WHO/Europe has published a new policy paper focusing on how countries can make mental health care more accessible and less stigmatizing through primary health care.
The paper, entitled “Scaling up mental health services within the primary care approach: lessons from the WHO European Region”, is the latest in a series that summarizes current evidence and offers practical ways to produce better health outcomes through increased investment in primary care and the adoption of the broader approach set out in the Astana Declaration.
Between one third and one half of all people presenting to primary care services do so because of mental health complaints, making primary care a crucial point for building trust in health systems. However, because of how mental health care has historically been delivered in many countries, mental health-related complaints can often go undetected. If detected, people may be immediately referred to specialist mental health services, where they often face long waiting times. These long delays can cause conditions to worsen, and the use of specialist services can also carry stigma, further discouraging people from seeking the help they need.
WHO/Europe’s new policy paper presents key evidence-based strategies for how countries can scale up mental health services within a primary care approach.
Addressing gaps in access
Despite over 125 million people living with a mental health condition in the WHO European Region, only a fraction receive the care and support they need. These access gaps are attributed to, among many other things, a shortage of trained professionals, inadequate or under-resourced facilities, and widespread stigma and discrimination that discourage people from seeking mental health care.
But mental health is shaped as much by life circumstances as by biological factors. Income, housing, education, employment and social connection all play a critical role, and struggles with these aspects of life are often the root causes of mental distress. When left unaddressed, these social determinants contribute to worse health and greater inequalities across population groups.
Primary care is well placed to help with both the treatment gap and many social determinants. For most, primary care is the first place they seek help. People tend to build trusted, long-term relationships with primary care providers, often spanning generations. This continuity can enable more sensitive conversations to take place, naturally weaving mental health into day-to-day care. On any given day, for example, primary care providers may meet with a young person who can’t sleep because of anxiety and an older person who is worried that they might be showing cognitive decline.
Primary care is also close to where people live, work and raise families, making it well placed to detect early warning signs of illness and life stressors, offer culturally appropriate support, and reach underserved populations who might otherwise not access health services. This proximity and trust also make primary care a natural hub for linking with services in other sectors and connecting individuals to other helpful resources in their community, such as social services or school programmes.
A broader public health approach
Many challenges impede the effective delivery of mental health care in primary care settings, such as financial and budget constraints; limited and overburdened human resources; a lack of training among primary care workers in delivering mental health services; and inadequate communication and referral between primary care professionals, specialists and other community services.
To help countries address these challenges and make mental health care more accessible, WHO/Europe synthesized evidence and good examples from across the Region on how to deliver mental health care more effectively within the primary care approach.
“Primary health care is not just a frontline service,” says Natasha Azzopardi-Muscat, Director of WHO/Europe’s Division of Country Health Policies and Systems. “It is the foundation of a resilient, equitable and people-centred response to mental health. It must be part of a broader public health approach where promotion of mental health and prevention of mental disorders is key to a recovery-oriented mental health care system. That’s why this policy paper is so important.”
Four key strategies
The policy paper centres on the following 4 key strategies for scaling up mental health services in primary care:
- Enhancing the mental health capacities of primary care workers: This involves training primary care workers in recognizing early warning signs of mental ill health and providing support, only referring to specialists when absolutely necessary.
- Expanding primary care teams with dedicated mental health workers: This means bringing specialized mental health workers, such as clinical psychologists, into existing primary care teams to help provide more comprehensive care in these settings.
- Strengthening linkages between primary care and specialist mental health services: This entails building stronger links between primary and specialist care to provide users with more options and smoother transitions according to their evolving needs.
- Promoting coordination and partnerships with other sectors: This involves building links with other community services – such as employment, housing and education – to address socioeconomic factors underlying mental ill health and ensure a longer-term view of recovery.
These interrelated strategies work best when implemented together, supported by investments in staff education and training, better funding models, and policy. The paper draws on both the latest scientific literature and real-world examples from countries across the Region to illustrate the possibilities.
“The evidence is clear: strong primary health care leads to earlier diagnosis, better outcomes and less pressure on hospitals,” says Melitta Jakab, Head of the WHO European Centre for Primary Health Care in Almaty, Kazakhstan.
She adds, “This matters most for people whose needs often go unrecognized, like mothers experiencing postnatal depression, older adults with early cognitive decline, or individuals whose mental health issues show up as fatigue, headaches or sleep disturbances. When people have a trusted primary care provider, these conditions are identified and addressed before they escalate. When that connection is missing, care is delayed, fragmented and far more costly – both for individuals and for health systems.”
Mental health as a return on investment
Scaling up mental health care in primary care is one way of increasing access to better quality, more inclusive services, and is part of a broader shift to strengthening mental health care delivery in the community.
“Primary care is the best place to provide person-centred care,” says Ledia Lazëri, Regional Adviser for Mental Health at WHO/Europe. “It is where care has to be sensitive to the whole person – to gender, age and more – and where we can address all their health determinants. So, there is unquestionable value in bringing mental health into primary health care.”
This capacity of primary care to attend to the whole person within their community is one of the key reasons why it delivers such strong return on investment. By investing in such services, countries can ensure a wide range of supports for all levels of mental health need, resulting in better population health and well-being, a reduced reliance on costly specialist services, and greater economic productivity.