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Investing in mental health.

Mental, neurological and substance-use disorders account for 9 out of the 20 leading causes of years lived with disability worldwide (more than a quarter of all measured disability) and 10% of the global burden of disease (which includes deaths as well as disability) (1,2). A recent analysis by the World Economic Forum estimated that the cumulative global impact of mental disorders in terms of lost economic output will amount to US$ 16 trillion over the next 20 years (3). Such an estimate marks mental health out as a highly significant concern, not only for public health but also for economic development and societal welfare. Worldwide, current investments in mental health are extremely meagre. Many lowand middle-income countries allocate less than 2%—or even less than 1%—of their health budget to the treatment and prevention of mental disorders (4). Most of the funds that are made available by governments are specifically directed to the operational costs of specialized but increasingly outdated mental hospitals (which are commonly associated with isolation, human rights violations and poor outcomes). This inevitably curbs the development of more equitable and cost–effective community-based services. It has been estimated that an integrated package of cost–effective mental health care and prevention can be delivered in community-based settings of lowand middle-income countries for US$ 3–4 per capita per year (5). The World Health Organization (WHO) recently set out 4 criteria against which public health investments are commonly made (6): the protection of human rights, including the right to health; the current and future (health and economic) burden of disease; the avertable burden of disease (resulting from the provision of cost–effective services); and the reduction of social inequalities, including access to essential health services. Application of these criteria to mental health revealed that a robust investment case can be made on the grounds of enhancing individual and population health and well-being, reducing social inequalities, protecting human rights, or improving economic efficiency. The consequences of not investing in mental health are manifold and include: