World Health Organization

The WHO Special Initiative for Mental Health (2019-2023):: Universal Health Coverage for
Mental Health
Author(s): Tedros Adhanom Ghebreyesus
World Health Organization (2019)

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The WHO Special Initiative for Mental Health (2019-2023):
Universal Health Coverage for Mental Health
“The world is accepting the concept of universal health coverage.
Mental health must be an integral part of UHC. Nobody should be denied access to mental health care
because she or he is poor or lives in a remote place.”
Dr Tedros Adhanom Ghebreyesus, Director-General of the World Health Organization

M ental health conditions contribute to poor health

outcomes, premature death, human rights violations, and
global and national economic loss. The WHO Director-General,
by a clear goal, the initiative seeks to ensure universal health
coverage involving access to quality and affordable care for
mental health conditions in 12 priority countries to 100 million
Dr Tedros Adhanom Ghebreyesus, has identified mental health more people. The WHO Special Initiative for Mental Health
for accelerated implementation of the 13th General Programme will advance mental health policies, advocacy and human
of Work (GPW13), covering 2019-2023. The time to act is rights, and scale up quality interventions and services for
now to empower communities and individuals to attain the individuals with mental health conditions, including substance
highest standard of health, which can only be achieved when use and neurological disorders. For continued scale up and
their mental health and well-being is ensured, and their rights global learning, WHO will implement this work in 12 priority
respected. The vision of the WHO Special Initiative for Mental countries, working in partnership with Member States, local,
Health is that all people achieve the highest standard of mental and international partners, as well as organizations of people
health and well-being. with lived experience. This WHO Special Initiative for Mental
Health is summarized in Figure 1, which demonstrates how
To implement the WHO Special Initiative for Mental Health the programme will contribute towards the wider goals of the
over 5 years, WHO aims to raise US$ 60 million. Anchored GPW13 and the Sustainable Development Goals (SDGs).

The WHO Special Initiative for Mental Health (2019-2023): Universal Health Coverage for Mental Health
THEORY OF CHANGE

THE PROBLEM : GOAL: By 2023 universal health coverage (UHC) ensures access to quality and affordable care
• There can be no health or for mental health conditions in 12 priority countries to 100 million more people
sustainable development
without mental health
• Depression and anxiety disorders
cost the global economy STRATEGIC
US$1 trillion per year ACTION 1: Contributes to WHOs GPW13 Triple Billion Targets to achieve:
Advancing mental 1 billion more people benefiting from UHC
• 800 000/year deaths from suicide,
which is a leading cause of death health policy, 1 billion more people supported during emergencies
in young people advocacy and 1 billion more people enjoying better health and well-being
STRATEGIC
human rights ACTION 2:
• Mental health conditions cause
1 in 5 years lived with disability Scaling up interventions
and services across
• Common among people affected by community-based,
communicable (e.g. HIV and TB) and general health WHO GPW13 TARGET 1:
non communicable diseases (e.g. WHO GPW13 TARGET 2:
and specialist Coverage of severe
cancer and cardiovascular disease) Reduced suicide
settings mental health conditions
mortality by 15%
• Treatment coverage is extremely low increased to 50%
• Especially common in populations
affected by humanitarian crises
and other forms of adversity SDG Target 3.4 when, by 2030,
(e.g. sexual violence) there is a one third reduction of
SPECIAL INITIATIVE
• People with mental health TARGET: premature mortality from NCDs VISION:
conditions often experience through prevention, treatment
severe human rights violations,
By 2023, access to
mental health care and promotion of mental health All people achieve
discrimination, stigma for 100 million and well-being the highest standard
• Lack of sustained financing for more people
services at scale SDG Target 3.5 to strengthen of mental health
• Effective evidence-based
the prevention and treatment
of substance abuse, including
and well-being
care is available but In partnership with WHO Member States and local,
narcotic drug abuse and
provision of services international and global implementing partners
harmful use of alcohol
is lacking (e.g. UN, NGOs, user groups, professional associations)

