Providing community-based mental health care that is respectful of human rights and recovery-focused has proven successful and cost-effective, according to a new report released by the World Health Organization. 

WHO’s new “Guidance on community mental health service: promoting person-centered and rights-based approaches”, released today, includes examples from countries including Brazil, India, Kenya, Myanmar, New Zealand, Norway, and the United Kingdom of community-based mental health services that have demonstrated good practices that are non-coercive, incorporate the community, and respect people’s legal capacity, or their right to make decisions about their treatment and life. 

“[These services] look more holistically at supporting people in their overall lives. [There are also] services that don’t tell people what to do but work in partnership with people, to find the best way forward for that person in their life,” Dr. Michelle Funk of the Department of Mental Health and Substance Use, who led the development of the guidance, told Health Policy Watch.  

The report reviews what is required in areas that include mental health law, policy and strategy, service delivery, financing, workforce development, and civil society in compliance with the Convention on the Rights of Persons (CRPD), adopted as the international human rights standards in 2006. 

Few Countries Meet CRPD Requirements; Majority of Mental Health Budget Towards Psychiatric Hospitals

Though an increasing number of countries have sought to reform their laws, policies, and services to mental health care, few countries have established the frameworks necessary to meet the requirements of the CRPD. 

“We see many of the services that are being provided are not helping people in the way that they want to be helped,” said Funk. 

Reports from around the world highlight severe human rights abuses and coercive practices that are still far too common for countries of all income levels. These include forced admission and forced treatment; manual, physical, and chemical restraint; unsanitary living conditions; physical and verbal abuse. 

The lack of compliance with the CRDP is “very challenging for many countries,” she added, attributing this to several reasons. 

There is still a stigma associated with mental health that leads people with psychosocial disabilities and mental health conditions to be perceived as incapable of making decisions for themselves. There is also the lack of overall investment in mental health services, with a focus instead towards institutionalization and specialized care. 

“Countries continue to invest in what they’ve been investing in.” 

According to WHO’s latest estimates, governments spend less than 2% of their budgets on mental health, with the majority of reported expenditure on mental health allocated to psychiatric hospitals. 

Good Mental Health Services Already Exist, Should Be Scaled-Up

Shifting the whole paradigm to community-based mental health service that respects human rights may be difficult, but there have been successful services that remain on the periphery and can demonstrate to policymakers and service providers that it is possible to achieve.

These services include crisis support, mental health services provided within general hospitals, outreach services, supported living approaches, and support provided by peer groups. 

“The services are available and functioning well in low-, middle-, and high-income countries are producing really good results. And they’re doing it at either a comparable cost or even less than the traditional mainstream services,” said Funk. 

While it is important to focus on services provided in a low-income context, she added, middle-income and high-income countries also have services that can be adapted and scaled-up by low- and middle-income countries. 

Funk emphasized the importance of learning from the principles of these services to create country-specific mental health services, whether it is a low-, middle-, or high-income country.  

Larger Investment in Mental Health Needed

In addition to adapting and scaling up existing person-centered mental health services, there also must be a larger investment in mental health. 

Over the course of the COVID-19 pandemic, there has been increased recognition of the importance of mental health and how it is closely linked to what is happening around us and the psychosocial determinants of health.

Concluded Funk: “We cannot afford to just perpetuate the services we have already. If we’re going to have increased investment, we must change the way we invest that money in mental health – towards community mental services that respect and promote human rights.” 

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