The global mental health crisis demands a new way of thinking

The world is caught in the grip of a mental health crisis.

From rising climate anxiety in rich countries like the United States to intense trauma in conflict zones like Ukraine and Gaza (especially among children), psychological suffering has spread, and traditional healthcare services can't keep up. .

This leaves tens of millions of people facing the risk of serious pathologies and suicide.

Today, more than 25% of the world's population reports feelings of social isolation and loneliness, and more than 150,000 people between the ages of 15 and 29 die by suicide each year.

Climate change threatens to raise these devastating figures.

As the American Psychiatric Association reports, climate change can “lead to job loss, force people to move, and affect social cohesion and community resources, all of which have consequences for mental health.”

Likewise, contemplating climate change and its consequences for both “national security and individual well-being” can cause “significant distress.”

More information

The UN warns that humanity feels distressed

No group is safe.

Young people fear for their future, older people grieve the destruction of the world of their childhood, and climate activists and scientists suffer emotional exhaustion and despair.

And this is without considering the post-traumatic stress and depression experienced by those already affected by climate-related disasters, particularly in vulnerable developing economies.

Traditionally, a psychiatric patient begins individual therapy with a trained physician.

But even the health systems of rich countries are not in a position to offer this type of services to the extent that is needed: in the United States, more than 150 million people live in areas with a shortage of mental health professionals.

In a few years, the country could be short of around 31,100 psychiatrists.

Zimbabwe, a country of 16 million inhabitants, has only 13 psychiatrists and 20 clinical psychologists

The situation is even worse in poor and conflict-affected countries, where it is often very difficult to access traditional psychiatric interventions, if they exist at all.

Consider my native country, Zimbabwe: despite being a country of 16 million inhabitants, it has only 13 psychiatrists and 20 clinical psychologists.

The consequences of this shortage became more evident in 2019, when Cyclone

Idai

devastated parts of Zimbabwe.

The storm's strong winds and heavy rains—and the massive flooding and landslides they unleashed—killed hundreds, displaced some 60,000 people, and destroyed 50,000 homes.

The cyclone also decimated unharvested crops, destroyed seed stocks and killed livestock, leaving people without food and livelihoods.

All of this contributed to mental health problems, including post-traumatic stress disorder.

Barely a year later, things got much worse: the Covid-19 pandemic forced nationwide lockdowns that further undermined people's socioeconomic well-being.

The resulting mental health problems far exceeded the health care system's ability to manage them.

But that doesn't mean Zimbabwe didn't have any options.

The Friendship Bank project, which I founded, trains community volunteers with no prior medical or mental health training to provide talk therapy from wooden benches in parks in the country's 10 provinces.

So far we have trained more than 2,000

grandmothers

to provide advice to their local communities.

The program works.

In 2016, a randomized clinical trial found that patients with common mental disorders and indicators of depression who received counseling from Friendship Bank had a significant decrease in symptoms.

Communities with access to Friendship Bank services also experienced improvements in other areas, from HIV outcomes to maternal and child health.

And the

grandmothers

who provide the therapy say they feel benefited by a stronger sense of belonging and resilience.

Other countries with fewer resources have also been implementing new scalable models to provide low-cost, high-quality psychiatric care to communities where it previously did not exist.

A pioneer in this area is Sangath, an NGO based in the Indian state of Goa that trains ordinary people to provide psychological treatment, particularly in areas with little access to mental health services.

Clinical trials have consistently shown that these “lay counselors” are effective in addressing a wide range of mental health disorders, from depression and anxiety to alcohol use disorders.

Likewise, StrongMinds trains “mental health facilitators” to provide free group therapy to low-income women and adolescents with depression in Uganda and Zambia.

The organization reports a strong impact, especially regarding supporting communities affected by climate-related environmental disasters.

And this impact is only going to grow: StrongMinds founder and CEO Sean Mayberry expects the program to reach 335,000 people this year.

Western models of psychiatric care make too intensive use of resources that must be deployed around the world, particularly in Africa and South Asia, where rapidly growing populations and accelerating climate risks pose immense challenges.

But well-designed community initiatives are effective, low-cost, and highly scalable.

Beyond improving mental health and individual resilience, these programs strengthen community cohesion and foster collective problem-solving, which will become increasingly important as the climate crisis intensifies.

Addressing the global mental health crisis will indeed require greater commitment from the international community.

The World Health Organization's Special Initiative for Mental Health, which sought to provide greater access to mental health services in its six regions in the period 2019-2023, was a step in the right direction.

But the program must continue and must be expanded.

Meanwhile, local and national governments and philanthropies should embrace new local strategies that have demonstrated their ability to help communities cope with increasing risks to their lives, livelihoods and well-being.

Dixon Chibanda

is Professor of Psychiatry and Global Mental Health at the University of Zimbabwe and the London School of Hygiene and Tropical Medicine, founder of Friendship Bank and winner of the 2023 McNulty Prize.

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