Establishing political priority for global mental health: a qualitative policy analysis

Abstract

Mental disorders represent the leading cause of disability worldwide, yet they remain a low global health priority. This paper uses a case study methodology and different data sources (35 interviews and documents) to analyse factors that have shaped the generation of political priority for global mental health over the past three decades (1990–2020) and their changes over time. The Shiffman and Smith framework on determinants of political priority for global health issues is used to organise data into themes: actor power, ideas, political context, and issue characteristics. Global mental health has gained political attention especially over the past decade, yet support remains limited. Findings reveal that actor power is undermined by a fragmented policy community, absence of one guiding institution or coordination mechanism, and little civil society mobilisation. Public portrayal of the issue is divided, hampered by the absence of a common understanding by the community, and by stigma. Some policy windows have been missed and a strong global governance structure is lacking. Credible indicators and evidence on simple cost-effective solutions especially in low- and middle-income countries are scarce. However, opportunities are arising, including an increasing number of leaders and grassroot organisations, multiple arguments for action and integrated solutions resonating with broader audiences, widening political support at national level, an emerging global governance structure, and an expanding evidence base on the scale of the problem and available solutions. The results points to three technical and four political challenges that advocates need to address to increase political support over the next decade.

Global Mental Health: Where We Are and Where We Are Going

“…Robust financing is needed to see strategies through to implementation [ 93 •]. Current funding is not commensurate with mental health needs in many countries and is often hindered by the lack of cohesive policy making efforts and governance [ 94 ]. Actual disbursements fall short of pledges and commitments (for all health priorities) [ 95 ].…”

Identifying Core Global Mental Health Professional Competencies: A Multi-Sectoral Perspective

“…While an array of communication skills have invariably featured in existing competency frameworks (Buzza et al, 2018; Merritt et al, 2019), the current job market analysis shines a light on a broader spectrum of communication and political skills, including some less commonly emphasised skills such as conflict resolution and influencing skills, together with policy and political knowledge and sensitivity. Multi-stakeholder collaboration, negotiation and consensus-building are indispensable in many GMH-related roles, particularly in the policy, advocacy, capacity-building and healthcare management sectors (Ng et al, 2016; Iemmi, 2022). Negotiation, specifically, has been highlighted as an emotionally demanding skill – hence its close links to leadership, emotional intelligence and resilience (Higazee and Gab Allah, 2022).…”

Understanding the factors affecting global political priority for controlling sexually transmitted infections: a qualitative policy analysis

“…3 The framework comprises four categories, which cover eleven determinants of political priority (table 1) and has been applied to the analysis of a number of global health initiatives, such as maternal mortality reduction, mental health, global surgery, emergency care, and early childhood development. 3,22–25…”