Global Mental Health Task Force Recommendations for the New Administration

About 1 in 4 people globally experience a mental health (MH) condition in their lifetime, and persons with mental health problems are more likely to develop diabetes, heart disease, stroke, HIV/AIDS, other chronic conditions. Of extreme concern is the growing gap in access to health coverage for common conditions (such as depression and anxiety), which can be as high as 90% in some parts of the world. Also of concerns are data estimating that up to 20% of children and adolescents experience a mental health disorder and between 15-23% of youth live with a parent with a mental health condition. The impact is profound: poor mental health in childhood and adolescence has been found to increase the risk for adverse outcomes, decrease chances of developing long-lasting relationships, and impair cognitive functioning in adulthood.

The Global Alliance for Behavioral Health and Social Justice recognizes the intersectionality of the Social Determinants of Health (SDOH)—where we live, work, learn, and play—and the structural inequities experienced by individuals and communities as having an impact on overall mental health. The Global Alliance supports the critical need to achieve universal health coverage, stresses the critical role of implementing and sustaining Sustainable Development Goal 3 (Good health and Well-being), and advocates for resources to mobilize countries to address the social determinants of health, from human-rights and community-based lenses.  

The Global Mental Health Task Force has been actively involved in raising awareness of global mental health since 2016, as well as behavioral health across the lifespan in the United States. At this critical juncture, when the world struggles with systemic injustices, political turmoil, and a global pandemic, the need to comprehensively address mental health is more important now than ever. The task force has developed the following recommendations for the Biden/Harris Administration.

Recommendations for Global Mental Health

The United States must recommit to the World Health Organization and the United Nations and provide leadership with member states and allied global partners to reframe mental health as part of the SDGs.

Drawing from the innovative modeling of the United States President’s Emergency Plan for AIDS Relief (PEPFAR) program, we urge the Biden/Harris Administration to use existing and emerging policy and guidance to create a global program to move the global mental health agenda forward.  A resourced Global Mental Health Initiative will ensure all persons have access to comprehensive health promotion and behavioral health prevention, care, and treatment services and resources.  The program will require bilateral partnerships and collaborations with donors, member States, and international and nongovernmental organizations (I/NGOs) and the involvement of community-based organizations (CBOs). 

The global program should:

• Include funding, policy, and programmatic guidance and resources for behavioral health issues (over the life course), to include health promotion and prevention that is integrated into all foreign aid and international work;
• Implement anti-stigma campaigns and advocacy apparatus to address historical and structural stigma and discrimination against people living with behavioral health challenges. (This effort should incorporate a multidisciplinary and multi-level approach [e.g., media, researcher, practitioner, educators, people with lived experience, youth] that is multilateral and multidisciplinary.);
• Integrate anti-racist values and anti-oppression work at every level;
• Meaningfully involve people with lived experience in program and policy development and implementation at all stages; and 
• Be modeled on Teach for America in its efforts to engage, train, and employ youth in diverse communities to build the capacity of community-based mental health and behavioral health literacy and resource access. 

Recommendations Specific to Mental Health in the United States

• Integrate behavioral health into primary care by providing (brief) behavioral health assessments in all primary care visits and establishing robust referral systems to connect people with behavioral health care specialists.
• Expand essential services so that primary care appointments include behavioral health as part of continuum of care.
• Develop culturally competent screening and interdisciplinary assessments that promote identification and early intervention of mental health concerns and disorders.
• Employ mental health expertise within all governmental agencies, federal task forces, panels, and advisory committees to facilitate interagency dialogue to review and connect policy implications with behavioral health and well-being. 
• Ensure that all future federal COVID-19 stimulus and relief packages allocate significant resources (to address the inequities that exacerbate the behavioral health and psychosocial well-being of those affected by the pandemic. Stimulus should be available equitably including for U.S. citizens and legal immigrants of mixed-status families.
• Expand “Healthy People 2030” mental health objectives to include evidence-based measurements that address systemic barriers (including stigma and discrimination) related to accessing mental health and behavioral health services as well as resources for children, youth, and adults.  
• Require all recipients of federal funding to monitor and report access to services that promote  behavioral health and psychosocial well-being. The data must be collected via culturally and linguistically appropriate methods and measure access to mental health and well-being beyond pathology and assess how programs impact all including youth well-being.
• Allocate federal funding for pre-service and in-service trainings that build the mental health and behavioral health workforce. Support partnerships with youth in historically underserved communities to be trained to serve in community – based agencies and programs to expand access to community-level mental health and wellness services and resources.