Figure 1. The WHO Special Initiative for Mental Health Theory of Change

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Why a WHO Special Initiative What will the WHO Special Initiative for
for Mental Health? Mental Health do?
Health is a state of complete physical, mental, and social well- Embedded in the GPW13 and contributing towards the
being, and not merely the absence of disease or infirmity1. SDGs, the WHO Special Initiative for Mental Health will
However, mental health remains a neglected part of global work towards a vision where all people achieve the highest
efforts to improve health. People with mental health conditions standard of mental health and well-being;
experience widespread human rights violations, discrimination and aligns with the global WHO
and stigma. More than 80% of people experiencing mental Mental Health Action Plan 2013-
health conditions, including individuals experiencing neurological Universal health 20202. The Goal of the WHO
and substance use disorders, are without any form of quality, coverage (UHC) means Special Initiative for Mental
affordable mental health care. This is despite mental health that all people receive Health also corresponds with
conditions accounting for 1 in 5 years quality health services recommendations of the
lived with disability globally, leading that meet their needs, recently published Lancet
to more than US$ 1 trillion per without exposing them Commission on Global Mental
Mental health
year in economic losses. It is to financial hardship in Health and Sustainable
conditions include
well known that people living paying for them. Development3 . It centers on
mental, neurological and
with mental health conditions scaling-up mental health care
substance use disorders,
are more likely to face other Quality mental health as part of universal health
suicide risk and
physical health problems (e.g. care refers to care that coverage, leaving no one
associated psychosocial,
HIV, TB, noncommunicable is safe, effective, timely, behind.
cognitive and
diseases), causing early mortality efficient, equitable
intellectual disabilities.
of 10-20 years. Suicide mortality and people-centered. By 2023, the WHO Special
is high (close to 800 000 deaths This includes ensuring Initiative for Mental Health
per year), disproportionately affecting interventions and will support access to quality
young people and elderly women in low- and middle-income services are evidence- and affordable community-
countries. Mental health conditions are especially common for based and respect based mental health care for
people affected by humanitarian crises and other forms human rights. 100 million more people. In
of adversity (e.g. sexual violence). reaching the programme goal,
WHO will contribute to (a) two
To date, mental health care has had many advocates but GPW13 targets, coverage of severe
there has been limited commitment and funding for sustained mental health conditions increased to 50% and reduced
implementation and scale-up of services. For WHO to realise its suicide mortality by 15%4; and (b) two SDG indicators, suicide
2019-2023 mission to Promote health, keep the world safe, serve mortality (3.4.2) and treatment coverage for substance use
the vulnerable, mental health has been flagged as a priority area disorders (3.5.1).
for accelerated implementation. Such implementation will benefit
from the many resources WHO has recently developed, including: Two strategic actions will be implemented, each with different
evidence-based guidelines, technical packages of interventions, expected outputs, shown in the table.
rights-based frameworks, implementation guidance and training
resources. WHO staff have extensive field experience, informing
what works for supporting quality and affordable mental health
care, and what is needed for scaling up services.

STRATEGIC ACTION 1: STRATEGIC ACTION 2:

ADVANCING MENTAL HEALTH POLICIES, SCALING UP INTERVENTIONS AND SERVICES
ADVOCACY AND HUMAN RIGHTS ACROSS COMMUNITY-BASED, GENERAL HEALTH
AND SPECIALIST SETTINGS

1. Globally, mental health is positioned high on the 1. Quality, affordable mental health care is scaled up
development and humanitarian agendas across health and social services
2. Local champions, people who use mental health 2. Quality, affordable mental health care is integrated
services, and their organizations are empowered to in relevant programmes (e.g. for HIV, gender-based
participate in the development and implementation of violence, disabilities)
mental health policies, strategies, laws and services
3. Mental health and psychosocial support is included
3. Mental health policies, strategies and laws are for preparedness, response and recovery in
developed and operationalized based on international emergencies
human rights standards
4. Priority interventions for groups in positions of
4. Media and community awareness about the importance vulnerability (e.g. women, children, youth, older
of mental health across the life course is raised people, staff) are developed and implemented
5. Human and financial resources for mental health are 5. Implementation is documented, monitored and
brought in line with the needs evaluated to improve services

1 Constitution of the World Health Organization. WHO, Geneva, 1948.

2 Mental Health Action Plan 2013-2020. WHO, Geneva, 2013. http://www.who.int/iris/handle/10665/89966
3 The Lancet Commission on Global Mental Health and Sustainable Development. Lancet, 2018, 392: 1553–1598.
4 This WHO Special Initiative will also contribute to 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.

