Transforming mental health systems globally: principles and policy recommendations

Vikram Patel, Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA; Department of Global Health and Population, Harvard T H Chan School of Public Health, Boston, MA, USA. Electronic address: vikram_patel@hms.harvard.edu.
Shekhar Saxena, Department of Global Health and Population, Harvard T H Chan School of Public Health, Boston, MA, USA.
Crick Lund, Centre for Global Mental Health, Health Services and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa.
Brandon Kohrt, Center for Global Mental Health Equity, School of Medicine and Health Sciences, George Washington University, Washington, DC, USA.
Christian Kieling, School of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.
Charlene Sunkel, Global Mental Health Peer Network, Paarl, Cape Town, South Africa.
Lola Kola, Department of Psychiatry, College of Medicine, University of Ibadan, Ibadan, Oyo State, Nigeria.
Odille Chang, College of Medicine, Nursing and Health Sciences, Fiji National University, Suva, Fiji.
Fiona Charlson, School of Public Health, University of Queensland, Herston, QLD, Australia.
Kathryn O'Neill, Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA.
Helen Herrman, Orygen, Parkville, VIC, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia.

Document Type

Journal Article

Publication Date

8-19-2023

Journal

Lancet (London, England)

Volume

402

Issue

10402

DOI

10.1016/S0140-6736(23)00918-2

Abstract

A burgeoning mental health crisis is emerging globally, regardless of each country's human resources or spending. We argue that effectively responding to this crisis is impeded by the dominant framing of mental ill health through the prism of diagnostic categories, leading to an excessive reliance on interventions that are delivered by specialists; a scarcity of widespread promotive, preventive, and recovery-oriented strategies; and failure to leverage diverse resources within communities. Drawing upon a series of syntheses, we identify five principles to transform current practices; namely, address harmful social environments across the life course, particularly in the early years; ensure that care is not contingent on a categorical diagnosis but aligned with the staging model of mental illness; empower diverse front-line providers to deliver psychosocial interventions; embrace a rights-based approach that seeks to provide alternatives to violence and coercion in care; and centre people with lived experience in all aspects of care. We recommend four policy actions which can transform these principles into reality: a whole of society approach to prevention and care; a redesign of the architecture of care delivery to provide a seamless continuum of care, tailored to the severity of the mental health condition; investing more in what works to enhance the impact and value of the investments; and ensuring accountability through monitoring and acting upon a set of mental health indicators. All these actions are achievable, relying-for the most part-on resources already available to every community and country. What they do require is the acceptance that business as usual will fail and the solutions to transforming mental health-care systems are already present within existing resources.

Department

Psychiatry and Behavioral Sciences

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