A call to action for evidence-based mental health campaigning

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Posted: 30th July 2020

The world is experiencing an unprecedented crisis in mental health. Mental health conditions contribute significantly towards causes of ill-health for all ages¹. Yet, governments typically spend less than 2% of their health budgets on mental health² and it is widely acknowledged that leaders need to invest in more accessible, humane and high-quality mental health care for populations through a re-defined public mental health approach³.

A movement to redress this inequity and gap has in recent times been driven by local and global advocacy groups. The Speak Your Mind (SYM) campaign is one such group, which globally unites national mental health advocates to leverage their collective strength.

SYM is a multi-country, nationally-driven, globally-united advocacy campaign designed to catalyse greater action on mental health. The campaign is supporting people around the world to speak their mind to global leaders and join the fight for mental health for all. The campaign was developed and launched in mid-2019 but has quickly grown. It is currently active in 19 countries: Argentina, Australia, Ghana, India, Indonesia, Kenya, Liberia, Nepal, New Zealand, Nigeria, Pakistan, Peru, the Philippines, Sierra Leone, South Africa, Sri Lanka, Tonga, US, and UK, and is driven by United for Global Mental Health. Speak Your Mind calls for greater investment, empowerment and education to improve mental health nationally and globally. It is achieving this by raising the voice of people with lived experience to be included in decision-making and reframing mental health as a critical issue at local and international levels.

Speak Your Mind is already having a tangible impact on global health policies and campaigners are driving legislative change at a national level. Some examples include:

In Sierra Leone, the 2019 SYM workshop and follow-up from the Mental Health Coalition contributed to the Ministry of Health and Sanitation launching a Mental Health Policy and Strategic Plan (and committing to reform the 1902 Lunacy Act); this development was presented at the Bill & Melinda Gates Foundation Goalkeepers event and the revision is being monitored and advocated for by the Coalition

In Tonga, where thanks to campaigning by the Speak Your Mind Tonga lead, the first-ever mental health policy was developed and the percentage of funding allocated to mental health was tripled in 2019

In Nigeria, where SYM campaign partners managed to achieve the outlawing of a pesticide that was one of the leading means of carrying out suicide in the country

And in Liberia, where the first-ever mental health-specific budget line has been agreed

In a survey conducted across 15 SYM countries in late 2019, all reported being part of a global movement for mental health as one of the most helpful aspects of participating in Speak Your Mind.

In a drive for informing evidence-based mental health advocacy, Speak Your Mind and the Mental Health Innovation Network worked together with national leads to develop country profiles to inform campaigning work at a national level. Eight country profiles (Argentina, Indonesia, Pakistan, Peru, the Philippines, Sierra Leone, South Africa and Sri Lanka), led by incredibly dedicated mental health campaigning and service-delivery groups were created, with the aim to inform effective mental health advocacy by identifying and documenting priorities for mental health campaigning efforts at the country-level. The profiles relied on situational analyses, national budget reports, mental health legislation and policy along with interviews with in-country experts. The data was aggregated and organised using the PESTLE framework (Political, Economic, Social, Technological, Legal and Environmental) of analysis along with a summary of the contextual gaps, challenges, opportunities and recommendations for key actors working within mental health promotion and advocacy in each of the countries.

The country profiles will officially be launched in October, building on the momentum after World Mental Health Day on the 10th of October. This blog presents a summary of the key findings across all eight countries.

What did we find?

Element		Summarized challenges reported by country
Political	Many countries have policies promoting a move to decentralized systems of healthcare and while this gave more autonomy to local regions, poor coordination and weak governance between central and regional authorities leads to a fragmentation of services and funding challenges Many countries reported difficulties with implementing national policy guidelines for mental health programming, specifically in the areas of community mental health, promotion and prevention. Countries that had a history of colonization saw that bio-medical approaches tended to dominate and marginalize traditional explanatory models for mental health Some countries suffered from a lack of a mental health-dedicated national body which impacted their coordination in advocating effectively to governmental bodies on mental health A lack of political buy-in for prioritizing mental health on a national level was reported by all countries writing a Country Profile, with poor funding being the most obvious consequence
Economic	Some countries found more stability in relying on international development or humanitarian assistance to fund mental health initiatives and programmes than investment from national or local bodies, including government Countries highlighted a lack of transparent reporting on the financing, forecast and spend for mental health services Countries reported high levels of household spending on mental health services, with out-of-pocket expenditure being highest among the least financially secure populations Low levels of allocated budget into mental health services (largely siphoned into in-patient care) varied between 2-3% of the health budget across the countries
Social	Countries highlighted how high levels of stigma and discrimination were still prevalent factors affecting people’s help-seeking behaviors for mental health care Suicide and substance abuse among young people and the elderly were raised as serious emerging issues not addressed by governing bodies (and in some countries suicide remains criminalized) Some countries attributed the out-migration of skilled mental health workers to the mental health resource gap they were facing In some countries, violence against women and girls was another high risk factor identified for inter-generational trauma, distress and mental ill-health, especially where there are strong patriarchal social structures Poor coordination seen between the work conducted through different sectors e.g. social welfare, health, employment, education - limiting the provision of holistic support
Technological	Countries identified the lack of national health statistics and monitoring systems as barriers to effectively addressing resource gaps, rates of mental health conditions, and informing research and service priorities Media groups lack sensitive reporting guidelines and use negative portrayals of people with mental health problems, reinforcing stigma All countries identified a high rate of cell phone penetration in young populations, potentially enhancing the opportunities for engagement as a rising proportion of populations are now starting to rely on electronic communication for information
Legal	Some countries identified discriminatory and outdated mental health legislation left over from colonial rule which have negative impacts on the rights of people with mental health conditions Countries identified ineffectual procedures and legal bodies limiting the power of individuals to appeal against human rights abuses targeted at them e.g. involuntary or prolonged detention in facilities Some countries also noted the existence of discriminatory laws (around employment, housing and voting) against people with mental health conditions that needed to be repealed urgently Countries highlighted the lack of information available to people with mental health conditions on their rights to autonomy and equity, as well as limited access to accountability mechanisms (like the Convention on the Rights of People with Disabilities) Where countries had a mental health act in place, they identified that it suffers from a lack of implementation at many levels e.g. healthcare services, community-based care, workplaces etc, often due to under-funding
Environmental	Some countries identified prolonged or protracted periods of civil war or politically instigated violence due to unstable governance as systemic reasons for intergenerational trauma and ill-health Many countries also suffered from periodic and destructive natural disasters that resulted in the death and injury of thousands, caused damage to infrastructure and left many homeless and displaced Vulnerable populations like children, women and people with disabilities are often disproportionately affected by the impact of these disasters and experience high levels of anxiety and PTSD following the event and for many years after The COVID-19 pandemic has severely affected healthcare workers and the general population due to strict lockdowns in all countries. Major challenges for continuing care for people with mental health conditions included access to medication, poor communication and limited information for mental health support in light of travel restrictions

