Advancing Access to Mental Healthcare and Health Equity Globally

October 10 marks World Mental Health Day – an opportunity to raise awareness, explore promising practices and lessons learned, and assess the needs to make access to quality mental health and psychosocial support a reality globally. This year’s theme, “Mental Health in an Unequal World” acknowledges the disparities in access to healthcare and how inequalities and inequities due to race, ethnicity, sexual orientation, gender identity or expression, sex characteristics, disability, age, and national origin have an impact on mental health and access to mental health services. Respect for mental health, access to mental health support, and recognition of the importance of engaging on mental health equity is often an unspoken pre-requisite to building an inclusive, democratic, safe, human rights respecting future.

Discrimination and inequality negatively impact both the mental and physical health of individuals. Nearly 1 billion individuals globally  live with a mental health condition, and every 40 seconds a person dies from suicide. Further, while men are more likely to die from suicide, women in the United States are approximately 1.5 times  more likely to attempt suicide and also disproportionately experience mental health issues such as depression and anxiety. Globally, approximately 80 percent of people  affected by conflict, war, and displacement are women and children, and 1 in 3 women  worldwide experience gender-based violence in their life time, which can contribute to gendered disparities in mental health. Eating disorders, including anorexia, bulimia, and binge-eating disorder , impact millions of people globally , particularly young women, LGBTQI+ persons, and women of color, though women of all ages are affected. However, disordered eating is also on the rise for boys . Challenges related to mental health and accessing mental health services exacerbates power differentials and make social inclusion and equity even harder to achieve.

Despite these staggering statistics, 75 to 95 percent of individuals  with mental health conditions in low and middle income countries don’t have access to mental health services and COVID-19 has only exacerbated existing inequities. Stigma and discrimination around mental health also prevents many people from accessing much needed mental healthcare.

In alignment with the Biden-Harris Administration’s commitment to equity and equality, the State Department supports access to mental healthcare globally, including through programming that works to ensure that women and girls, in all their diversity, and historically marginalized groups benefit from holistic programming efforts, recognizing the trauma that they often experience. For example, the Secretary’s Office of Global Women’s Issues mainstreams gender-based violence prevention and response, rights-based approaches, psychosocial and well-being support, and social inclusion principles across all of its programming. The Bureau of Democracy, Human Rights, and Labor requires that partners provide support for psycho-social and well-being support when it funds programming. The Office to Monitor and Combat Trafficking in Persons also incorporates trauma-and survivor-informed approaches in all its programs, especially through the Emergency Victim Assistance Program. Ensuring accessibility to mental health and psycho-social support for everyone, including persons with disabilities, is also key. We must respond to the needs of all people in society in order to achieve inclusive implementation of U.S. foreign policy goals. Below are a few examples of Department programming that advance mental health equity:

• Substance use is a critical mental health challenge among women. In partnership with the World Health Organization, the Bureau of International Narcotics and Law Enforcement Affairs (INL) developed the first International Guidelines for Pregnant and Addicted Women  which led to the development of a specialized course to provide care for women who use drugs called the “Women’s Intervention for Substance Exposure “. Addressing substance use among women is critical from both a public health and public security perspective, particularly given the central role of mothers in the development of children who themselves are at high risk for substance use, criminality, and violence when a parent is under the influence of drugs. In partnership with CARE, a non-governmental organization, INL/Lima developed drug treatment trainings for professionals to treat LGBTQI+ persons and built a network of clinicians that provide tailored support around discrimination and stigma as well as patient-centered care in Peru. For rural populations in Afghanistan and Pakistan, INL adapted past approaches and innovated a new model of community-based treatment, which focuses the most intensive treatment for more significant cases to save resources. The model also prioritizes active patient involvement, increases in quality health services, and the reduction of discrimination and social marginalization or reduction in the stigma of drug use.
• In Guatemala, the Office to Monitor and Combat Trafficking in Persons is supporting the Pan American Development Foundation (PADF) to strengthen the capacity of government, civil society, and vulnerable communities to prevent and respond to trafficking in persons. PADF is training and empowering indigenous women in four select municipalities in the Western Highlands to conduct anti-trafficking prevention and education efforts in their communities. To support the mental health and well-being of survivors, PADF and project partners are implementing a therapeutic community-based care model in two in-take shelters that includes specialized counseling for survivors to help them process their experiences, express their emotions, work in teams, and be more independent. Staff from both shelters noted that they have already begun to see a difference in the survivors they work with, who are demonstrating greater confidence and more interest in participating in activities. They also highlighted that the care model makes it easier and more seamless to integrate new survivors into the shelter community, as well as navigate and respond to survivors’ various trauma responses.
• The Bureau of Conflict and Stabilization Operations’ (CSO) Veterans Reintegration Program in Ukraine connects veterans of the conflict against Russia’s aggression in eastern Ukraine with resources and assistance in support of their transition from military service to civilian life. CSO conducted data-driven analysis to identify and understand veterans’ legal, medical, and vocational needs and generated targeted programming to address their circumstances, including mental health needs. The data showed social stigma is a key barrier to veterans who are seeking mental health-related assistance from government and private medical providers. The program discovered this is most prominent among women veterans, who often face social penalties for challenging notions of gender-appropriate roles. In response, CSO’s mental health programming incorporated efforts to combat negative perceptions related to military service and raised awareness among government officials and mental health professionals of the often unique medical needs of the veteran community, including those of women and the combat-wounded.

Initiatives like these – as well as continued learning and collaboration with all stakeholders, including civil society, academia, the private sector, and governments – are essential to advancing equitable access to mental health resources. As we work to advance U.S. foreign policy and build a more secure, inclusive, and democratic future that respects human rights and strives to eliminate discrimination and inequity, respect for mental health and access to mental health services must be a part of the work.

About the Author: Kerri Sjoblom serves as a Senior Data Analyst in the Secretary’s Office of Global Women’s Issues at the U.S. Department of State.