Investing in a more resilient European region with better systems

Copenhagen, October 10, 2023

Mental health systems in the European Region are not suitable for the conditions currently prevailing in the world.

In a region where one in seven suffers from a mental illness, too few people receive any support and care. Many people continue to be discriminated against because they seek psychiatric help – this can lead to the loss of a job or apartment; At the same time, physical health problems are sometimes incorrectly attributed to an existing psychiatric diagnosis.

Although mental health has gained greater prominence in health policy in recent years, access to mental health care is becoming increasingly difficult, in part due to worrying skills shortages. Between 2017 and 2020 their number fell from 50 to 45 per 100,000 inhabitants. This results in both longer waiting times and a greater risk of burnout for staff.

A constant succession of crises over the past three years – COVID-19, war in Ukraine, rising costs of living, multiple natural disasters and extreme weather events – have further highlighted that current approaches to mental health are not meeting people’s needs and preferences become. Too many vulnerable people fall through the cracks.

It is time for the WHO European Region to invest in and make better mental health systems more meaningful in this time of permacrisis.

The WHO Regional Office for Europe calls on the 53 Member States in the European Region to:

• to rethink what mental health systems should look like;
• listening to the people who keep these systems running – particularly health workers and people with their own experiences – when it comes to implementing mental health policies;
• to invest mental health budgets more sensibly, in a variety of different offerings.

Rethink

Mental health systems include both health care and community-based support. WHO has long advocated for a transition to community-based care, but it is important to recognize that notions of “community” or “community” have changed.

Rapid urbanization has blurred or even eliminated traditional community spaces in many countries. For many people, public space is increasingly digital, detached from physical spaces but connected by shared interests or shared knowledge.

While digital technologies have great potential for improving access to psychosocial support, they also bring new challenges in terms of having a direct impact on our mental health (e.g. through the increase in addictive behavior) and at the same time new potential ones Creating access gaps (the so-called “digital divide”).

The WHO European Region must embrace this changing definition of community, including by recognizing that mental health extends far beyond healthcare. Education, housing, law, industry, employment, transport, art and culture, sport – these and many other areas inevitably have an impact on the mental health and emotional well-being of the population. For this reason, it can be difficult to bring about lasting change in mental health systems, as initiatives are patchwork and often limited to healthcare rather than inclusive of all relevant sectors.

In short, countries need to reimagine mental health systems as networks that include all types of support. They must enable other sectors to communicate their role and capabilities in protecting and promoting mental health and well-being and support the implementation of these efforts.

Listen

Is a mental health policy a guarantee of change? Unfortunately, although there are more mental health strategies and plans in the European Region than ever before, their implementation remains poorly assessed in terms of processes, outcomes and impact. Many policies do not contain indicators for evaluation or are not developed with the people on whom they will ultimately impact.

Although most countries report that they involve people with mental illness and their families and carers in designing or updating policies, limited participation from these individuals continues to be a barrier to the implementation of such measures. This suggests that whose participation generally does not involve meaningful participation or real participation. Governments and policymakers must make a serious effort to harness the diverse expertise of people with lived experience so that policies can be designed and implemented with their beneficiaries in mind.

The simple truth is that if governments want their policies to have an impact, they need to listen to the people on the ground – and listen continuously.

Invest

It is encouraging that countries are investing more in mental health systems than in the past. However, in most countries in the European Region, the share of the total health budget devoted to mental health is still only around 3.6% on average. Worse still, large psychiatric hospitals around the world continue to receive the lion’s share of funding, even though they are not considered effective for recovery.

This historic approach to mental health budgeting cannot be allowed to continue. Instead of allocating resources based on past budgets, as is currently happening in many countries, we need to allocate resources flexibly based on people’s current needs. It is not enough to invest more, but also to invest more wisely.

With better funding, the focus would be on recovery rather than illness. It would give preventive and supportive measures the same priority as treatment, care and rehabilitation. This would also break the vicious circle of stigmatization and prejudice that has persisted through decades of underfunding, outdated service offerings, unfavorable therapeutic outcomes and the continued widespread belief that mental illness is invincible.

In summary, countries need to invest more wisely if we want mental health systems to work as they should, enabling long-term recovery and well-being.

If not now then when?

The permacrisis of the last few years and the decades of under-investment have taught us a lot about what mental health systems are and what they could and should achieve. We cannot wait for the next crisis to remind us what we already know: that mental health is critical across the life cycle and that our systems to protect and promote that health can and should be better .

We have no time to waste in our strategic investments in protecting mental health as the foundation for individual and societal well-being.