WHO Mental Health Global Action Plan

1. Presented by: Dr. Aneesh K Mathew
Mental Health Gap
An initiative by the World Health Organisation (WHO)

2. Introduction
What is the programme?
• The WHO Mental Health Gap Acton Programme aims at scaling up mental health
services in non specialised health settings to achieve universal health coverage.
• The programme aims at scaling up services for mental, neurological and
substance use disorders in countries, especially those with middle and low
income.
• The programme asserts that with proper care, psycho social assistance and
medication, millions could be treated for depression, schizophrenia and epilepsy
and could help in prevention of suicide.
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3. Purpose
• In many countries, services remain concentrated in urban psychiatric hospitals
and are frequently associated with human rights violations.
• People with mental and neurological disorders affect due to substance disorder
should have access to timely high-quality evidence based health and social
care to promote recovery and attain the highest possible standard of health.
• It aims to promote recovery and attain the highest possible standard of health,
full participation in society and work free from stigmatisation and discrimination.

4. Operations
• Plan
• Assemble an operations team.
• Conduct a situational analysis.
• Develop mhGap operations and budget
• Advocate for mental health.

5. Operations
• Prepare
• Adapt MH gap.
• Train the workforce.
• Coordinate Care pathways.
• Improve access to psychotropic medications and psychological interventions.

6. Operations
• Provide
• Provide services at facility level.
• Provide treatment and care in the community.
• Raise awareness of mental health.
• Support prevention and promotion.

7. Plan: Assembling the team
• Planning is the systemic identification and specification of desired goals.
Appropriate courses of action and the resources required to achieve the goals.
• Strengthening district mental services is a continuing process, including
planning for modification and refinement of the provision of mental health
services.

8. • The team include a district health manager of facility manager, representative of
medical records or health information, system, staff, community and traditional
leaders, senior health leaders, representative of various workforce, keyers,
skilled trainers and supervisors and people with MNS conditions and their
families.
• The operations team may also include representatives of regional and national
health authorities who oversee implementation in districts.

9. Plan: Conducting a situational analysis
• A situation analysis defines the circumstances prevailing in a district that may
affect people with MNS conditions and may facilitate or obstruct integration of
mental health services into the general health system.
• It is an essential first step for informed decision making and is used directly in
preparing an operations plan and budget.
• It provides an opportunity to engage with many stakeholders not only to
obtain the practical input but also to make them aware of plans for mental
health reform and engage them for the future.

10. Plan: Developing operations and budget
• A plan for MHA implementation at district level include specific sequential
activities, a budget for human and financial financial resources.
• The responsible agencies of people, the timeframe and monitoring indicators.
The district budget also includes the estimated cost of activities for
implementing the plan.
• Many L/MIC currently allocate less than 2% or even 1% of their health budget
to the treatment and prevention of MNS conditions whereas high income
countries typically spent 5 to 10%.
• This usually results in a lower budget for mental health at district level.

11. Plan: Advocate for mental health
• Advocacy is widely recognised as an effective method for generating support
for health issues.
• It involves raising the awareness of district stakeholders, particularly policy
makers and healthy leaders about the burden of MNS conditions, self harm
and suicide.
• The aim of mental health advocacy is to promote the human rights of people
with MNS conditions to recognise stigmatisation and discrimination, and to
respect peoples autonomy to be advocates for themselves and each other.

12. Prepare
Adapt components of the mhGAP package
• mhGAP adaptation is necessary due to diverse country contexts,
encompassing policies, mental health systems, culture, and resources.
• Adaptation ranges from basic translations to more intricate adjustments,
ensuring mhGAP’s relevance in different settings.
• Complex adaptations may involve acknowledging local spiritual beliefs or
healing concepts in managing mental, neurological, and substance use
conditions.

13. Prepare
Train the workforce
• Training enhances the capabilities of non-specialist health care providers in
mental health, including family doctors, clinical officers, nurses, midwives, and
general para-professionals.
• Coordination with mental health specialists ensures optimal delivery, support, and
supervision, applicable to training programs like mhGAP Humanitarian
Intervention Guide and e-mhGAP.
• mhGAP training manuals, designed for service use, focus on continuing
education. They expand attitudes, knowledge, and skills through clinical training
blocks, lectures, active teaching, and tailored practical aids based on the
provider’s type and previous training.

14. Prepare
Coordinate care pathways
• Meeting the diverse needs of individuals with MNS conditions involves cross-
disciplinary and cross-sector coordination.
• “Care pathways” shape how people access MNS treatment, involving
collaboration among public and private service providers at various levels.
• Given the interconnectedness of MNS conditions with the social environment, a
multidisciplinary approach is essential, considering factors beyond mental
health services.

15. • Complex needs, like managing both MNS and physical health conditions,
require a broad skill set, necessitating a collaborative effort.
• The mhGAP operations team can establish or support referral systems for
comprehensive care, ensuring effective communication across health system
levels and facilitating bidirectional care pathways between hospitals, non-
specialized health settings, and communities.

