Harry Minas and Jan-Paul Kwasik
The likelihood that mental health will receive more attention, political commitment and financial resources in the future than it has in the past will depend to a significant extent on the discussions that are now occurring within the United Nations (UN) and Group of 20 (G20) organizations that will shape the post-2015 development agenda.
The health agenda in low- and middle-income countries (LMICs) has been dominated by the Millennium Development Goals (MDGs). While there has been progress towards achievement of the goals in very many countries a significant number of countries are struggling to meet targets. The period leading up to 2015 will see many of these countries focus most of their efforts on the MGGs. At the Global MDG Conference in Bogota in February 2013 Helen Clark, the UNDP Administrator, said: “The aim of this Conference is to share experiences on what works, and motivate all participants to return to their MDG work determined to use every last minute remaining until the end of 2015 focused on achieving the goals and targets. 31 December 2015 is little more than 1,000 days away, so there is no time to lose!” An unintended consequence of this last-ditch effort may well be even greater neglect of areas that are not explicitly part of the MDGs, including mental health.
The UN is now engaged in several related processes - the UN System Task Team’s review of the MDGs and their contribution to the post-2015 agenda; the work of the 27 member UN High-Level Panel of Eminent Persons on the Post-2015 Development Agenda, which is due to report to the UN Secretary-General in May this year; and the Open Working Group on Sustainable Development Goals (OWG) which has been set the task of suggesting new Sustainable Development Goals (SDGs). These processes have highlighted broad concepts for a post-2015 vision - reshaped and revitalized global governance; protection of the global environment; sustainable production and consumption; strengthened means of implementation; and data availability and better accountability in measuring progress – that are expected to form the basis for a single post-2015 development framework that will be considered during the 68th Session of the UN General Assembly, on 17 September 2013.
To address one of the main systemic issues in the MDG program - sustainability - WHO and the World Bank are strongly championing universal health coverage (UHC) as a key component of the post-2015 development agenda. WHO’s Director-General, Margaret Chan, at a WHO/World Bank ministerial-level meeting on universal health coverage in Geneva in February 2013, called UHC “the single most powerful concept that public health has to offer”. The recent Lancet series on universal coverage hailed UHC as the third global health revolution after sanitation and epidemiology. WHO has completed a plan of action on the path to universal health coverage.
Complementing other UN processes are a what some are calling ‘ground-level panels’ as part of the UN approach to consult more widely with all stakeholders. The primary focus of this direct consultation is the UN-sponsored online portal worldwewant2015.org/ which contains resources, articles, discussion fora, and a simplified website myworld2015.org which hosts a global survey with direct voting on priorities for the post-2015 development agenda. We would particularly urge members of MGMH to register (which is done at the worldwewant2015.org/ site) to vote through the MyWorld site. After registering, vote for your top six priorities for change on the website http://www.myworld2015.org/.
Don’t forget to ‘suggest a priority (optional)’, which can be found at the bottom of the list of priorities, and make a statement about the importance of mental health as part of the post-2015 development framework. Free text answers provided as the 7th option will be analysed to see if there are missing themes or new ideas that are receiving strong support. The analysis of these free-form options is available on the website http://trends.worldwewant2015.org/. Clicking on the infographic words ‘health’ and ‘mental’ will reveal the content and count of mental health-related suggested priorities.
The WHO Global Action Plan for the Prevention and Control of NCDs, and the UN General Assembly Special Session (UNGASS) on NCDs did not include mental health. Although a case has been made for a UNGASS on Mental, Neurological, and Substance Use Disorders, whether this can be brought about is uncertain. So where does this leave mental disorders in the NCD, UHC and post-2015 development agendas?
A key event in global efforts to focus attention on mental health is the 66th World Health Assembly, the supreme decision-making body of the World Health Organization (WHO), scheduled for in 20-28 May 2013. On the provisional agenda is consideration of the WHO Draft Comprehensive Mental Health Action Plan 2013–2020, which is likely to be endorsed.
WHO has highlighted the fact that persons with mental disorders are a vulnerable group that has been marginalized in terms of development aid and government attention in it’s 2010 report “Mental health and development”. The UN has recognized that persons with all forms of disability (long-term physical, mental, intellectual or sensory impairments) experience disproportionately high levels of poverty due to being excluded from equitable access to resources and that they are largely ‘invisible’ in the MDG processes. A High- Level Meeting of the General Assembly on Disability and Development is scheduled for 23 September 2013. The General Assembly meeting will be informed by multiple regional, and online consultations and a number of informal meetings on disability-inclusive development.
There is much work to do at country-level to implement the Mental Health Action Plan. When the broad sweep of the post-2015 development agenda has been determined by the UN there will also be a great deal of work to do on ensuring that mental health is part of the implementation strategies. Individual and institutional members of MGMH can make a major contribution to this work.