Mental Health for Universal Health Coverage (MH4UHC) – Phase 2

The COVID-19 pandemic shined a light on people’s mental health and exposed national mental health systems’ weaknesses. Mental, neurological and substance use disorders make up 10% of the global burden of disease. Nearly one billion people have a mental disorder and 700’000 people die by suicide each year. Projected global economic losses attributable to mental conditions between 2011 and 2030 are estimated to be USD 16 trillion, with depression alone likely to be costing the global economy USD 1 trillion per year. Predictably, the treatment gap for mental, neurological and substance use conditions is wider in low-resource settings.

Despite these alarming figures, countries spend only 2.1% of their health budgets on mental health. Low- and middle-income countries are lagging further behind. The World Health Organization’s (WHO) World Mental Health Report 2022 calls for the urgent transformation of mental health services. This requires the inclusion of mental, neurological and substance use conditions as part of universal health coverage.

In co-creation with the SDC, the WHO launched a Special Initiative for Mental Health in 2019, with the goal to ensure access to quality and affordable care for mental health conditions in countries and to carry out normative and policy work for moving the global mental health agenda forward.

Building on the results achieved in the first phase and on the experience and models adapted from the Swiss mental health system (case management, integrating medical and social care), the second phase will phase-down work in countries already involved and expand to more countries for intensive or targeted support. Intensive support will comprise multi-year and multi-sector actions, while targeted support will assist countries to address factors which commonly present barriers for mental health services (financing, workforce, legislation). 

The project is fully aligned with the Swiss Health Foreign Policy 2019-28, the SDC Health guidance 2022-24. It complements and leverages SDC mental health interventions in Ukraine, Moldova and in the Great Lakes Region with normative and policy work. The project also works synergistically with other SDC global initiatives such as the WHO Special Initiative for Action on Social Determinants of Health for Advancing Health Equity.

Ultimate beneficiaries: people living with mental disorders.

Direct beneficiaries: caregivers and families of people living with mental, neurological and substance use conditions; policymakers supported to lead in mental health system reform; health staff across different health cadres (community workers, nurses, primary care staff, psychiatrists).

1. Country, regional and global advocacy to promote normative and policy development are updated and strengthened to support the scale up of quality and affordable care for mental health conditions.
2. National mental health legislation, policies, plans and advocacy efforts are assessed and updated, and human rights are advanced.
3. Learnings are shared to support ongoing advocacy and for the development and transformation of mental health services.

Expected results:  

• Increased number of people with access to and availability of mental health services.
• Increased treatment coverage represented by the number of people in selected sites receiving treatment for selected mental, neurological and substance use disorders in areas where access to mental health services has been created or strengthened.
• Improvements based on Patient Reported Outcome Measures in selected groups of mental health service users.

Results from previous phases:  

• Increased access to community-based mental health services for 54 million more people across 9 countries, with nearly 444’000 children and adults receiving treatment for a mental, neurological or substance use condition for the first time.
• Training on mental health and psychosocial support provided for 30,000+ people; over 13’000 individuals completed the QualityRights e-training.
• Significant progress towards transforming mental health services: updates to mental health laws and policies (Bangladesh, Nepal); inclusion of mental conditions into health information systems (Nepal, Zimbabwe); addition of psychotropic medications to essential medicine list (the Philippines, Zimbabwe); inclusion of mental health care as part of national health insurance (Ghana); increased budget for mental health (Nepal); integration of mental health systems strengthening alongside mental health and psychosocial support emergency responses (Bangladesh, Ukraine, Zimbabwe).
• All countries made substantial in-roads towards decentralized mental health services, through the integration of mental health services into primary health care.
• WHO completed normative work on key global mental health resources: Comprehensive Mental Health Action Plan to 2030, Mental Health Atlas (2019/2020), mhGAP intervention guidelines (2023) and landmark World Mental Health Report 2022.