The Global Mental Health nursing workforce: Time to prioritize and invest in mental health and wellbeing

The world faces grave consequences from the lack of available mental health services and treatment. Mental illness impacts every country, culture and community, with the World Health Organization (WHO) stating that 10% of the global burden of disease is related to mental, neurological and substance use disorders. In low-and middle-income countries, more than 75% of people with mental disorders receive no treatment at all for their disorder. During 2020, as a result of the global pandemic, 93% of countries reported their mental health services were either halted or interrupted (WHO, 2020e). WHO reported a 25% increase in depression and anxiety alone during the pandemic. The Organisation for Economic Co-operation and Development estimates depression and anxiety cost the global economy US $1 trillion dollars a year. All nurses have a health care role in mental health and substance use. ICN strongly advocates for the investment of further education and professional development in this area in order to support individuals and communities achieve the highest attainable standard of health which includes physical, mental and social wellbeing. Whilst all nurses have a role, this report focuses explicitly on nurses who have been educated and prepared in the specialty area of mental health and substance use. Throughout this report, these are referred to as mental health nurses. Mental health nursing is a specialty within the field of nursing that provides holistic care to individuals at risk for or experiencing mental and substance disorders or behavioural problems to promote their physical and psychosocial wellbeing. It emphasizes the use of interpersonal relationships as therapeutic tools and considers the environmental factors that influence mental health. Mental health nurses not only provide physical care, but also use socialization, activation and communication with their patients to create a safe, comfortable environment that promotes positive change. Mental health nurses, which represent the largest proportion of the mental health care workforce (44%), are vital to improving access to professional mental health care which will not only improve the lives of millions, but also have positive outcomes for the world. ICN estimates that there are approximately 300,000 mental health nurses across the world. However, the number of nurses working in mental health varies vastly across regions, ranging from 0.9 per 100,000 in Africa to 25.2 per 100,000 in Europe. The report offers a stark reflection on the disparity of available nursing personnel by income level, with low-income countries having 0.4 per 100,000 and high-income countries having 29 per 100,000. The WHO Mental Health Atlas (WHO, 2021b) states that only 31% of countries collect and analyse mental health specific data which adds further complexity to our ability to clearly understand the mental health nursing workforce as well as undertake the necessary mental health nursing workforce planning and development. To support the mental health of the global community, the International Council of Nurses (ICN) was keen to develop a report which could assist governments, policy makers, nursing associations, nursing educators, and workplaces to review and develop the workforce. To gather the information, ICN undertook the development of a survey with the assistance of mental health nursing experts from across the global. The survey was completed by mental health nurses, specialist mental health organisations, ministries of health, or experts in the area of mental health across 44 low-, middle- and high-income countries with all regions represented.