The <scp>WHO</scp> Special Initiative for Mental Health: increasing access to mental health services for millions of people
Authors: Dévora Kestel, Dan Chisholm, Alison Schafer
Journal: World Psychiatry (2025)

The World Health Organization (WHO) has consistently documented the global burden of mental, neurological and substance use disorders, and the significant treatment gaps, which are most pronounced in low-resource settings1. Despite global targets set for WHO Member States in the Comprehensive Mental Health Action Plan2, progress has been slow. In 2019, aiming to support countries to work towards targets in that Action Plan, and to demonstrate that transformation of mental health services is achievable, the WHO launched its Special Initiative for Mental Health: Universal Health Coverage for Mental Health3. This Special Initiative aims to increase access to mental health services for 100 million more people across 12 countries. It features two strategic actions: a) advancing mental health policy, advocacy and human rights, and b) scaling up interventions and services across community-based, general health and specialist settings. These actions are deliberately broad, to allow for a health system strengthening approach to transform national-level mental health systems and services, as described in WHO's World Mental Health Report1. Engaging with ministries of health, service users and other stakeholders, the Special Initiative for Mental Health has walked a multi-year journey in each country. Even though the myriad challenges facing mental health services cannot be addressed under one programme, the Initiative has catalyzed interest and investments, and is building foundations for continued work. Alongside expressed government readiness for services transformation, the Special Initiative countries were selected to represent each of the WHO six regions. Following baseline situational assessments4, consultative planning and design work began in 2020 in six countries: Bangladesh, Jordan, Paraguay, the Philippines, Ukraine and Zimbabwe. Implementation of activities commenced later that same year and in early 2021. As financial resources allowed, Ghana, Nepal and Argentina later entered the Initiative. These nine countries are the focus of the Initiative to date. Based on monitoring data from the nine countries (as of September 2024), access to newly available mental health services, at local levels, has been enabled for nearly 60 million people. Due to data constraints, treatment coverage information is only being tracked from specific services, but is indicating that at least 717,000 children and adults are receiving mental health services, most for the first time. With government in the lead, supported by the WHO, more than 34,000 people have received mental health and psychosocial support training, and over 1,000 organizations have contributed to this success. The quantitative data show only part of the story, however. Major national-level changes in every country have also been achieved. Priority focus on deinstitutionalization is gaining ground (in several provinces of Argentina and Paraguay); mental health laws have been introduced or updated (in Paraguay); ministries of health have restructured to increase focus on mental health (in Bangladesh); mental, neurological and substance use disorders have been included in national insurance coverage (in Ghana); essential medicine lists now include essential psychotropic medicines (in Zimbabwe); health information systems have expanded to include common mental, neurological and substance use disorders (in Nepal); provincial, district or local government units are increasing allocations for community mental health services (in Nepal and the Philippines); services for child and adolescent mental health have expanded (in Jordan); and, in addition to meeting emergency mental health and psychosocial support needs, Ukraine has progressed in the re-structuring of services, including establishment of more than 65 community mental health teams. All countries have implemented elements of the WHO Mental Health GAP Action Programme (mhGAP)5 and WHO's QualityRights6 training, to include rights-based person-centered mental health services at primary health care levels, with many additionally expanding secondary care services in district level hospitals. Remarkably, all this work has evolved from relatively small financial investments. Total expenditures for the Initiative to date amount to US$ 25 million. For every US$ 1 million spent, over two million people have now access to newly available mental health services in their communities. Or, put another way, the cost per newly reached person is less than US$ 0.507. The vital system level changes that have emerged so far are paving the way for improved access and service quality in the future. Even though financial support for this type of longer-term mental health programme has not been easy to obtain, all contributions are attaining an impressive return on investment. The WHO Special Initiative for Mental Health is by no means a perfect programme. It has demanded a heavy time and personnel commitment from governments, with robust support from local WHO staff, who have been subsequently supported by WHO regional and headquarters colleagues. Challenging long-held beliefs and practices about mental health services is taking time, and monitoring results from the Initiative has proved onerous and challenging. Figures presented here represent only high-level results being recorded, and the routine assessment of service user outcomes remains elusive. Similarly, the quality of services being provided requires further emphasis and oversight. Although not a research programme, the Special Initiative will undergo reviews, case study analyses and the documentation of learnings in the coming 12-24 months. Exploring service user outcomes is also planned. These various learnings will benefit other countries seeking to undertake mental health transformation work. They will additionally inform WHO's plans to expand the Initiative by the end of 2028 under a second iteration. Notwithstanding its limitations, the WHO Special Initiative for Mental Health is demonstrating that ambitious targets or recommendations, such as those set out in the Comprehensive Mental Health Action Plan2 and the World Mental Health Report1, are feasible. While there are many angles from which such targets and recommendations may be achieved (e.g., focusing on specific groups, interventions or policies), having functional mental health systems and services will always be non-negotiable, as will a foundation from which to build quality and competency over time.