A new mental health framework is needed to prioritize action on global mental health

For mental health to gain significant attention, and funding from policymakers globally, it is not enough to convince people that it has a high disease burden but also that there are deliverable and cost-effective interventions – according to South African researchers writing in this week's PLoS Medicine.

Mark Tomlinson and Crick Lund from the Department of Psychiatry and Mental Health based at the University of Cape Town, argue that global mental health must demonstrate its social and economic impact. The authors argue: "a coherent evidence base for scalable interventions that can be shown to have an impact at the structural level—on economic development and human well-being—is central. This is the language of most policy makers."

World-wide, the lifetime prevalence of mental disorders is between 12% and 49%, with over 70% of this burden in low- and middle-income countries. Despite this, mental illness has not received appropriate visibility, policy attention, or funding. Furthermore, 44% of African countries do not even have a mental health policy, and 33% do not have a mental health plan. Yet even in rich countries, when health budgets are cut, quite often the first area to be cut is mental health. In the United States, US$2,100,000,000 has been cut from mental health budgets over the last three years, and further cuts are expected for 2012.

Tomlinson and Lund discuss a framework to help understand why some global health initiatives are more successful in generating funding and political priority than others and argue that a health issue gains political priority when three conditions are met: country political leaders and international leaders publicly and privately express support for the issue, and do so in a sustained fashion; policies are enacted to address the problem; and resources appropriate to the disease burden are allocated to the issue.

However, the authors say: "in the case of mental health, none of these conditions is currently being met in a substantial way."

The authors conclude: "Greater community cohesion and international governance structures need to be developed to contribute to a more unified voice regarding global mental health. International organisations such as the World Health Organization, the World Federation for Mental Health, and the Movement for Global Mental Health, as well as national organisations, need to become a united force, for example, through a unified organisational network that delivers clear, consistent, and well-timed messages for policy and public consumption. "