Feature

Having a mental disorder in the developing world can be grim. Up to 85 percent of people with severe mental disorders in low- and middle-income countries receive no treatment, according to the World Health Organization (WHO). People with mental disorders often face inhuman living conditions and harmful, degrading treatment practices in health-care facilities. They are frequently denied the right to work, go to school and have families.

That may soon change, thanks to WHO's new Comprehensive Mental Health Action Plan 2013–20. Adopted by the World Health Assembly in May and formally launched in October, the plan is a call to action that will help guide countries as they strive to ensure that all citizens with mental disorders receive the treatment they need. The plan has four specific objectives: strengthening leadership in mental health, providing comprehensive mental health and social services in community-based settings, implementing prevention and mental health promotion strategies and strengthening research, evidence and information systems for mental health.

The plan also sets ambitious targets for countries to strive for, including a 10 percent reduction in suicide rates and a 20 percent increase in service coverage for severe mental disorders by 2020. The plan also includes a menu of policy options that countries can adopt as they implement the recommended actions.

At the plan's October roll-out, WHO Director-General Margaret Chan, MD, called it a landmark achievement.

"It focuses international attention on a long-neglected problem, and it does so with a welcome sense of urgency," she said. "It is a signal that mental health deserves much higher strategic priority."

APA President Nadine J. Kaslow, PhD, joined delegations from around the world at the plan's roll-out in Geneva.

"Psychology has played an instrumental role in the preliminary work related to this plan and will continue to actively advance the plan and its implementation worldwide," she says. "The plan's interdisciplinary nature and focus on public mental health are impressive."

Psychology's role

The action plan was developed by and for member states, explains psychologist Michelle Funk, PhD, of WHO, who coordinates mental health policy and service development, human rights and legislation. And those member states relied on input from psychologists and other mental health professionals, she says.

The result is a plan that has many elements that will appeal to psychologists, says Funk.

For example, the plan promotes a recovery model instead of the medical model that predominates in most of the world, says Funk. "We're not just talking about treatment, but looking at a much more holistic approach where recovery is the focus," she says.

That approach extends to the kinds of services the plan recommends, Funk adds. "The plan focuses on a coordinated response from social services and ensures that when you're addressing mental health issues, you're also addressing educational needs, social care needs, employment needs and so on," she says.

The plan's focus on human rights is also of special interest to psychologists, she adds.

"Rather than providing treatment and care, the mental health facilities in many countries can sometimes be perpetrating human rights abuses against the people in those facilities," Funk says, citing such examples as degrading living conditions and inappropriate use of medications and electro-convulsive therapy. "The action plan tries to build in a human rights approach that protects people against human rights abuses but goes a step further to promote people's human rights."

The plan calls for getting patients' informed consent, enhancing their role in decision-making and respecting their autonomy. It emphasizes treatment and care in community settings, rather than institutions, as another way to help prevent abuses.

Another unique aspect of the plan is that it incorporates concrete goals, says Funk. "This is really the first time we've set clear targets to be reached for mental health over the next years," she says. Goals include ensuring that 80 percent of countries have introduced or updated national plans for mental health to conform with international human rights instruments and that 80 percent of countries routinely collect and report on a core set of mental health indicators.

Psychologists will be among those helping to put the plan into action and ensuring those goals are met, says University of Ottawa psychology professor Pierre Ritchie, PhD, the former secretary-general of the International Union of Psychological Science. Ritchie, WHO main representative-psychology, headed the psychology delegation to the launch meetings.

Psychologists will have two key roles to play, says Ritchie. First, they can help identify appropriate psychological interventions.

Second, they will help evaluate progress toward the indicators, says Ritchie.

"We're very well-placed to develop and interpret that evidence and contribute to making policy," he says. "We can help [countries] determine what is the best investment."

Download the Mental Health Action Plan.

View the WHO video, "Hidden Pictures," for background on the international needs addressed by the WHO's new Comprehensive Mental Health Action Plan 2013–20.

Rebecca A. Clay is a writer in Washington, D.C.