Special Initiative for Mental Health

Innovation summary

Mental health conditions contribute to poor health outcomes, premature death, human rights violations, and global and national economic loss.

The vision of the WHO Special Initiative for Mental Health is that all people achieve the highest standard of mental health and well-being. It was launched in 2019 for implementation over 5-years, in 12 countries at a cost of US$ 60 million.

The goal of the WHO Special Initiative for Mental Health is to ensure universal health coverage involving access to quality and affordable care for mental health, neurological and substance use conditions for 100 million more people. The Special Initiative for Mental Health focuses on two strategic actions:

advancing mental health policies, advocacy and human rights, and
scaling up quality interventions and services for individuals with mental health, substance use and neurological conditions.

Impact summary

WHOs Special Initiative for Mental Health is underway in nine countries: Argentina, Bangladesh, Ghana, Jordan, Nepal, Paraguay, the Philippines, Ukraine and Zimbabwe. It has contributed to nearly 6 million more girls, boys, women and men having mental health and psychosocial support services available in their communities; trained more than 5,500 individuals; and is collaborating with over 450 partner organisations.

"I request WHO and donors to carry on this initiative, which will help to build capacity for more districts because the government is just not ready yet to lead this initiative and roll it out across the country."

– MoH interviewee

"We brought together the contribution from different mental health specialists, other partners, UN agencies and MoH... that has been a positive achievement since this initiative started." – MoH interviewee

"Being part of the initiative created a momentum and put mental health on the list of priorities for the national authorities and stakeholders. The start of the initiative prompted work on updating the national action plan which had expired." – WHO Country Office interviewee

"The initiative was a catalyst for bringing all the most prominent players – such as government and key other organisations in the mental health field – together and giving them space to harmonise their experiences and expertise." – Other country-level stakeholder

"Our community-based mental health framework and the national Mental Health Strategy were developed through the Special Initiative funding." – MoH interviewee

Innovation details

The WHO Director-General, Dr Tedros Adhanom Ghebreyesus, has identified mental health for accelerated implementation of the 13th General Programme of Work (GPW13), covering 2019-2025[1]. Mental health is high on the global health agenda following COVID-19, increased conflicts and climate emergencies, and growing economic uncertainties. The time to act is now.

The foundation of the Special Initiative for Mental Health is to work in partnership with Member States, local, and international partners, as well as organisations of people with lived experience. It aligns fully with global mental health mandates[2] and recommendations[3], contributes to WHOs GPW13[4] triple billion targets and universal health coverage agenda, including to leave no one behind. In doing so, WHOs Special Initiative for Mental Health contributes, directly and indirectly, to multiple Sustainable Development Goals[5].

Annual updates about country specific achievements are posted to the WHO Special Initiative for Mental Health webpage[6].

[1]In resolution EB150.R4, WHO’s Executive Board recommended that the Seventy-fifth World Health Assembly in May 2022 extend the endpoint of the Thirteenth General Programme of Work by two years from 2023 to 2025.

[2] E.g., the updated Comprehensive Mental Health Action Plan 2013-2030

[3] E.g., the World mental health report: Transforming mental health for all

[4] WHO’s GPW13 targets 1, 4, 5, 6, 10, 16, 17, 19, 20, 21, 23, 35, 36, 39, and 41, covering a wide range of health priorities

[5] Directly, SDG 3: Good health and well-being, and indirectly, SDGs 1 (No poverty), 4 (Quality education), 5 (Gender equity), 8 (Decent work and economic growth), 10 (Reduced inequalities), 13 (Climate action), 16 (Peace, justice and strong institutions), and 17 (Partnerships for the goals).

[6] https://www.who.int/initiatives/who-special-initiative-for-mental-health

Key drivers

The factor most frequently referenced is senior country-level buy-in to the initiative. While government commitment was a necessary condition of becoming a participating country in the Special Initiative, on-going support from senior leadership regarding the human rights and primary care orientation of the Initiative was crucial to sustain progress.

Challenges

Monitoring and Evaluation. The greatest challenge we face with M&E is lack of data about mental health care. Most facilities do not identify or record individuals experiencing mental disorders, nor their treatment. And for countries that do record even minimal data at a health systems level, their records differ from each other. This has been an enormous challenge for WHOs Special Initiative for Mental Health to demonstrate collective impact. Nonetheless, we have been working to find ways to address lack of data by considering mapping approaches for M&E (i.e., to assess increasing availability of services) and smaller geographic areas to be representative of increased coverage.

Commitment. Political commitment remains an important factor in the successful implementation of the Special Initiative. This typically referenced uncertainty in follow-through on stated policy objectives. In some instances, this is linked with the wider issue of competing priorities. Although all governments had signed up to the objectives of the Special Initiative, in practice there were a wide range of other government interests and policy areas that were competing for attention and resources.

Workforce. In terms of workforce, the lack of trained human resources is a frequent theme in discussions, whether addressing the need for recruitment of cadres of personnel, their training and supervision, or the retention of staff within the health system.

Lack of funds. The lack of clear funding flows to sustain services is a common challenge among countries, whether the emphasis was on government allocation to mental health provision, the tax basis to enable this, or the perceived continued dependence on donor support.

Continuation

Each Special Initiative for Mental Health country progresses through similar stages.

