The Mental Health Atlas 2020

Overview

The Mental Health Atlas, released every three years, is a compilation of data provided by countries around the world on mental health policies, legislation, financing, human resources, availability and utilization of services and data collection systems. It serves as a guide for countries for the development and planning of mental health services.

The Mental Health Atlas 2020 includes information and data on the progress made towards achieving mental health targets for 2020 set by the global health community and included in WHO’s Comprehensive Mental Health Action Plan. It includes data on newly-added indicators on service coverage, mental health integration into primary health care, preparedness for the provision of mental health and psychosocial support in emergencies and research on mental health. It also includes new targets for 2030.

Key findings

171 of WHO’s 194 Member States (88%) at least partially completed the Mental Health Atlas 2020 questionnaire;
the submission rate exceeded 73% in all WHO regions.

INFORMATION SYSTEMS AND RESEARCH FOR MENTAL HEALTH

• 31% of WHO Member States regularly compile mental health-specific data covering at least the public sector in their country. In addition, 40% of Member States reported the compilation of mental health data as part of general health statistics only.
• The percentage of countries reporting no mental health data compiled in the last two years has declined from 19% of responding countries in 2014 to 15% of responding countries in 2020.
• 76% of Member States were able to report on a set of five selected indicators that covered mental health policy, mental health law, promotion and prevention programmes, service availability and the mental health workforce. This is an increase from 60% of Member States in 2014.
• 64 646 articles on mental health were published in 2019. The global percentage of research output on mental health relative to total research output was 4.6% in 2019.

MENTAL HEALTH SYSTEM GOVERNANCE

• 75% of Member States have a stand-alone policy or plan for mental health, which is an increase from 68% in 2014.
• 57% of Member States have a stand-alone mental health law, which is an increase from 51% in 2014.
• 46% of WHO Member States have updated their mental health policy or plan and 27% have updated their mental health law since 2017.
• 99 countries, equivalent to 67% of responding countries, or 51% of WHO Member States, reported full alignment of their policy or plan for mental health with international and regional human rights instruments.
• 74 countries, equivalent to 64% of responding countries, or 39% of WHO Member States, reported full alignment of their law for mental health with international and regional human rights instruments.
• Human and financial resources allocated for the implementation of policies/plans are limited. In addition, only 19% of WHO Member States reported that indicators were available and used to monitor implementation of a majority of the components of their policies/plans.
• 45% of WHO Member States reported that a dedicated authority or independent body undertakes inspections of mental health services and responds to complaints about human rights violations.
• 21% of WHO Member States have a mental health policy or plan that is in the process of implementation and is fully compliant with human rights instruments.
• 28% of WHO Member States have a mental health law that is in the process of implementation and fully compliant with human rights instruments.
• 76% of responding countries have ongoing formal collaboration with at least one stakeholder group. Levels of collaboration with service users and family/caregiver advocacy groups are low (35% of responding countries).

FINANCIAL AND HUMAN RESOURCES

• Levels of public expenditure on mental health are low (a global median of 2.1% of government health expenditure) and particularly meagre in low- and middle-income countries.
• 80% of responding countries reported that care and treatment of persons with severe mental health conditions are included in national health insurance or reimbursement schemes and in insurance coverage for inpatient/outpatient mental health services.
• Globally, the median number of mental health workers is 13 per 100 000 population. There continues to be extreme variation between World Bank income groups (from below two workers per 100 000 population in low-income countries to over 60 in high-income countries).

SERVICE AVAILABILITY AND UPTAKE

• Only 49 countries, equivalent to 31% of responding countries, or 25% of WHO Member States, reported the integration of mental health into primary health care. This was estimated based on the adoption of guidelines forintegration into primary care, the provision of pharmacological interventions, psychosocial interventions and training for mental health conditions at primary care level, and the involvement of mental health specialists in training and supervision of primary care professionals.
• The median number of mental hospital beds per 100 000 population ranges from below two in low-income countries to over 25 in high-income countries. Globally, the median number of mental hospital beds reported per 100 000 population increased from 6.5 beds in 2014 to 11 beds in 2020, while the median admission rate per 100 000 population increased from 36 admissions in 2014 to 72 admissions in 2020.
• Outpatient visits per 100 000 population ranged from 100 visits in low-income countries to over 5000 visits in high income countries. Globally, the median rate of reported visits increased from 2014 to 2020, along with the median number of outpatient facilities.
• Globally, the median number of child and adolescent inpatient facilities is less than 0.5 per 100 000 population and less than two outpatient facilities per 100 000 population.
• 112 countries reported that, on average, 0.64 community-based mental health facilities exist per 100 000 population. There is extreme variation between income groups, with 0.11 facilities per 100 000 population in low-income countries and 5.1 facilities per 100 000 population in high-income countries.
• The service utilization rate for persons with psychosis per 100 000 population was 212.4, with considerable variation between high- and low-income countries.
• Service coverage for psychosis was estimated at 29% using 12-month service utilization data data collected for the Mental Health Atlas 2020. Service coverage for depression was estimated at 40% using the World Mental Health Surveys.

MENTAL HEALTH PROMOTION AND PREVENTION

• 101 countries, equivalent to 68% of those countries that responded, or 52% of WHO Member States, have at least two functioning national, multisectoral mental health promotion and prevention programmes. This is an increase from 41% of Member States in 2014.
• Of 420 reported functioning programmes, 18% were aimed at improving mental health awareness or combating stigma, 17% were school-based mental health prevention and promotion programmes and 15% were aimed at suicide prevention.
• 54 countries, corresponding to 39% of responding countries, or 28% of WHO Member States, reported programmes for mental health and psychosocial support integrated as a component of disaster preparedness and/or disaster risk reduction. The global age-standardized suicide rate in 2019 was estimated to be 9.0 per 100 000 population. This represents a 10% reduction in the rate of suicide since the 2013 baseline of 10 per 100 000 population.

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Recommended readings

• World Mental Health Day 2021: Mental health care for all: let’s make it a reality!
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• Comprehensive Mental Health Action Plan 2013 – 2030
• National Mental Health Strategy & Action Plan 2077
• Mental Health for All! Greater Investment–Greater Access.
• National Mental Health Survey, Nepal-2020 Fact Sheet
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