In light of the contextual challenges facing the countries involved in this project, locally-driven recommendations addressing these gaps were proposed. While each country has their own specific advocacy asks, the following prevalent themes were identified across all the countries as key messages to incorporate within evidence-based campaigning:

In-patient services in mental health facilities have long been the primary recipient of national funds diverted towards this area. There is a strong need to shift investment in mental health to preventative and promotional approaches across different sectors and health systems as these have long-lasting benefits on nurturing well-being and resilience
The need for increased investment towards mental health funding and transparent financing mechanisms for reporting was highlighted across all the profiles. The BluePrint Group (a global mental health advocacy network) recommends this should be 5% for low- and middle- income resource settings and 10% for high-income resource settings
Countries also called for increased focus and investment in child and adolescent mental health. The findings show that this is a starkly neglected group when it comes to mental health care access and provision in many countries, and is a strong priority for future funding into research, services and policy guidelines
Media plays a strong influencing role in the attitudes towards people with mental health conditions. There is a need to engage more collaboratively with the media sector to develop ethical guidelines for reporting and promoting a more positive and realistic image of mental health and recovery
Across all the profiles, there was a strong push for ensuring that people with lived experience are supported in raising their voices and leading the change required in many countries for inclusive and equitable mental health care. There is a need to recognise that organisations of people affected (including service users’ organisations) are experts whose voices and stories need to be raised and promoted on all campaigning and advocacy fronts

Acknowledgements

We wish to thank the dedicated SYM country team members as well as the volunteers from the MSc in Global Mental Health at LSHTM who contributed to these Country Profiles. In addition, we recognize the expertise offered by the many local actors in mental health in countries where we interviewed. Without the enthusiasm, hard work and dedication of these contributors, the Profiles would not have been so rich, or offer so many insights into the gaps and challenges, and potential solutions to needs in countries.

Notes:

We aim to officially launch the country profiles closer to World Mental Health Day in Oct 2020. If you would like to access any of the country profiles before this time, please contact hello@gospeakyourmind.org.

References:

Vigo D et al. Estimating the true global burden of mental illness. The Lancet Psychiatry. 2016; 3(2):171-8.
Gilbert BJ, Patel V, Farmer PE, Lu C. Assessing development assistance for mental health in developing countries: 2007–2013. PLoS medicine. 2015; 12(6).
Perera R. The PESTLE analysis. Nerdynaut; 2017 Sep 19
Patel V et al. The Lancet Commission on global mental health and sustainable development. The Lancet. 2018; 392(10157):1553-98

Photo Credit:

The first Speak Your Mind Planning Meeting in South Africa, 2019 © United for Global Mental Health.

Speak Your Mind Asia-Pacific capacity strengthening workshop in Indonesia, 2019 © United for Global Mental Health.

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Comments

It is very heartening to know

Submitted by Margaret Nakhid Chatoor on Friday, 31st July 2020

It is very heartening to know of the many different campaigns and projects that are done in the various countries, to promote mental health and to speak out for investment in services for the most vulnerable in our societies - our children and adolescents. It is the hope that this advocacy will bear fruit in the long-term.

Very interesting and relevant

Submitted by on Monday, 17th August 2020

Very interesting and relevant campaign, and has been categorized into sections which shows proper way of addressing the issue although all of them are inter-linked and has connected relevance. I am more focused looking at social aspects although political and economic are effects of it. It would be great if more and more mental health professionals are connected as different countries have diverse priorities although the common goal of all mental health professionals is to mainstream and integrate in all public health projects and developmental programs.