Mental Health Math: A $1 Trillion Opportunity for Good

Written by Michael TS Lindenmayer and Thomas Roades of HFI and Garen Staglin of One Mind

Content Warning: This article includes discussion of mental health issues including depression, anxiety, and suicide.

Mental Health Moment

The world thrives when we acknowledge, understand, and invest in mental health. Precipitated by the COVID-19 pandemic, the mental health field has been cast out of the shadows into the forefront of global debate. There is a critical window of opportunity to advocate and act.

COVID-19 has transformed this into a mental health moment. Mental health is front and center on people’s minds. Depression and anxiety levels are skyrocketing. According to the U.S. CDC, 4 in 10 Americans are experiencing some form of mental health challenge. To put this into perspective, it’s at least two times higher than the level reported at the same time last year.

Mainstream media is also reporting similar findings. Women’s Health Magazine surveyed 2500 of its readers and reported that 70% of the respondents had indicated that their mental health had deteriorated.

The numbers become even more stark when you consider the unequitable access and use of mental health services by Blacks, Hispanics and Native Americans.

Mental health is tantamount to a pandemic wrapped within a pandemic. The good news is that people are talking about it. Social media, mainstream media and governments are acknowledging the challenge. And rising to the challenge are innovative care providers, new therapeutics and impact investors. Transformation is on its way to this field with the potential to advance resilience and thriving during and post a COVID-19 world.

Mental Health Math

While COVID-19 has both revealed and exacerbated the current mental health crisis, it is important to note that this non-communicable disease was widespread and adversely impacting people’s lives and economies prior to the pandemic.

Before COVID-19, about 13% of people worldwide experienced mental illnesses. These conditions account for about 20% of all years lived with a disability, and, according to WHO estimates, cost the global economy $1 trillion annually in lost productivity. Despite this massive global burden, just 0.3% of all global development assistance for health went toward mental health. This major gap illustrates that the scope, scale and pace of funding in mental health has been woefully inadequate.

Yet by flipping the script on this problem, we can begin to think through how to advance fresh investments in research, therapeutics and care services. This will require new financing instruments and healthcare delivery models. This holds true for both high resource and low resource environments.

When considered from this perspective, investing in mental health care is an opportunity with the potential to unlock up to $1 trillion in global productivity, improve individual well-being and increase social resilience.

Impact Investment and Transformation

The good news is that investment and transformation is picking up pace from the private sector. A wave of new digital technologies offers promising solutions for mental healthcare. Forbes reports venture capital deals in mental health have more than tripled since 2013, and the total capital invested has risen from about $150 million to $750 million over the same period. Organizations such as One Mind are encouraging the mental healthcare space to make the system more patient-centered and reduce the stigma surrounding mental health disorders. And we at HFI are constantly working with stakeholders around the world to design and generate innovative finance mechanisms that make investments in NCDs, including mental health. Our role is to look at the unique ways in which understanding patient protocols and blended finance combine to generate the most impactful outcomes for all stakeholders.

COVID-19 and Mental Health

As we know, COVID-19 slammed into people’s lives and ratcheted up negative impacts on people’s mental wellbeing. Tracking polls from the Kaiser Family Foundation (KFF) over the summer found Americans’ concerns about the pandemic are being expressed through mental health symptoms. As shown in the graph below, and as of June 2020, a majority of Americans reported negative mental health impacts as a result.

In America, just under one-in-five people suffered from mental illnesses prior to the pandemic. The prevalence of mental illness is significant, and has been steadily on the rise since the onset of COVID-19.

KFF’s polling data also covered specific symptoms Americans have been reporting. Those findings are shown in the graph below.

Difficulty sleeping was the most common, with well over a third of American adults experiencing this issue, but other concerning symptoms were commonly reported as well. More than one-in-ten reported increased drug or alcohol use, pointing up the well-established relationship between mental health and substance abuse disorders. And the impacts of mental health disorders are not distributed evenly across demographic groups; certain populations are more vulnerable and bear disproportionate burdens from these diseases.

Social Determinants of Mental Health

The WHO defines social determinants of health (SDH) as “the conditions in which people are born, grow, work, live, and age, and the wider set of forces and systems” that can affect health outcomes. These factors have been found to be strong predictors of individuals’ likelihood of suffering from a wide variety of health conditions and health outcomes. This includes mental health. Drawing from KFF data on mental health during the pandemic, we observe how these social determinants are linked to mental health.

The graph above shows how mental health symptoms are distributed based on a variety of socioeconomic and demographic categories. This visualizes the negative effects and inequities. The national average is 52%, but women were more likely than men to report symptoms, and Black and Hispanic people more likely than White people. The single strongest predictor, though, was economic status. People who faced difficulty affording their household expenses due to the pandemic were more likely than any other group to report mental health symptoms, and the biggest gap was between those who struggled to cover their expenses and those who did not.

Understanding social determinants also means we can look at policy, programs and blended finance models that enhance mental well-being through precision public policy. This is in line with academic research on the social determinants of mental health. A 2014 WHO report on the subject included a “systematic review of the epidemiological literature on common mental disorders and poverty in low and middle-income countries” and found that “of the 115 studies reviewed, over 70% reported positive associations between a variety of poverty measures and common mental disorders.”

A review of population surveys in European countries, also cited in the same WHO report, found an association between material disadvantage, unemployment, and higher rates of common mental disorders such as anxiety and depression. A 2007 study by the Institute of Health Equity was able to quantify these impacts. The researchers found every 1% increase in unemployment was associated with a 0.79% increase in the rate of suicide below the age of 65.

Resilience and Recovery: Mental Health Cornerstone

It is clear that system shocks like COVID-19 amplify pre-existing underlying problems. As people think through and past COVID-19, they need to consider and plan for alternative futures that address some of the biggest challenges surfaced during this storm.

Recovery plans need to be built around the principle of resilience. These robust plans will be needed to generate sustained recoveries and readiness for the next systemic shock. And a cornerstone of any successful resilience and recovery strategy requires investing in the importance of mental health. HFI and One Mind are committed to resilience and thriving global mental health. We welcome dialogues with stakeholders looking to collaborate on this shared vision.


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