Director-General's Office

Time to Act on Global Mental Health: Building Momentum on Mental Health in SDG Era

Dr Tedros Adhanom Ghebreyesus

United Nations General Assembly, New York, USA
26 September 2018

Excellencies, colleagues, distinguished guests, ladies and gentlemen,

It’s such a great honour to be here today for this important event.

My special thanks to my sister Cynthia and the Born This Way Foundation for your commitment and leadership, and also to the Alliance of Champions for Mental Health and Wellbeing.

Let me tell you about a friend of mine, a doctor actually, in Ethiopia who struggled with a mental health condition and was ostracized by his family.

Caring for mental health actually starts at the family level. From my experience, this doctor, because of his mental health problem, it strikes you as a bit violent, and his family couldn’t understand him. Because of his violence, they didn’t want to even allow him to come home.

A psychiatrist said to the family, please understand your son. His violence is not deliberate. That’s his illness. It’s like diabetes or any other illness. I remember that psychiatrist saying to his family that mental health is like any other illness.

But the psychiatrist couldn’t be understood. That’s why I always say stigma starts at home. Stigma is very rampant in our societies. That’s one of the major problems. But not only in the family and society, but stigma in our institutions.

I was interviewing one psychiatrist who wanted to be hired by WHO, and I impressed by something she told me. She said as soon as I graduated, I was assigned in a hospital with 3000 beds – this is a mental health hospital that treats the patients actually as criminals.

She said, that changed my life. This is more than 30 years ago. That changed her views about mental health.

She became an advocate of mainstreaming mental health services in all institutions, and addressing the stigma in the health system itself. So when stigma is rampant in the health system, it’s rampant in the society and it starts from the family, the fight is hard.

We have to be really prepared to fight hard. There should be a sustained fight, a movement that can address all these challenges.

That’s why we say there is no health without mental health. That’s how we should understand it.

WHO’s own constitution describes health as a state of complete physical, mental and social well-being.

But the reality is that mental health is often forgotten and ignored in public health planning.

Every year, an estimated 800,000 people lose their lives to suicide. The recent suicides of several celebrities has brought attention to the fact that this is a tragedy for thousands of people whose names don’t make headlines.

One in four of us will have to deal with a mental health condition at some point in our lives. If you’re not directly affected, someone you love will be.

Suicide is the second-largest cause of death among adolescents and young adults.

But in many countries, people with mental health conditions either do not receive any services, or languish in custodial mental hospitals. This must stop.

The human rights of people with mental health conditions are very often abused and discrimination is rife, as I told you in my own experience. This must be eradicated.

Low- and middle-income countries often spend less than 1% of their health budget on mental health, which is completely inadequate to provide any meaningful services. This must increase.

In 2013 the World Health Assembly adopted a Mental Health Action Plan, and although we have made some gains, progress is inadequate because of the lack of funding.

WHO’s new five-year strategic plan includes mental health as one of five platforms that we will prioritise to achieve better health and well-being for everyone, everywhere.

To achieve that, it’s vital that mental health services are included in benefit packages as part of universal health coverage.

Nobody should be denied access to mental health services because she or he is poor or lives in a remote place.

Tomorrow’s High-Level Meeting on Noncommunicable Diseases is an important moment for raising the profile of mental health.

Instead of the “4 by 4” of four NCDs and four risk factors, we have now added mental health to make it 5 by 5.

I’m glad to tell you that our Secretary-General is also with us, a great champion, and I think we will have a sustained and strong fight.

That’s important because risk factors for NCDs such as diet, alcohol, physical activity and tobacco use are all influenced by a person’s mental health, which is the 5 by 5. Better mental health can therefore have a knock-on effect that reduces the burden of other NCDs.

Excellencies, ladies and gentlemen,

Let me leave with you with three areas in which we are calling on all countries to take action.

First, countries must increase spending on mental health services that respect human rights. If there is political commitment, it can be translated into action when we’re committed to increase spending.

Second, countries must include mental health services in benefit packages as part of the journey towards universal health coverage;

And third, countries must include measures to address mental health as part of their response to NCDs.

Thank you all for your commitment. WHO is encouraged by the unprecedented attention the world is paying to mental health.

We’re with you. Thank you so much.