Launched in 2019, the WHO Special Initiative for Mental Health aims 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.
Kathleen O'Donnell Burrows, Mental Health and Psychosocial Support Program Advisor, USAID shares insights on USAID’s partnership with the WHO Special Initiative for Mental Health:
Mental health promotion activities are essential to achieving USAID’s goals. Mental health conditions may preclude individuals from engaging in foreign assistance programs and opportunities that further their development and recovery, and the economic development and recovery of their communities and countries. USAID, through WHO, is investing in approaches to improve the performance of a nationwide mental health system in partnership with the local government, known as a systems-level initiative, that go beyond service provision interventions.
USAID has supported WHO’s Special Initiative for Mental Health since its inception in 2019 and is among its top three donors. The Special Initiative employs a systems-strengthening approach that involves establishing community-based systems for mental health provision combined with the policies, structures, and processes required to sustain access to these services. This approach maximizes access to appropriate and affordable mental health service provision for the population. This scope is a complex undertaking that requires close partnerships with multiple stakeholders (Ministries of Health, donors, WHO technical staff, and people with lived experiences) to design comprehensive, multi-faceted solutions that will impact the mental health environment in partner countries for years to come, for example strengthening mental health infrastructure to integrate mental health services in primary care.
While mental health service delivery activities–including standalone individual or community-level interventions–are critical to address unmet mental health needs in certain contexts, on their own, these interventions can be short-term and fragmented if core challenges related to availability, access, delivery and uptake of services are not addressed. By focusing on countries (or large regions within countries) and supporting them consistently for up to five years, WHO and partners can address these issues through an integrated, comprehensive approach in that country (for example, advocating for specific policy changes that impact mental health services access nationwide). They can also glean systematic learnings to inform scaling up initiatives in additional countries. Long-term investments are necessary to go beyond service delivery and advance mental health policies and the right to mental health.
Key outcomes from the Special Initiative indicate long-term reforms in national mental health systems
USAID’s investment in the Special Initiative has resulted in tangible results, including governmental prioritization and investment towards mental health in Special Initiative countries. For example in the Philippines, the central government budget for mental health medications is increasing to 1 billion pesos in 2023 (up from 57 million pesos). In Ghana, the Ministry of Health allocation to mental health services has been raised from 1.0 percent to 1.4 percent of the annual health budget. Four partner countries (Nepal, Zimbabwe, Bangladesh, and Jordan) undertook economic investment cases for mental health to better understand why it makes sense to invest in mental health for their population, taking into consideration a range of perspectives including return on investment figures and public health outcomes, which will help inform key budgetary and policy needs. In addition, some countries have created or updated their mental health policies and laws, including Paraguay’s Mental Health Law No. 7018, Nepal’s National Action Plan for Suicide Prevention, and Zimbabwe’s inclusion of mental health services in the primary care essential services package.
Further, most Special Initiative countries have endorsed or developed national mental health plans to integrate mental health within the healthcare system, for example Bangladesh’s National Mental Health Strategic Plan 2020-2030. These new laws, policies, and investments are meaningful. They impact how someone will be able to access appropriate mental health services not only today during the Special Initiative program but long after the initiative is complete.
Prioritizing localization and commitment to investing in systems-level work
USAID endorses the systems-strengthening transformational approach that underpins the Special Initiative for Mental Health. Results and outcomes from implementing countries, provide strong evidence in support of this approach. Such a systems-strengthening approach maximizes access to appropriate and affordable mental health services provision. This sustainable impact gets to the core of USAID’s localization priority and why USAID is committed to investing in systems-level work. The Special Initiative for Mental Health utilizes a participatory process, ensuring inclusion of mental health care staff, primary health care staff, and persons with lived experiences during the planning and implementation phases.
Based on progress so far, we expect the success seen in Special Initiative countries, now mid-way through their work plans, to continue to grow and expand to ultimately support the advancement of improved mental health systems across all the countries we partner with at USAID.