Advancing multisectoral and life course approaches in mental health research

The Academy of Science of South Africa (ASSAf) and Academy of Medical Sciences UK, jointly hosted a workshop on mental health on 21–22 November 2022 in Sandton, Johannesburg.

Mental and behavioural problems account for 6.6% of the global disease burden (including substance use conditions) and are the leading contributor to the economic cost of non-communicable diseases. Some estimates have placed the figure of the global burden of disease to be even higher at 13%, when including the premature mortality associated with having a mental health condition. In Lower and Middle-Income Countries, the cost of mental illness in 2010 was estimated at $870 billion and it is projected to at least double by 2030.

However, the World Health Organisation’s (WHO) most recent Mental Health Atlas showed that in 2020, governments worldwide spent on average just 2% of their health budgets on mental health. Despite a growing global recognition of the importance of mental health, as reflected in its inclusion as a health priority in the United Nation’s Sustainable Development Goals (SDGs), fewer than one in four people with a mental health disorder receive treatment. Within low-resource settings, access to treatment is even more limited, with many low-income countries reporting having fewer than 1 mental health worker per 100 000 people.

In 2018, the Academy of Medical Sciences (UK) produced a report exploring the barriers and challenges to strengthening mental health services in Low and Middle Income Countries (LMICs). A key overarching issue highlighted in the report was the need to expand coverage to treatments. Since the report, there has been ongoing work in this space, this includes the WHO’s special initiative for Mental Health (2019–2023) to ensure universal health coverage for mental health in 12 priority countries to 100 million more people. There are also the UNICEF’s comprehensive report and The State of the World’s Children 2021, examining child, adolescent and caregiver mental health. The Lancet Commission’s report on mental health and sustainable development and one on stigma and discrimination in mental health. In addition, there is limited engagement across sectors to advance and scale up mental health promotion and prevention activities, in spite of robust evidence demonstrating effectiveness. The COVID-19 pandemic has also had a profound impact on mental health across the world.

According to a scientific brief by the WHO, in the first year of the pandemic, global prevalence of anxiety and depression increased by 25%. The increased prevalence of mental health problems has coincided with disruptions to mental health services. Even as services resume, people may face gaps in access for pre-existing and newly developed mental health conditions. The pandemic has also further highlighted the need for an intersectoral view of mental health, through the lens of social determinants. In 2019, the ASSAf produced a report focused on the integration of social determinants when considering mental health. For example, economic and social factors can have a profound impact on +


one’s mental health, such as the financial precarity that might have been caused by the pandemic.

The WHO released its World Mental Health Report: transforming mental health for all, highlighting why and where change is most needed and how it can be best be achieved, including around mental health research. For example, the report highlighted how less than 5% of mental health research funding goes to LMICS and most research is basic rather than clinical or applied. The Africa Center for Disease Control and Prevention (Africa CDC) also launched the Africa CDC Non-Communicable diseases and injuries prevention and control and mental health promotion strategy (2022-26), which also included reference to research and the need to enhance continental capacity to produce and apply contextually relevant research for Africa-led mental health priorities.

The workshop on Advancing multisectoral and life course approaches in mental health research provided a good opportunity to identify ways of accelerating efforts to achieve the actions needed around mental health research and progress towards a vision for mental health outlined in the WHO report and Africa CDC strategy.

The main objectives of the workshop were to comprehensively review the evidence on multisectoral and life-course approaches for mental health in sub-Saharan Africa, to understand the gaps and identify research innovations and interventions, from both outside and within health systems, that could provide solutions to strengthen social, community, and health systems for mental health.

The workshop also brought together stakeholders, including researchers, community engagement specialists, representatives from key organisations such as the WHO and Africa Centre for Disease Control (CDC) to outline priority research areas and opportunities for collaboration, which stakeholders can take forwards within their own settings.

To achieve this, the workshop learned from the existing evidence from sub-Saharan African countries and the UK on multisectoral and life-course approaches on mental health, including lived experience and community perspectives. The participants shared examples of positive innovations focused on multisectoral and life-course approaches and considered how health and social care systems should respond to mental health needs, including those exacerbated by COVID-19, by discussing key challenges in the provision of effective programmes.

On the basis of the evidence, they identified gaps in our knowledge and the associated research priorities and considered lessons and interventions that can be learned from one setting and applied more widely. Areas were also identified where research can create an enabling environment for evidence-based policy interventions.

The workshop was followed by a Researcher Capacity Building Workshop which offered the opportunity for participants to share and discuss good practices and opportunities for researchers building their careers in Sub-Saharan Africa. It included participants that have direct interest or experience in capacity building from the UK and from ten African countries (South Africa, Ghana, Kenya, Malawi, Zambia, Ethiopia, Tanzania, Sierra Leone, Uganda, and Nigeria). This workshop covered models of mentoring, peer support, and career development skills training, as well as explore regional networks that offer learning and support opportunities for researchers.