However, only a small proportion of people with mental disorders receive minimally adequate treatment. Compared with treatment, there is even less coverage of interventions to prevent the associated impacts of mental disorders, prevent mental disorders from arising, or promote mental wellbeing and resilience. This implementation failure breaches the right to health, has increased during the COVID-19 pandemic, and results in preventable suffering, broad impacts, and associated economic costs.
Public mental health (PMH) interventions exist to prevent mental disorders from arising, prevent the associated impacts of mental disorders (including through treatment), and promote mental wellbeing and resilience. PMH practice takes a population approach to mental health to improve coverage, outcomes, and coordination of PMH interventions. Such practice supports efficient, equitable, and sustainable reduction of mental disorders and promotion of mental wellbeing of populations. PMH practice is more relevant than ever during the COVID-19 pandemic, which has brought unprecedented challenges but also opportunities for a stronger PMH approach.
At least 18% of the proportion of the global burden of disease is due to mental disorders and self-harm, as measured by years lived with disability, although even this proportion is an underestimate by more than a third. The large impact of mental disorders occurs for four reasons: the prevalence of mental disorders is high; most lifetime mental disorders arise before adulthood, with 50% of lifetime mental disorders occurring by age 14 years and 45% of global disease burden for people aged 10–24 years being due to mental disorders; mental disorders result in a broad range of health, social, and economic consequences relevant to different sectors (including health, education, employment, and criminal justice) and policy objectives; and there is very low population coverage of effective PMH interventions.
The impacts of mental disorders can occur across different stages of the lifecourse. During pregnancy, maternal mental disorders, including substance use (eg, alcohol, tobacco, and cannabis), are associated with an increased risk of child mental disorders.
Mental wellbeing has health and wider benefits relevant to different sector policy objectives. As such, mental wellbeing is a global public good that should be accessible to all.
Different conceptualisations of wellbeing include affective wellbeing, which refers to present state satisfaction, pleasure, and mood, and evaluative wellbeing, which refers to global, longer-term aspects, including meaning and development. However, definitions of mental wellbeing vary by culture.
Resilience involves the capacity to manage and adapt to different types of adversity, including stress, trauma, abuse, and poverty, and is important in maintenance of mental wellbeing and prevention of and recovery from mental disorders.
Mental health can be viewed on a continuum between mental disorders and wellbeing, and individuals can be at different points on this continuum at different times. The dual continuum model describes mental disorders and mental wellbeing on two related yet distinct continua, as having a mental disorder does not preclude mental wellbeing and vice versa. Similarly, good mental wellbeing is associated with reduced risk of mental disorders, whereas mental disorders are associated with increased risk of poor mental wellbeing.
A Guest Editorial