By Sarah Jones and Naomi Radcliffe in support of World Mental Health Day
A recent survey by the WHO found that amongst its member countries, the lifetime risk of mental health illness was between 18 – 36%.  Yet the vast majority of people are undiagnosed or not receiving treatment, especially in low-income countries. The World Economic Forum estimates that between 2011–2030, mental health conditions will be responsible for the total loss of $16.2 trillion to the global economy. We can compare this to five other non-communicable diseases – cardiovascular disease, chronic respiratory disease, cancer and diabetes – which together will account for the loss of $30 trillion by 2030. To put these figures into perspective, the total global spending on health in 2009 was only $5.1 trillion. 
Rising direct costs are partly due to an ageing population and a greater proportion of individuals over the age of 75 years, which have resulted in more people living with costly conditions such as dementia.  We also have higher expectations on the level of care that we should receive. In high-income countries, this translates into demand for new and expensive treatments and drugs that may only elicit marginal benefits in comparison to existing treatments. 
The indirect costs of mental health conditions are largely attributable to increased sickness absence, reduced productivity and the impact on the welfare state (if one exists). The International Labour Organization estimates that over between one-third and one half of all new disability claims in the European Union are for reasons of mental ill health. Amongst young people this rises to over 70%. 
Despite this huge potential economic impact, little investment is made into mental healthcare and it has received scant attention in comparison to other global health challenges. Many low-income countries allocate less than 1% of their health budget to mental health and the majority do not have any specific mental health budget at all.  There is a lack of awareness about the scale of the problem, as well as stigma associated with mental health conditions. In some countries there is a lack of infrastructure, services or a skilled workforce to provide treatment.
The good news is that there are interventions that can reverse this trend and dramatically improve the quality of life for those living with mental health conditions, as well as reduce the future burden of mental health disease. These interventions need not be costly and can be applied across a range of high- and low-income settings.
Technology based innovations have the potential to provide a scalable and consistent quality of care in most mental health settings. Yet their widespread use has not yet been adopted. This is despite the fact that mobile phone technologies have increasingly high global penetration rates that outstrip even Internet penetration. Mobile phones present a readily available platform literally at the fingertips of the user.
There is also a growing body of research showing that mobile mental health technologies based on existing evidence-based therapies are acceptable to patients, increase patient satisfaction and can, in the case of some interventions, supplant labour without compromising outcomes. Interventions and mental health promotions should bring themselves to the patient, not the other way around.
For example in Sweden, mobile phone technologies used in therapy for anxiety and depression have achieved equivalent treatment outcomes using 60% fewer sessions than treatment with a therapist alone (7). In Ireland daily automated text messages sent to patients’ mobile phones improved outcomes and increased satisfaction following in-patient treatment for dual diagnoses of depression and alcohol dependence (8) and Columbia University primary care medical students access their PCORE system’s mental health training tools from mobile devices.
Policy makers and mental health care providers should consider stepping outside of their comfort zone and look to opportunities in mobile technology innovations for the future of mental health care. This is especially critical since the World Health Assembly, representing the political health leadership in the world, has passed the first ever Mental Health Action Plan, with clear and challenging targets to be achieved by year 2020 (9).
For more on mobile mental health innovations see the recent article in Health Affairs by Jones et al: http://content.healthaffairs.org/content/33/9/1603.full
- Kessler RC, Aguilar-Gaxiola S, Alonso J, Chatterji S, Lee S, Ormel J, et al. he global burden of mental disorders: An update from the WHO World Mental Health (WMH) Surveys. Epidemiologia E Psichiatria Sociale-an International Journal for Epidemiology and Psychiatric Sciences. 2009 Jan-Mar;18(1):23-33.
- The Global Economic Burden of Non-communicable Diseases. [Internet] Cambridge (MA): World Economic Forum and Harvard School of Public Health. 2011 [cited 2014 Jul 30] Available from: http://www.weforum.org/reports/global-economic-burden-non-communicable-diseases
- Paying the Price. The cost of mental health care in England to 2026. King’s Fund, 2008.
- Macdonnell, M. and Darzi, A. A key to slower health spending growth worldwide will be unlocking innovation to reduce the labour-intensity of care. Health Affairs, 2013, 32:4, p.653-660
- Sick on the Job? Myths and Realities about Mental Health and Work. OECD, 2011.
- Jenkins, R., Baingana, F., Ahmad, R., McDaid, D., Atun. R,. Should low income countries and other development actors care about mental health? Commonw Health Partnership. 2013:18-25.
- Viary [home page on the Internet]. Stockholm: Viary [cited 2014 Jul 30] Available from: https://www.viary.se/
- Agyapong VIO, Ahern S, McLoughlin DM, Farren CK. Supportive text messaging for depression and comorbid alcohol use disorder: single-blind randomised trial. J Affect Disord. 2012 12/10/;141(2–3):168-76.
- Mental health action plan 2013-2020. Geneva: World Health Organization, 2013.