Public Policy and Mental Health: What We Can Learn from the HIV Movement

Nimeh, Zina; Nimeh, Zina

Mental health plays a key role in human development, both as a driver and as goal in itself. Despite this, it has been strikingly neglected to date. The Human Immunodeficiency Virus (HIV) movement has revolutionized health advocacy and registered remarkable successes in the past decades. As public health issues, the HIV epidemic and mental health share an all too common fate. Just as HIV when it first broke out, most mental disorders are still poorly understood and surrounded by an air of myth, superstition and prejudice. In both cases, stigma, discrimination and social exclusion play an ever-important role in worsening the diseases' impact and hindering an effective response. Through exhaustive literature review, the present study draws on the experience of this exceptional movement in order to find ways forward in the field of mental health. Adopting a broad analytical perspective, it discusses the differences and similarities between the fields of HIV and mental health and, based on this analysis, provides a concrete framework for action that takes into account the peculiarities of mental health as a policy issue.

The HIV movement has come a long way since the first recognition of the Acquired Immune Deficiency Syndrome (AIDS) in the early 1980s. Thanks to an incessant concerted effort, HIV is nowadays a priority public health issue on the international agenda, drawing on substantial funding and strong political advocacy. Mental health, however, still remains a strikingly neglected issue, especially in low- and middle-income countries (LMICs). While neuropsychiatric disorders are estimated to account for 13% of the global burden of disease in terms of Disability Adjusted Life Years (DALYs), the global median percentage of government health budget expenditures dedicated to mental health amounts to a mere 2.8% (World Health Organization [WHO], 2011). Moreover, with 0.5% and 5.1% respectively, the gap between low- and high-income countries is far from proportional.

Even though the HIV movement is one of the most prominent global health movements, systematic analysis of its achievements has emerged only recently and remains scarce. Most notably, Kapstein and Busby (2013) provided one of the first efforts to systematically process the HIV movement's experience in order to learn for other policy areas. Similarly, despite mental health receiving increasing attention in global development, there is very few and only very recent literature aimed at systematically conceptualizing it as a policy issue. In both fields, stigma is mentioned as a major issue throughout the literature, but the application of conceptual frameworks to properly understand stigma and its etiology is still lacking behind, especially when it comes to engendering practical, change-oriented implications.

Given this setting, this research paper will do the following:

1. Explore the role of mental health in global development and identify the most relevant response gaps.

2. Discuss the key aspects that shaped the HIV movement's history and the current global response.

3. Apply the HIV movement's experience to the field of mental health and provide new conceptualizations, insights and concrete policy recommendations.

Association for Public Policy Analysis & Management

Panel Paper: Public Policy and Mental Health: What We Can Learn from the HIV Movement

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