By Sarah Johanek, MPH

On June 17th, 2022, the World Health Organization (WHO) released its largest review of mental health data and programs across the globe since the 20th century in its World Mental Health Report: Transforming Mental Health for All. The blueprint outlines the necessary action that needs to be taken by governments, academics, health professionals, civil society, and others. The blueprint pulls from the most recent research, successful models of care, and highlights people’s lived experiences to justify each call to action. Although all 194 WHO Member States signed the Comprehensive Mental Health Action Plan 2013-2030, mental health remains an overlooked area for many countries’ leaders and their federal budgets.

This report was created to show examples of strategic changes to mental health policies, insurance coverage, community-based mental health services, and the integration of mental health into other services. The blueprint encourages countries to accelerate the implementation of the Comprehensive Mental Health Action Plan through three main goals:

Deepen the value and commitment we give to mental health
Reshape environments that influence mental health, including homes, communities, schools, workplaces, health care services, natural environments
Strengthen mental health care by changing where, how, and by whom mental health care is delivered and received

The WHO Director-General, Dr.Tedros Adhanom Ghebreyesus notes: “Everyone’s life touches someone with a mental health condition. Good mental health translates to good physical health and this new report makes a compelling case for change. The inextricable links between mental health and public health, human rights, and socioeconomic development mean that transforming policy and practice in mental health can deliver real, substantive benefits for individuals, communities, and countries everywhere. Investment into mental health is an investment into a better life and future for all.”

Is Maternal Mental Health discussed in this Plan?

This blueprint reports on the overall status of mental health across the world, details the drivers in public mental health, explores the benefits and foundations for change, and provides recommendations for restructuring mental health care. By providing a global summary of effective programs, this report presents evidence-based practices to transform the mental health care delivery system and reshape environments.

The areas that directly report on the state of maternal mental health (MMH) across the world are outlined below.

Storytelling revealing the pain of mothers around the globe: A major portion of this report was storytelling to highlight people from around the world who have experience with mental health conditions. These stories underline different types of social support, levels of stigma, and social exclusion. By sharing the narratives of diverse communities, these stories serve as a reminder that transforming mental health care means investing in people. The first story of a woman who experienced a Maternal Mental Health Disorder (MMHD) is titled “The illness stole precious moments from me and my girls: Olivia’s Experience.” Olivia explains, “Both my girls were born prematurely and after giving birth to my eldest I immediately started to experience symptoms of psychosis. I felt deeply depressed and anxious, was plagued with irrational beliefs and fears, and had severe panic attacks. My symptoms went unrecognized by myself and undiagnosed by the medical staff taking care of me.” She detailed the terrifying visions she experienced, becoming filled with terror, and feeling “trapped in her own horror film.” Due to the lack of care she received, she experienced the same symptoms in her second pregnancy as well. Olivia highlights the importance of educating women on the symptoms of MMHDs and how to care for their mental health during pregnancy. Olivia aims to raise awareness on the importance of this education through publishing a book on her experiences and leaning into peer support initiatives. She also set up The Letters of Light Project: a peer-run program that sends letters of support from women with lived MMH experience to women throughout the world receiving MMH care.
The second story of a woman who experienced an MMHD is titled “Join us as we spark a renaissance in mental health: Amira’s experience.” Amira explains her experience of postpartum depression and the constant feeling of sadness, isolation, and aversion. Due to the stigmatization and lack of awareness around mental health in Jordan, Amira states, “I suffered for a long time. My depression became chronic because of my ignorance and the ignorance of those around me. I was exhausted by the psychological pain and made multiple suicide attempts.” Amira faced high prices and harassment after visiting a private mental health clinic and decided to go to a government mental health clinic where recovery was slow. Amira explains that during this time, Jordan’s government integrated mental health care into local clinics, where she was able to receive psychological treatment and community support. After being invited by the WHO to a workshop on human rights, Amira and others created Our Step, an association to support the rights of people with mental health issues. This led her to support the production of Jordan’s first national mental health strategy in 11 years. Amira emphasizes the importance of advocating and raising awareness of mental health issues.
The importance of caregiver support: This report emphasizes the cyclical nature of mental health complications and the necessity of prevention interventions to support parents’ mental health. The blueprint explains that “Even before we are born our parents’ mental health can impact our own. Poor nutrition, exposure to drugs or toxins, maternal infections or stress, and birth complications can all adversely affect fetal development and put a child’s later mental health at risk. Pregnant women with untreated depression or anxiety are more likely to have birth complications or die during pregnancy, and to have a low-birthweight baby.”
This report explains that many caregivers face psychological distress after birth, such as depression or psychosis, leading to adverse outcomes for the mother and baby. As demonstrated in the personal narratives above, postpartum depression and anxiety can disrupt a mother’s ability to bond with their baby. Depression during pregnancy can also have long-term impacts on the baby’s brain development. Prevention interventions for caregiver mental health are vital to decreasing the risk of mental health conditions in children. According to the WHO’s research, these interventions for caregivers who are already experiencing mental health conditions can decrease the risk of mental health conditions in children by 40%. Additionally, promotion strategies like identifying and supporting parents and other caregivers with mental health conditions and establishing peer support groups for new parents aim to decrease the impact of mental health conditions on the parents and the child.
The WHO outlines a successful initiative developed by the Parenting for Lifelong Health program in 2020. This program was “the COVID-19 Parenting Resources to reduce caregiver stress and lessen the risk of violence against children during the pandemic. Through tip sheets, interactive text messages, online parent support groups, phone-based counseling, and more, the resources use a strategic approach to deliver messages to support caregivers and children during the pandemic. More than 210 million people accessed these resources during the first two years of the pandemic.” Increasing accessibility to education materials and raising awareness on support groups helps parents to utilize the resources they need to support their mental health and their children’s health.
Integrating MMH into obstetric care: The WHO outlines the importance of integrated care to take a holistic approach and support the health of mothers and babies. The report states, “Integrating mental health in perinatal programmes is especially important because maternal mental ill-health is common and impacts both mothers and infants.” By offering mental health care as a part of reproductive care, the healthcare delivery system can help decrease stigma and increase accessibility for birthing people.