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How will the WHO Special Initiative With guidance from WHO regional and country offices,
a country-level WHO focal person for mental health and
for Mental Health be implemented? substance abuse will be appointed in each of the 12 countries.
The WHO Special Initiative for Mental Health will scale up these Their role will be to adapt and disseminate WHO normative
key strategic actions in 12 priority countries. With support from guidance and technical packages to local contexts, to work
WHO, each country will assess the current situation for mental closely with relevant government departments and coordinate
health care needs across the life course, with other implementing partners. Local service providers,
and design approaches for context- NGOs, WHO’s global network of collaborating centres,
specific implementation. organizations of persons with lived experience, professional
Examples of the types
associations (e.g. societies for social work/psychology/
of services countries
There is a need for this type psychiatry), universities and fellow United Nations (UN)
will implement include
of special initiative in all or organizations will all be involved. Such collaboration and
mental health care in
almost all countries of the coordinated activities will enable WHO to support governments
primary health centres,
world. In the selection of the to lead substantial scale up of care for mental health conditions.
community-based mental
health centres, mental 12 countries, precedence will
health units in general be given to the many Member
hospitals, day centres, States who prioritized the
mobile clinics, and GPW13 target “increased What budget is needed to implement the WHO
coverage of mental health
outreach services for
conditions” during WHO’s
Special Initiative for Mental Health?
home-based support—
offering evidence-based 2018 country prioritization The WHO Special Initiative for Mental Health requires
treatment, rehabilitation, exercise.5 These will include US$ 60 million over five years for full implementation6. This can
care and recovery. countries with large, medium and be supported by contributions to individual countries for some
small size populations with the or for the full 5-year special initiative.
aim of achieving access to quality,
affordable mental health care of 100 • Average cost per country per year = US$ 1 million
million more people across the 12 countries. At least four of
the countries will have so-called fragile, conflict, or vulnerable • Average cost per country over five years = US$5 million
(FCV) settings, where mental health issues are among the • Total WHO Special Initiative for Mental Health for
humanitarian concerns. 12 priority countries over five years = US$ 60 million

WHO country-by-country approach to the WHO

Special Initiative for Mental Health How will the budget for the WHO Special
The status of mental health care varies widely Initiative for Mental Health be used?
from country to country. Many countries already Combined regional office and headquarters costs are
have policies to deliver services for mental health calculated at 30% of the annual total, leaving 70% of all costs
conditions in primary care settings but require for targeted in-country work. Regional Office and headquarters
system strengthening to achieve integration. costs will contribute significantly towards ensuring that mental
Many countries deliver care mainly in institutional
health is positioned on the highest political agenda in each
settings and need dedicated advocacy and
region and globally.
support in phasing out long-stay institutions
and developing community-based alternatives.
• Country offices will ensure adequate staffing coverage
Some countries may require support for policy
to support implementation; engage with strategic partners
development or to implement mental health reform
to advance policy dialogue, advocacy and human rights
efforts. By taking a country-by-country approach,
WHO can help formulate a tailored approach for in mental health for implementation; provide technical
each priority country, building on existing strengths support to the government and partners to plan and
and needs. implement activities; manage financial support for
implementation; and document, monitor and evaluate
A key advantage to a country by-country approach the activities.
is sustainability. Over recent decades, there has • Regional Offices will assess priority needs under the
been a focus on small mental health initiatives strategic actions in the countries; technically support
that have had only short-term funding. This limits and oversee country work; provide technical support to
impact and has not paved the way for sustainable facilitate country-to-country learning within each region;
scale up to reach whole populations. Further, it and be active in regional advocacy, particularly with the
has led to ad-hoc learning about the facilitators media, to promote effective mental health messaging.
and barriers to scaling up effective interventions
or strengthening systems to embed mental health • WHO headquarters will oversee and be accountable for
care. By focusing on countries (or large regions the WHO Special Initiative for Mental Health; provide
within countries) and supporting them consistently technical inputs based on regional and country needs;
for up to five years, WHO can glean systematic oversee data collection and monitoring and evaluation
learnings to inform scale up in additional countries. needs across regions; and lead the development of new
normative guidance, technical packages, and information
products.

