral to not only COVID-19 recovery, but also to COVID-19 is set to significantly exacerbate this cost achieving much-needed impact on sustainable investment exist, such as technology-based
effectively addressing priority health areas (such to societies and economies. development, universal health coverage, and counseling and crisis line services, development
as HIV/AIDS, TB, and maternal, newborn, and child attainment of fundamental human rights. of national policy and regulatory instruments, and
health), to ensuring attainment of basic human Despite this high disease burden and attendant research and development, information- and data-
rights, and to ensuring sustainable development, economic impacts, mental health continues to Investment in mental health makes good gathering, and development of new evidence-
economic growth, and prosperity in the years and suffer from historic underinvestment. Globally, economic sense. This investment will not only based practices.
decades ahead. government mental health expenditure is less bring finance ministries substantial economic
than 2% of total government health expenditure. returns, but will also constitute a catalytic WHY NOW IS THE TIME TO ACT
Given the looming post-COVID-19 mental health This equates to a global median annual contribution to transformative health, societal, As we emerge from the COVID-19 pandemic and
crisis predicted by global health and development government mental health expenditure of just and economic outcomes — as well as favorable face the challenge of addressing and recovering
experts — but also the tremendous significant US$2.50 per capita, with wide geographical sustainable development outcomes at large — for from first the immediate and then the long-term,
returns on mental health investment and positive variation and disparity — for instance, in low- the future wellbeing, growth, and prosperity of long-lasting effects of the pandemic, finance
impact of investment to individuals, societies, income countries annual expenditure is just every community, government, and nation. ministries have a unique chance to set the stage
and national economies — now is the time to US$0.02 per capita per year. for decades of sustainable development ahead.
act. Finance ministries should take the lead in CLEAR, EFFECTIVE PATHWAYS FOR INVESTMENT
providing catalytic investment in mental health This historic underinvestment is connected to Fortunately, there are numerous proven, The economic and societal burden of mental
for the profound betterment of both national existing health outcomes. For example, 76–85% straightforward pathways for high-return, health was tremendous in the years leading up
economies and society at large. of those living with a mental disorder in low- and impactful investment in mental health. At the to the pandemic. This burden has already grown
middle-income countries do not receive treatment highest level, increasing government expenditure significantly and rapidly due to COVID-19, and is
MAGNITUDE OF THE PROBLEM — and therefore are oftentimes impaired in on mental health to the recommended 5–10% of only predicted to grow much worse.
Mental health and substance-use conditions are their ability to not only meet their full productive total health expenditure would increase service
the leading cause of years lived with disability potential in contributing to their local economies, coverage by 40–80%. At this pivotal moment in history — this moment
in the world, with 23% of all YLDs attributable but also to lead meaningful and healthy lives. that will surely be remembered for decades
to these conditions. Globally, nearly 1 billion Such investment can support integration of to come with regard to how leadership and
individuals are living with a mental disorder. These This historic underinvestment has been a mental health services into primary care (which governments led the way in recovery from the
conditions significantly affect all ages, with 1 in 5 significant detriment to attainment of desirable has been described by WHO as the most viable pandemic, and in lifting nations from the health
of the world’s children living with a mental health mental health outcomes in the past, but also way of ensuring mental health care access), as well and economic crises felt worldwide — it is critical
condition. Unfortunately, suicide is the second- offers opportunity — investment is proven to go a as integration into priority health programmes that finance ministries take the lead in providing
leading cause of death among individuals 15 to 29 long way, with significant returns both in economic (such as HIV/AIDS, TB, and maternal, newborn, and transformative investment in mental health in
years of age. terms and in terms of benefit to individuals, their child health — and, also including integration with order to ensure sustained wellbeing, productivity,
workplaces, and their communities. emergency and disaster response programmes), and prosperity for their nations for many years to
which is proven to strengthen prevention and care come.
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