April 5, 2019

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Transforming mental health through equity

By Patrick McGorry


Inspiring progress in mental health has been made in recent years through increased awareness, reduced stigma, and the provision of early intervention in some jurisdictions. Yet this progress has also been undermined and retarded by the more widespread and pervasive under-investment in mental health care, even in the highest-income countries. World Health Day, with its focus this year on universal health coverage, provides a timely opportunity to call for action on equity for mental health within all societies and health systems.

The scale of neglect in mental health is most noticeable in the huge gap between level of need and actual investment.

Mental illness contributes to nearly 15% of the health burden in Australia, comparable to cancer and cardiovascular disease, yet it is allocated just over 5% of the health budget. In the UK, the recent MQ: Transforming Mental Health report and its related article published in Lancet Psychiatry highlight the fact that investment in mental health research over the last decade has essentially been stagnant. It is a fraction of the investment in cancer and other medical research areas, a mismatch even more stark in the philanthropic domain than in the government sector. The gross worldwide underinvestment in mental health was also recently detailed in the Lancet Commission on Global Mental Health and Sustainable Development. The treatment gap was shown to be wide and unchanged over the past decade, with the vast majority of people on the planet with mental illness failing to access quality care.

The consequence of this neglect and inequity is a global tsunami of preventable, premature deaths, blighted lives and lost futures. This is shameful and unnecessary. The solution is the mobilisation of people around the world to demand action, major redesign and investment in new models of evidence based care, prevention and early intervention, and major growth in new research for better and safer interventions.

Individuals experiencing mental illness are often faced with poor access to mental health services. When they do receive care, access to even minimally adequate treatment is poor, with treatment rationed and capped inappropriately. The situation for individuals with severe and complex needs is bleak, as they are often locked out of community mental health services.

This level of unmet need would not be tolerated in other fields of health such as cancer. Prevention and early diagnosis are standard components of intervention in cancer, yet in mental health we typically see the direct opposite, and access to care is rarely on the basis of treatability but on the level of risk the person poses to themselves or others. This is back-to-front health care. Research into the prevention, diagnosis and treatment of mental illness is significantly underfunded, obstructing any real progress in mental health care.

What is the solution?

Increased investment in mental health care is the ‘best buy ’ in health because we can demonstrate that it will generate a major return on investment. Early intervention and sustained, evidence based care is the building block needed for a major redesign and reform of the whole public mental health system to provide accessible and quality care.

A key focus should be on young people under 25 years, who constitute the age group where mental illness is most likely to emerge, has the highest prevalence,and where effective treatment can avert the potential lifelong social and economic impacts.

This reform focus can only be progressed and sustained if it is powered by evidence, which in turn can only result from sophisticated and high quality mental health research. The latter must be accorded equity – and in the short term, affirmative action – within medical research more broadly.