5 As per 10 May 2019, more than 70 countries and territories have thus far prioritized coverage of mental health conditions across six regions, including:
African Region: Algeria, Burundi; Botswana; Central African Republic; Comoros; Cabo Verde; Eritrea; Ethiopia; Ghana, Guinea Bissau; Kenya; Mali; Mauritania;
Malawi; Namibia; Nigeria; Sierra Leone; South Sudan; Sao Tome and Principe; Uganda; South Africa; Eastern Mediterranean Region: Afghanistan; Djibouti; Egypt;
Iraq; Jordan; Lebanon; Libya; Pakistan, occupied Palestinian territory; Qatar; Syrian Arab Republic; Tunisia, United Arab Emirates; Yemen; European Region:
Bosnia and Herzegovina, Bulgaria; Croatia; Czech Republic; Estonia; Greece, Kyrgyzstan; Lithuania; Kosovo, Malta; Republic of Moldova; Poland, Russian Federation;
Turkmenistan; Turkey; Ukraine, Uzbekistan; South-East Asia Region: Bangladesh, Democratic People’s Republic of Korea; India, Indonesia; Maldives; Myanmar;
Nepal; Sri Lanka; Timor-Leste; Western Pacific Region: Cambodia, China; Fiji; Niue; Nauru; Philippines; Tonga; Viet Nam, and Region of the Americas: Countries
from the Region of the Americas will be added to this list on completion of their regional country prioritization process in 2019.
6 Funding allocation per country may differ depending on size, needs and costs of services.

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How will the success of the WHO Special Assumptions for the success of the WHO
Initiative for Mental Health be measured? Special Initiative for Mental Health
By 2023, the WHO Special Initiative for Mental Health is aiming This special initiative is designed with multiple assumptions.
to increase treatment coverage for mental health conditions These include:
by ensuring access to mental health care for 100 million more • Priority efforts being needed to integrate mental health
people over its 5-year plan. Within this aim is to contribute to care across all levels of health care, including community,
the broader GPW13 targets for increasing service coverage for primary, non-specialist hospital, and specialist services. Such
severe mental health conditions to 50% and reducing suicide integration of care will be critical to achieving universal health
mortality by 15%. The high-level indicators of service coverage coverage and ensures optimal reach to as many individuals,
and suicide mortality are aligned with the indicators of the families and communities as possible.
WHO Mental Health Action Plan 2013-2020, which WHO
reports on every two years through the Mental Health Atlas.7 • Affordable services and interventions for mental health
conditions refers to care that does not expose people using
Each country, following assessment and determination of services to financial hardship.
priority actions, will establish a country-specific monitoring and • Focusing across the life-course, leaving no-one behind. This
evaluation framework. This will enable regular assessment of includes women, men, girls and boys across cultures, contexts,
each country office being on track to achieve their overall 5-year health conditions and in all phases of life.
plans under the special initiative.
• Respecting international human rights standards, particularly
the UN Convention on the Rights of Persons with
Disabilities, and the principles of legal capacity, liberty, non-
discrimination, participation and inclusion of people with
PAHO/WHO copyright
mental health conditions.
• Respecting humanitarian principles of humanity, neutrality,
impartiality and independence; in addition to other global
frameworks and standards for mental health and psychosocial
support implemented in emergency settings.
• Being adaptable to local context and their available resources,
culture, language, social structures, gender and ability; and in
response to social, environmental and economic determinants
of health.
• Commitment to a multi-sectoral approach, which may mean
the need to work with individuals, families and communities
on a prioritized set of interventions at critical phases based on
country-specific needs.
• Commitment to collaboration with Member States’ ministries
of health and other relevant government entities, in addition
to other local stakeholders.
• Commitment to collaborating with governments, UN
organisations and NGOs, research institutions, global
partnerships, and donors.

For further information, please contact:

Dévora Kestel, Director, Department of Mental Health
and Substance Abuse, World Health Organization,
Geneva ([email protected])

7 Mental Health Atlas 2017. WHO, Geneva, 2018. http://www.who.int/mental_health/evidence/atlas/mental_health_atlas_2017/en/

WHO/MSD/19.1
© WHO 2019. Some rights reserved.
This work is available under the CC BY-NC-SA 3.0 IGO licence.

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