WHO proposes reforms to strengthen mental health policies

Mental health is recognized as a public health priority and a fundamental human right. However, many healthcare systems continue to rely on outdated biomedical models and institutional care, often neglecting the social factors and human rights standards that impact mental health. Individuals with mental health conditions frequently encounter discrimination and stigma, as well as coercive practices within care settings.

The COVID-19 pandemic has heightened awareness of the urgent need for mental health services, revealing the negative consequences of isolation and disruptions in care. Broader issues such as climate change, conflict, and economic instability have intensified trauma and worsened conditions like poverty and inequality. These challenges, coupled with fragmented governance and insufficient funding, maintain inequities in mental health care.

In response, the World Health Organization (WHO) has developed a Mental Health Policy and Strategic Action Plan Guidance, along with the WHO/OHCHR Mental Health, Human Rights, and Legislation framework. Both documents outline necessary reforms to enhance mental health policies and legal structures, advocating for a rights-based approach to care.

Key areas for reform include: 1. **Governance and Leadership**: Establish clear mandates, coordination bodies, and ensure active participation from individuals with lived experiences in policy development. 2. **Community-Based Care**: Transform service delivery from institutional settings to community-based models. This includes integrating mental health services into general healthcare, establishing community mental health centers, and providing outreach services. 3. **Workforce Development**: Focus on competency-based training and include peer support roles to enhance person-centered care. 4. **Financial Reforms**: Align budgets and insurance systems to prioritize community services, improving outcomes and upholding human rights. 5. **Cross-Sectoral Actions**: Address social determinants of mental health through policies in education, employment, and housing to mitigate stigma and promote mental health. 6. **Elimination of Coercion**: Replace guardianship systems with supported decision-making, abolish forced treatment, and ensure informed consent and anti-discrimination laws are embedded in policy. 7. **Monitoring and Evaluation**: Implement robust systems to track progress and ensure accountability, using indicators in national information systems for continuous improvement.

The WHO guidance comprises five modules, each targeting specific policy areas: – **Leadership, Governance, and Enablers**: Focus on coordination, financing, and rights-based law reform. – **Service Organization and Development**: Promote community-based, rights-oriented, and recovery-focused services. – **Human Resource Development**: Build a diverse and competent workforce through training and staff well-being initiatives. – **Person-Centered Interventions**: Implement multidisciplinary assessments and support that address various aspects of health and well-being. – **Sector Contributions**: Encourage collaborative actions on social determinants affecting mental health.

The WHO/OHCHR guidance emphasizes essential legal provisions to protect rights, including the promotion of autonomy, informed consent, and access to community services. It calls for the deinstitutionalization of care and the prohibition of forced treatment, ensuring legal equality between mental health and general health services.

To implement these reforms, countries can follow a structured process, starting with a comprehensive analysis and forming a multistakeholder drafting committee. Policymakers can co-develop laws tailored to their national context, ensuring public consultation and adoption of these policies.

In summary, WHO’s proposed reforms aim to create a mental health system that emphasizes rights, community care, and the involvement of individuals with lived experience. By focusing on these areas, countries can build mental health systems that promote well-being and uphold human rights.