Millions of people across the globe are unable to access mental health services – let alone ones that respect and promote their rights. This is a problem that is happening worldwide. This is happening in higher, middle and lower-income countries. Many people struggling with mental health conditions and psychosocial disabilities, face poor-quality care and even human rights violations in mental health services.
The urgent need to improve mental health services is why MQ welcomes the launch of the World Health Organization’s (WHO) good practice guidance and technical packages on community based mental health services: promoting human rights and recovery.
This represents a critical milestone in supporting mental health reform. It will help ensure that we respond to mental health challenges in the aftermath of COVID-19
The Key Principles:
- respect for legal capacity
- alternatives for coercive practices
- community inclusion
- community participation
- recovery approach
How does mental health research contribute?
There is increasing evidence of the effectiveness of community-based services. However, human-rights based approaches are scarcely studied in high-income countries and practically absent in research in low and middle-income countries. The studies that do exist often lack patient and public involvement and engagement, which is vital for empowering experts by experience to help improve services.
We still have a long way to go to address mental health inequalities, which is why it is one of the pillars of MQ’s Research Plan 2020-2025.
As mental health is increasingly expanding from clinical settings into society, research is essential to ensure decentralisation does not affect the quality of care. Every person living with a mental health problem should receive support that respects their dignity, is aligned with the latest scientific evidence, and supports their recovery - whether the service is provided by a psychiatrist, a peer or a community worker.
Through research, we can identify and guide the scaling-up of community-based services, such as MQ funded-researcher Dr Etheldra Nakumuli’s group support psychotherapy in Northern Uganda. Community-based services are cost-effective and consistent with human rights and recovery principles, particularly in low and middle-income countries. An important aspect of this involves giving a voice to people with lived experience from low or middle-income countries to identify and prioritise lines of research.
Focus on the person, not the disease
MQ has been a leading voice in promoting a holistic view of people affected by mental health conditions, including physical health, environment, socio-economic conditions. We take a multi-disciplinary approach, funding research across over 30 disciplines, championing public and patient involvement.
However, it is evident that:
1) We need even more coordination across sectors to harmonise scientific, healthcare, funding, and policy agendas in mental health, and
2) We cannot talk about a person-centred approach without meaningfully involving people with lived experience.
These were two clear takeaways from the most recent MQ Mental Health Science Summit, delivered in collaboration with Wellcome, which will be available on our YouTube channel next week.
Towards effective influence
In our current times of information overload, we cannot solely rely on digital channels to to influence real life practice and policy. Social media can be effective to raise awareness and transform narratives but should be complemented through networks and partnership work.
We are delighted to work as part of a global network of organisations to bring the WHO guidance to life. During the World Health Assembly, WHO revealed that 90% of Member States reported through a survey in early 2021 that mental health and psychosocial support were included in their COVID-19 response plans. The OECD’s Forum Addressing the hidden pandemic: The impact of COVID-19 on mental health also shed light on the challenges countries face and the range of policy responses that governments are exploring.
Governments are likely to adopt austerity policies as a result of the Covid-19 pandemic. This could mean public spending to high-cost crisis services and reducing spending on services that prevent problems or intervene earlier. This affects the provision of safety nets and services that promote mental health in communities, such as youth work, social care services for adults and children.
It is important that messages for policymakers address common concerns and constraints that governments face in the challenge of improving mental health services:
| Concern | Strategy |
| Competing priorities such as social, health, security or the economy |
Emphasise the alignment with national policies and international commitments. Stress the spillovers and multi-sectoral benefits of human rights and recovery interventions in mental health, such as gains in physical health outcomes, productivity, reduction of domestic violence, homelessness and addiction. |
| Lack of funding for implementation, training |
Seek influence at the policy-planning stage when funding decisions are made. Communicate ease of access in terms of financial expenditure. Present proposals in partnership with other organisations, funders, researchers or the private sector |
| Lack of funding for long-term sustainment | Highlight cost-effectiveness of human rights and recovery based interventions. |