16. Prepare
Improve access to psychotropic medications and psychological
interventions
• Access to psychotropic medicines is integral to the right to the highest attainable
standard of health for individuals with MNS conditions.
• Four main groups of medicines address priority MNS conditions in mhGAP-IG
version 2.0: antipsychotics, drugs for mood disorders, anticonvulsants, and
medicines for substance withdrawal.
• Barriers to access at the district level include societal factors, limited mental health
services, and challenges in supply chain perception.
• Overcoming these barriers involves local adaptation, awareness-raising, education
for health professionals, and adherence to clinical guidelines in prescribing, use, and
monitoring.

17. • mhGAP recommends evidence-based psychological interventions, including
self-help, CBT, IPT, and relaxation, delivered by well-trained non-specialist
health care providers.
• Recent evidence supports the effectiveness of these interventions by non-
specialists, addressing the shortage of mental health specialists in low-
resource settings.
• To increase access, the mhGAP operations team should train and supervise
non-specialists, establish care pathways, and enhance health information
systems.
Caption Caption Caption

18. Provide
• The WHO mental health action plan advocates a shift from long-stay
psychiatric hospitals to community-based services, spanning short-stay
inpatient care, outpatient care in general hospitals, primary and non-
specialized health services, comprehensive mental health centers, day care
centers, family support, and supported housing.
Caption

19. Provide
Provide services at facility level
• In many countries, psychiatric institutions are distant, leading to
underutilization. Non-specialist care in district facilities enables accessible
treatment, keeping families together and supporting community integration.
• Facility-level MNS care involves assessment, including physical and mental
status examinations, differential diagnosis, and basic laboratory tests.
• Management steps include treatment planning, psychosocial interventions,
psychotropic medicines, two-way care pathways, follow-up planning,
addressing barriers, involving carers and families, and fostering links with
education, social services, poverty reduction, and relevant programs.

20. Provide
Provide treatment and care in the community
1. A balanced approach combining community and facility services is more
effective than hospital-based care alone, emphasizing mental health services at
the district level.
2. Community services, delivered by non-specialist providers, family doctors, and
community workers, are prioritized, aiming for brief hospital stays when
necessary.
3. Community health workers (CHWs), despite potential challenges, play a crucial
role in delivering health services, especially in areas with workforce shortages.

21. 4. Recent policy initiatives broaden the community platform to include non-
health settings and various individuals, expanding access to mental health
services and interventions.
5. Community-based treatment and care effectively reduce disability and
symptoms, improve acceptance, decrease hospital admissions and suicides,
and enhance social functioning, proving cost-effective in low-resource
settings.
6. Community mental health interventions encompass awareness and mental
health literacy, prevention and promotion activities, and management and
rehabilitation strategies to address diverse aspects of mental health.

22. Provide
Raise awareness of mental health
1. Awareness-raising in mhGAP operations at the district level involves
disseminating information to diverse groups, including individuals with MNS
conditions, families, healthcare providers, community workers, faith and
traditional healers, teachers, community leaders, NGOs, government
stakeholders, and the public.
2. The goal is to improve understanding, change attitudes, and influence behavior
toward mental health and those with MNS conditions.
3. Accessible and accurate information is crucial to creating a demand for
integrated services and fostering positive attitudes. Limited service use may
result from a lack of such information.

23. 4. Awareness-raising is vital because individuals affected by MNS conditions
face human rights violations, stigmatization, and discrimination.
Misconceptions about MNS conditions can lead to extreme discrimination,
restricting individuals’ political, civil, and social rights.
5. Those with MNS conditions often encounter barriers to education and
employment, contributing to their marginalization and reducing opportunities
for societal participation.

24. Provide
Support prevention and promotion
• Mental well-being promotion and prevention of mental illness are essential
components of SDGs, emphasizing the reduction of premature mortality from non-
communicable diseases (NCDs) and promoting mental health (SDG 3.4).
• Prevention involves awareness, understanding of early warning signs, and
interventions to reduce the risk, incidence, prevalence, and impact of mental health
conditions.
• Promotion focuses on fostering individual competencies and mental well-being
through health-enhancing public policies, employment opportunities,
antidiscrimination laws, supportive environments, community action, personal skills
development, and reoriented health services.

25. • Prevention and promotion programs, aligned with the WHO Comprehensive
mental health action plan, aim to reduce risk factors and strengthen protective
factors, with a target for 80% of WHO Member States to have functional
programs by 2020.
• The mhGAP operations team should adopt a multisectoral approach,
mainstreaming prevention and promotion efforts into communities.
• Implement mass public awareness campaigns in the district, emphasizing the
significance and accessibility of mental health services, including anti-
stigmatization efforts.

26. • Disseminate awareness-raising materials on MNS conditions and mental
health treatment within health facilities (section 3.3).
• Encourage active participation of individuals living with MNS conditions in
awareness-raising initiatives.

27. Thanks.