Why you should care

Because it’s a killer.

Authors Chris Underhill, Moitreyee Sinha and Lian Zeitz are part of the collective action platform mhNOW being incubated at the Global Development Incubator, a group dedicated to startups for social change.

Memories of the HIV/AIDS epidemic are vivid for those who lived through the 1980s. It was everywhere and nowhere at the same time — emerging as a killer while simultaneously being swept under the rug by American leaders. People with HIV/AIDS struggled without access to appropriate care and were left stigmatized and vulnerable to discrimination.

Today, mental illness is in a similar place. One in four suffer from it at some point, many facing human rights violations, a dearth of services and stigma. Critically, the disease often proves deadly, with suicide now being the leading cause of death for girls ages 15-19 globally. Much as HIV/AIDS expanded to millions of new cases over a decade, mental illness is expected to increase considerably by 2030. Trouble is, the disease is not being spotlighted as a global crisis. Just as we saw with HIV/AIDS, effective action now can save millions, but it can’t come from one group alone. As today marks World Mental Health Day, let’s take this moment to begin working together and to put a star next to 2016 as a pivotal turning point for mental health.

At the height of the AIDS epidemic, people were fighting for access to lifesaving treatments while politicians refused to acknowledge the problem. Stigma, secrecy and shame characterized the experience. Beyond social constraints, scarce funding and underappreciation of the problem made it difficult for the epidemic to gain recognition it needed. Sociopolitical and economic factors also came into play: In 1998, AIDS-related mortality in the U.S. for Blacks was almost 10 times that of whites and three times that of Hispanics. While the HIV/AIDS crisis was initially branded as a gay men’s health crisis, it eventually became associated with marginalized populations worldwide.

Revealing the urgency and complexity of the problem proved crucial to making major gains. Rapid development of innovations, activism and targeted geographic and cultural programming made a difference, with critical turning points including improved understanding and the consideration of treatment as a human right, regardless of race, sexuality or class. Dramatic commitments in funding solidified efforts, and the collective impact of these efforts has halted and reversed the spread of HIV. In 2015, approximately 15 million people received treatment, compared to just 770,000 in 2000, and this decade has seen ambitious goals set by the global community to ensure all those living with HIV receive lifesaving solutions.

The mental health gap, meanwhile, is one of the world’s most devastating and under-resourced problems, affecting more than 450 million people. It hurts schools, workplaces, prisons and homes — impacting people’s daily lives, whether they’re privileged or poor. It profoundly impacts the young, setting the stage for a lifetime of difficulty and often tragedy.

Fortunately, mental health has made tremendous gains in the past two years. Through the Sustainable Development Goals, mental health was included in the U.N.’s development agenda for the first time, and in April 2016, the World Bank and WHO discussed how to move mental health to the forefront of global development priorities. Yet mental health is seldom considered one of the most pressing issues of our time, and taking action on it lacks the level of urgency we’ve seen for other global health issues. The stigma is strong, the political will is scant and just as we saw with HIV/AIDS, marginalized populations are disproportionately affected.

Looking at how the HIV/AIDS movement overcame its barriers to progress, we propose that the mental health movement adopt four key lessons.

  1. Build a cross-sector movement. Individual efforts alone cannot address a problem. Like HIV/AIDS, mental illness does not sit squarely within the health sector and touches upon issues like economics and human rights. So addressing it requires active involvement from players across sectors.
  2. Set measurable, time-bound and actionable targets. UNAIDS recently launched a 90-90-90 target, aiming for 90 percent of those with HIV to be diagnosed, 90 percent to have access to antiretrovirals and 90 percent to achieve viral suppression by 2020. For mental health, let’s aim for a 50 percent reduction in suicide rates by 2030.
  3. Keep programming flexible, adaptable and community-based. HIV/AIDS responses look different in Russia than they do in Kenya. Similarly, mental health responses must be context-specific and locally driven.
  4. Empower sufferers to build a strong network of grassroots movements. People living with mental illness are already speaking up and demanding change, but they need support.

Having faced similar global crises, we know what works: activating proven treatments and models by coming together. We’re launching a new multi-stakeholder mental health initiative called mhNOW that aims to bring mental health into the mainstream. It will activate change through youth and cities. Cities bear the highest burden of mental health but also have the biggest potential for making an impact. mhNOW will work with youth organizations to activate movements to destigmatize mental health illness and create an enduring culture of social inclusion.

We believe this sort of collective effort will move the needle. But we can’t do it alone. We hope to motivate others to join us and drive systemic change for mental health.

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