WHO Director-General launches mental health action plan
Dr Margaret Chan
Director-General of the World Health Organization
Excellencies, ambassadors, friends and colleagues in public health, representatives of professional associations and civil society organizations, ladies and gentlemen,
The Comprehensive Mental Health Action Plan 2013–2020 is a landmark achievement in many ways.
It focuses international attention on a long-neglected problem, and it does so with a welcome sense of urgency. It is a signal that mental health deserves much higher strategic priority. And it is a signal with an articulate and unified voice behind it.
Rarely have I seen Member States work so hard to get an action plan right and ensure that its recommendations are workable and on target.
Support came from countries with well-established mental health services in place, backed by legislation. But it also came from countries that must balance the demands of better mental health services with competition from other pressing priorities, including HIV/AIDS, tuberculosis, malaria, and high maternal and child mortality.
This tells us that mental health really matters.
The action plan is firmly rooted in the principles of human rights, and draws support from a number of international conventions that uphold human rights. This is also a landmark achievement. As some of you have noted in previous meetings of this Forum, the treatment of people with mental and behavioural problems remains cruel, inhuman, and degrading in a number of countries.
The action plan calls for change. It calls for change in the attitudes that perpetuate stigma and discrimination. It calls for change in the way services are delivered, and rightly so.
No country in the world can say that its services are reaching all those in need, with the most appropriate interventions, provided with adequate social protection, and delivered in ways that promote social inclusion and recovery.
The action plan calls for an expansion of services, and it does so in ways that promote greater efficiency in the use of resources. This tells us that coverage can expand in austere times if waste and inefficiency are reduced.
Major emphasis is given to the need to redirect resources from mental hospitals to smaller, community-based services that are integrated into general health services. As recommended, national action plans should aim to provide outpatient services, supported by an inpatient unit in all general hospitals.
Doing so facilitates the continuum of care, comprehensive care of co-morbidities, and better use of scarce human resources. Above all, it helps normalize the management of mental disorders and reduce the stigma and discrimination that have isolated people with these disorders since ancient times, leaving them helpless and hopeless.
Recommended actions are sufficiently simple and straightforward to facilitate implementation on a large scale, yet also sufficiently flexible to allow adaptation to national priorities and specific circumstances, in any resource setting.
By stressing the many opportunities for greater efficiency, the action plan helps meet the increased need for services at a time when joblessness, homelessness, and hopelessness affect so many in the current economic downturn.
The action plan aims to be comprehensive, and it is, on many levels.
It is comprehensive in its approach, from promotion and prevention to treatment, rehabilitation, care and recovery. Recent research has given us the evidence, and the confidence, to make the promotion of mental health and the prevention of disorders a realistic and entirely feasible objective.
The recommended life-course approach facilitates the early detection of problems, when rehabilitation and recovery often have their greatest chance of success. Recommended actions are strongly evidence-based, with emphasis on established risk factors and approaches that have been shown to work, especially in promoting rehabilitation and recovery.
Because the determinants of mental health are so broad, the action plan is comprehensive in its engagement of numerous non-health sectors, including education, social welfare, labour, housing, and the judiciary. It gives due credit to the tremendous support provided by civil society organizations, including peer support from patients’ associations.
The wide-ranging and inclusive scope is readily apparent in the menu of policy options for the implementation of recommended actions. Everything is there: from the inclusion of services and essential medicines in health insurance schemes, to programmes to counter bullying in schools, from yoga and meditation, to the importance of mental health legislation, from the dangers of over-diagnosis and over-medicalization, to the importance of information and monitoring.
We are well aware that many countries will need technical support from WHO to implement the action plan. We are fully committed to provide this support at all three levels of the Organization, and are taking steps to enhance our capacity to do so.
Just as there is no health without mental health, there is no progress without clear benchmarks for measurement. And this is what we all want to see: progress.
The action plan is not just visionary. For the first time, Member States have set ambitious global targets for monitoring levels of implementation, progress, and impact.
Think about what achieving these targets will mean. By 2020:
- 80% of countries will have introduced or updated a national plan for mental health in line with international and regional human rights instruments.
- Half of all countries will have developed or updated their mental health legislation to protect human rights.
- Service coverage for severe mental disorders will show a 20% increase.
- 80% of countries will have at least two multisectoral programmes for the promotion of mental health and the prevention of disorders.
- The suicide rate will have gone down by 10%.
- And 80% of countries will be routinely collecting and reporting on a core set of mental health indicators.
The enthusiastic participation of so many in the development of the action plan leaves me confident that these targets can be reached. Doing so will be a major step forward in giving many millions of people hope and a chance for a healthy life, in all its dimensions.