A Focus On: Mental Health


Mental health: no parity of esteem with physical health



Image: CC0 Public Domain via Shutterstock. 


Mental illness remains one of the most common disorders affecting people in all parts of the world. Around 183.9 million (7.4%) of Disability-Adjusted Life Years (DALYs) are attributable to mental and substance use disorders. In terms of years of life lost to premature mortality (YLLs), mental disorders accounts for 8.3 million, 0.5% of all YLLs. For years lost to disability (YLDs), mental and substance use disorders are the leading cause of disability worldwide [1]. 


The global cost of mental illness is US$2.5 trillion [2]; in the UK, it is £105 billion [3]. Mental health services and research are central to reducing the burden of disease, disability and mortality that mental illness causes. Yet, the level of spend on mental health services, and the investment in both is disproportionate to the burden of disease and social and economic cost of mental health problems.  


On the service side, public expenditure on mental health in low and middle income countries is less than US$2 per capita; in high income states it is US$58 [4]. GIobal cancer spend in 2014 was US$100 billion[5]. In the UK, mental health accounts for 23% of the burden of disease but only 11% of the NHS budget [6]. 


Mental health receives around 5.5% of all UK health research spend compared to 37.6% spent on cancer and other major illnesses. The amount of research spend per person affected is £1571 for cancer, but £9.75 for mental illness. Despite the relatively low levels of research spend on mental health, every £1 spent generates returns of 37p [7], rendering this excellent value for money. When it comes to research spend we are a long way from the parity of esteem accorded mental health problems when compared with other health care conditions.  


The WHO Global Mental Health Strategy aims to promote mental well being, prevent mental disorders and reduce mortality and morbidity in persons with mental health problems. It aims to do this by better access to services, improved compliance with human rights conventions, attending to mental health needs throughout the lifespan, a multi-agency approach and greater involvement and empowerment of mental health service users in the planning and development of mental health policies and services. These are ambitious targets, without improved parity of esteem in the funding of mental health; it is hard to see how these targets can be met.   



Patrick Callaghan is Professor of Mental Health Nursing, University of Nottingham, Queens Medical Centre, Nottingham, UK; he is the Editor of the Oxford Handbook of Mental Health Nursing, 2 ed, published by Oxford University Press.



[1] Whiteford, HA., Degenhardt, L., Rehm, J., Baxter, AJ, Ferrari, AJ, Erskine, HE, Charlson, FJ, Norman, RE, Flaxman, AD, Johns, N, Brstein, R, Murray, CJL & Vos, T. (2013) Global birden of disease attributable to mental and substance use disorders; findings from the Global Burden of Disease Study 2010. The Lancet, 382, November 9, 1585-1586

[2] World Health Organisation (2014) Mental Health Atlas 2014. Geneva: WHO

[3] MQ Landscape Analysis (2015) UK Mental Health Research Funding London: MQ

[4] World Health Organisation (2014) Mental Health Atlas 2014. Geneva: WHO

[5] IMS Institute for Health Informatics (2015) Health. Developments in Cancer Treatments, Market Dynamics, Patient Access and Value: Global Oncology Trend Report 2015. IMHs, Washington

[6] The King’s Fund (2105) Has the government put mental health on an equal footing with physical health? Accessed at http://www.kingsfund.org.uk/projects/verdict/has-government-put-mental-health-equal-footing-physical-health on 10 February 2016

[7] Association of Medical Research Charities (2014) Charities’ contribution to UK medical research, London, UK