Closing the mental health gap

Statement by Ambassador Hans Brattskar at the opening of the WHO mhGAP Forum 9 September 2017.

Ladies and Gentlemen,

I am very glad to be here to speak about this important issue. Five types of mental illness appear in the top 20 causes of global burden of disease. This makes mental health conditions a truly global challenge. Promotion of mental health is part of the Sustainable Development Goals and a commitment for all countries. The theme for this year’s mhGAP Forum “Mental Health capacity building within countries” is thus very timely.


For Norway, mental health remains a priority both in itself and as a risk factor for somatic illness, especially the four main types of non-communicable diseases.  In order to reach target 3.4, we must do more – and in new ways. We draw on work done both by WHO, the EU and the OECD.


For us, the gradual shift away from specialized treatment is an especially important part of the WHO mental health action plan. Norwegian mental health care has traditionally been built around centralized institutions, with long-term inpatient care as the default treatment for severe mental health problems. Over the last decades, Norway moved towards a more outpatient, locally based and open psychiatry. We have reduced the number of hospital beds markedly, and transferred resources from hospitals to outpatient units. Traditional mental health hospitals have been downscaled or closed. We will continue this important work through further strengthening the municipal health and care services.


In line with work done both in the WHO, the EU and in the OECD, we know that we must work harder to help people with mental health conditions back into the workforce, or into training and education. Our experiences are surprisingly good. Just a few years back no one in neither the health nor the social services believed that severely mentally ill people had a place in the workforce. Now we know that not only can severely mentally ill people succeed in a job, their mental health even improves through it.


The next logical step is to move effective treatment even closer to patients. We have piloted a low threshold, community based treatment program for mild to moderate depression and anxiety as a collaboration between the municipal services and the specialized services. The results are remarkable, with significant reduction in hospitalizations and involuntary admissions as well as increased quality of life. To achieve these results, we have learned from inspiring projects, services and solutions in many other countries.


All projects I have mentioned have one thing in common, which is also key to WHO's work: They are built by listening to users' and patients' needs. To build the services of the future, the service users must continue to lead the way.

As mentioned earlier, mental health is a major global challenge. And as with other non-communicable diseases, mental illness represents an increasing burden, especially in poor countries. We know that these issues are interrelated; for instance poor health status and nutrition of mothers and infants result in reduced cognitive development, which can lead to a life-lasting reduction in quality of life, as well as productivity. We therefore need to take a holistic view and make sure that mental health is included in all relevant programs. Norway’s support to mental health in global health is primarily channeled through NGOs. We are also working to integrate mental health in ongoing programs directed towards youth and early childhood.


Last, but certainly not least, mental health and psycho-social response in humanitarian contexts is crucial, in particular within child protection and the response to sexual and gender based violence. We have therefore, as part of our humanitarian response, supported the development of a training manual on mental health and gender-based violence to help survivors of sexual violence in conflict.


Let me finish by reiterating Norway’s support to the important work the WHO is doing to promote mental health capacity building within countries and wishing you a successful mhGAP Forum.


Thank you.