The process begins with a country mental health landscape analysis and multi-stakeholder design consultations, allowing for co-creation of the Special Initiative for Mental Health workplan in each country. Beyond ministries of health, stakeholders may include non-health government departments, local service providers, traditional healers, NGOs, WHO’s global network of collaborating centres, organisations of persons with lived experience, professional associations (e.g., societies for social work/psychology/ psychiatry), universities and fellow United Nations (UN) organisations.
Focus areas for implementation vary in each country depending on needs, priorities and resources, and by consensus from stakeholders involved in design.
Once agreed with Ministry of Health, a 5-year logical framework, with monitoring and evaluation indicators, forms the basis to direct implementation.
A baseline assessment in selected geographic areas is completed.
Annual workplans (linked to the 5-year plan) guide actions for each country and the stakeholders engaged for implementation. Annual workplans allow for flexibility to context changes.
Estimated increases for access to mental health services over the five-year period builds with the initiative’s momentum: Year 1 = 0%; Year 2 = 10%; Year 3 = 40%; Year 4 = 70%; Year 5 = 100%[1].

An appointed country-level WHO focal person for mental health and substance use in each country supports and works towards progress of the planned actions. They work closely with relevant government departments, coordinate with partners, apply relevant technical packages and facilitate local, regional and global expertise for implementation or learning.

WHO country-by-country approach to the WHO Special Initiative for Mental Health

A key advantage to WHOs Special Initiative for Mental Health country by-country approach is sustainability. In recent decades, there has been a focus on small mental health initiatives that have had only short-term funding. This limits impact and has not paved the way for sustainable scale up to reach whole populations. Further, it has led to ad-hoc learning about facilitators and barriers to scaling up effective interventions or strengthening systems to embed mental health care. By focusing on countries (or large regions within countries) and supporting them consistently for up to five years, WHO also gleans systematic learnings to inform scale up in additional countries

[1] Pace of progress varies by country

Partners

The foundation of the Special Initiative for Mental Health is to work in partnership with Member States, local, and international partners, as well as organisations of people with lived experience.

Funders

Key donors are: NORAD, SDC and USAID. There are also donors which contribute directly to specific countries.

Evaluation methods

By ensuring access to mental health care for 100 million more people, the WHO Special Initiative for Mental Health also aims to increase treatment coverage for people living with mental health conditions. Each country working with WHOs Special Initiative for Mental Health regularly monitors “cross-country indicators” (e.g., # people for whom mental health services are available). This enables WHO to monitor progress of the Special Initiative for Mental Health overall, while countries also monitor progress via their country-specific monitoring and evaluation frameworks and indicators.

Cost of implementation

The original budget for the WHO Special Initiative for Mental Health was US$ 60 million over five years for full implementation across 12 countries (i.e., US$ 1 million per country per year). To date, this level of funding has not been realised. To meet costs committed to existing Special Initiative for Mental Health countries and achieve its goal to expand to a total of 12 countries, WHO requires an additional US$ 36 million for the next five-years (up to end of 2028). Contributions are ideally made to a pooled WHO Special Initiative for Mental Health fund[1], or individual countries could be supported for the full 5-year commitment.

[1] Funding allocation per country differ depending on size, needs and costs of services. Pooled funding to WHOs Special Initiative for Mental Health takes an equity approach with participating countries, considering annual workplans whose budgets may be higher/lower in different years and stages of implementation.

Impact details

Special Initiative has contributed to nearly 6 million more girls, boys, women and men having mental health and psychosocial support services available in their communities; trained more than 5,500 individuals; and is collaborating with over 450 partner organisations.

Annual updates about country specific achievements are posted to the WHO Special Initiative for Mental Health webpage[1]. However, since inception, only two of many highlights from each implementing country is provided in the table.

Argentina	Developed Special Initiative for Mental Health 5-year plan Launched a national mhGAP[2] Training of Trainers programme
Bangladesh	Approved a National Mental Health Strategic Plan (2020-2030) Trained 45 trainers, plus 61 health workers and 3 field coordinators trained in readiness for mhGAP integration to primary health care
Ghana	Created a Mental Health Board for national-level strategic guidance for mental health services Trained health workers to screen for mental health conditions for people and their caregivers living with TB
Jordan	Developed a National Mental Health and Substance Use Action Plan (2022-2026) Doubled the percentage of primary health centers providing mhGAP services (to 31% since the start of the Special Initiative for Mental Health)
Nepal	National and district-level mental health care programmes adopted Trained 1,200 primary health care workers and 215 service managers to identify and refer people with mental health conditions
Paraguay	Passed the National Mental Health Law and created a National Mental Health Directorate in the Ministry of Health Used virtual mental health services (sustained since COVID-19), increasing coverage in one region to500%
The Philippines	Boosted Government of the Philippines investment of US$ 10.4 million to increase free access to mental health medication in 2022, supporting more than 140,000 more people with mental, neurological and substance use conditions now receiving care from mhGAP trained service providers in primary health care facilities Released an eLearning course on mental health advocacy and leadership for persons with lived experience
Ukraine	Launched the “Ukrainian Prioritized Multisectoral Mental Health and Psychosocial Support Actions During and After the War: Operational Roadmap” as part of Ukraine’s First Lady Initiative Continued support for Community Mental Health Teams who have supported 1,400 individuals living with severe mental disorders with more than 23,000 consultations since February-2022
Zimbabwe	Included mental health conditions in Zimbabwe’s Essential Health Care Package Screened 16,000 health care workers for depression and anxiety (as part of the COVID-19 response) and provided support where indicated

[1] https://www.who.int/initiatives/who-special-initiative-for-mental-health

[2] The WHO Mental Health Gap Action Programme (mhGAP) aims to scale up services for selected mental, neurological and substance use disorders via integration of mental health care in primary health care services. https://www.who.int/teams/mental-health-and-substance-use/treatment-care/mental-health-gap-action-programme

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Alison Schafer

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Country

Bangladesh, Philippines, Ghana, Zimbabwe, Nepal, Argentina, Paraguay, Ukraine, Jordan

Affiliated organizations

WHO Special Initiative for Mental Health

World Health Organization