Transforming mental health systems globally: principles and policy recommendations.

A burgeoning mental health crisis is emerging globally, regardless of each country's human resources or spending. We argue that effectively responding to this crisis is impeded by the dominant framing of mental ill health through the prism of diagnostic categories, leading to an excessive reliance on interventions that are delivered by specialists; a scarcity of widespread promotive, preventive, and recovery-oriented strategies; and failure to leverage diverse resources within communities. Drawing upon a series of syntheses, we identify five principles to transform current practices; namely, address harmful social environments across the life course, particularly in the early years; ensure that care is not contingent on a categorical diagnosis but aligned with the staging model of mental illness; empower diverse front-line providers to deliver psychosocial interventions; embrace a rights-based approach that seeks to provide alternatives to violence and coercion in care; and centre people with lived experience in all aspects of care. We recommend four policy actions which can transform these principles into reality: a whole of society approach to prevention and care; a redesign of the architecture of care delivery to provide a seamless continuum of care, tailored to the severity of the mental health condition; investing more in what works to enhance the impact and value of the investments; and ensuring accountability through monitoring and acting upon a set of mental health indicators. All these actions are achievable, relying-for the most part-on resources already available to every community and country. What they do require is the acceptance that business as usual will fail and the solutions to transforming mental health-care systems are already present within existing resources.
Competing Interests: Declaration of interests VP has received grant funding from the National Institute of Mental Health (NIMC), Grand Challenges Canada, and the Medical Research Council (MRC). VP receives book royalties from Oxford University Press and Cambridge University Press. VP has received consulting fees from Modern Health and Google. HH has received support for attending meetings from the World Psychiatric Association. HH also has leadership roles with Orygen Australia, citiesRISE New York, and Kindred Collaborative Australia. LK has received grant funding from the NIMH. CK has received grant funding from the National Institute of Health, the MRC, MQ: Transforming Mental Health (UK), Royal Academy of Engineering (UK), Academy of Medical Sciences (UK), Conselho Nacional de Desenvolvimento Científico e Tecnológico (Brazil), and Fundação de Amparo à Pesquisa do Estado do Rio Grande do Sul (Brazil). CK has received consulting fees from UN Children's Fund. CK is the founder of a digital mental health platform, Wida. SS has received consulting fees from McKinsey Health Institute for work related to mental health. All other authors declare no competing interests.
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