The blueprint also details an example of a successful model of integrated care in Uganda: “Maternal (and paternal) mental health conditions are treatable, including by trained non-specialists through maternal and infant health services. For example, in Uganda, trained and supervised midwives screen pregnant women for perinatal depression in maternal care settings; and treat those screening positive with group-based problem-solving therapy given during scheduled antenatal visits. Studies show significant improvement in treated women’s clinical and functional outcomes after six months.”

Lastly, the WHO also states that ”Maternal mental health care should be integrated into early childhood health and development services because of the indirect benefits on caregiving and child development outcomes.” By utilizing an integrated care model for all stages of pregnancy and parenting, mental health will become destigmatized and a standard practice for all healthcare professionals.

2020 Mom’s Priorities: Key Recommendations from WHO

2020 Mom is grateful for the WHO “Blueprint on Transforming Mental Health” to outline the global status of mental health and highlight programs that have been effective in other countries. The WHO recommendations that 2020 Mom believes should be prioritized in the United States include:

Integrated Mental Health Care in OB Settings
Integrating mental and physical care helps to improve accessibility, meet all of the needs of individuals, and decrease duplication and fragmentation of resources. Adding mental health professionals into health services also allows for task-sharing among health providers and increases the efficiency of the healthcare delivery system. In order for an integrated care model to be successful, the mental health care workforce needs to be further developed and strengthened to provide adequate care. Collaborative care models have been shown to improve mental health outcomes. The blueprint presented Chile’s Acceso Universal con Garantías Explícitas program, which is a universal health coverage package of medical and psychosocial benefits. This program has shown to improve early care for first-episode schizophrenia, increase access to care, and enable diagnosis and treatment for underprivileged individuals. Additionally, the WHO states, “In South Asia and sub-Saharan Africa, the cost of scaling up delivery of an integrated package for epilepsy, depression, bipolar disorder, schizophrenia, and heavy alcohol use has been calculated at US$ 3–4 per capita. The return on that investment is estimated at 500–1000 healthy years of life for every million dollars spent.” Integrating MMH care into obstetric settings would allow early diagnosis of disorders, increased treatment, and ultimately, healthier lives.
Peer Support
The use of peer support services is vital to destigmatize mental health and shift public attitudes. Peer support services encourage people with lived experience to share their knowledge, provide emotional support, and support with care navigation. Peer support specialists help to enhance cultural competency in care and provide cost-effective services. 2020 Mom encourages the use of peer specialists in addressing MMHDs and is propelling the training and employment of state-certified peer specialists. 2020 Mom is an advocate for the standardization of reimbursement for peer support under Medicaid and private insurance.
Community-Based Organization (CBO) Support
The WHO states that “Community based mental health care is more accessible and acceptable than institutional care, prevents human rights violations, and delivers better recovery outcomes.” Increasing funding for CBOs is vital to reduce stigma around mental health and providing people-centered care. In locations where there are minimal CBOs, the main service for mental health is long-stay psychiatric hospitals, which are not effective preventive services. 2020 Mom advocates for the increased funding and utilization of CBOs to improve availability of services as ready access and to address health disparities.

Join 2020 Mom in promoting these three recommendations here in the U.S. by sharing these priorities, engaging with others at our FORUM and webinars, and advocating for policy change.