Nurses shoulder burden of co-occurring pandemic of mental health

The International Council of Nurses welcomes the new World Health Organization (WHO) World mental health report: transforming mental health for all launched on 17 June 2022, which highlights persistent workforce shortages as one of the major challenges preventing effective action in mental health programmes. There are simply not enough health care professionals to meet demand across the continuum of care which includes prevention, promotion, treatment and rehabilitation of mental health and wellbeing.

Nurses form the largest number of providers in mental health care services across the world and are responsible for the delivery and coordination of the majority of patient care. However there are significant workforce shortages in nearly all countries. The problem is most profound in low and lower-middle income countries – less than 5% of all mental health care nurses can be found in these areas.

ICN is equally concerned about the mental health of nurses who have been facing mass trauma as a result of the pandemic, poor working conditions, staffing shortages, and other challenges.

ICN President Dr Pamela Cipriano said:

“We have been experiencing the perfect storm when it comes to mental illness. Chronic long-term underinvestment, poor planning and irresponsible regulations coupled with a pandemic, climate change and political crises. All of this has highlighted and exacerbated the world’s mental health challenges and work needs to be done in all countries to strengthen mental health care.

‘The pandemic has been a powerful catalyst in exposing the weaknesses in our health systems, particularly in its approach to mental health. What it has also done is illuminated the fact that mental health is more than just a health issue, it also a societal and economic crisis. It should be considered just as much of a pandemic affecting our communities.”

As the WHO mental health report¹ states, the human and community costs are immense:

• Undertreated - 71% of people with psychosis do not receive mental health services
• Widespread - 1 in 8 people live with a mental health condition
• Under-resourced - Mental health care is severely under-resourced with less than 2% of health budgets spent on mental health.

In addition to this, there are other consequences:

• Costly - The cumulative economic output loss associated with mental health is projected to be $16.3 trillion worldwide. The direct and indirect costs of mental ill health are estimated at over 4% of GDP ,which is more than the cost of cancer, diabetes and chronic respiratory disease combined.²
• Isolating – Stigma, discrimination and the poor legal protections isolate individuals from participating in communities.
• Life limiting - People with severe and persistent mental illness die 10-20 years earlier than the general population. ^3,4

The report also addresses the stigma of the mental health workforce and of those suffering from mental illness. It also calls for a scaling up of community-based mental health care, strengthening primary care, de-institutionalising mental health care facilities, improving the integration between health services and offering the full spectrum of mental health services. In this environment, the work of mental health nurses is optimised and the greatest return on investment can be made.

ICN Chief Executive Officer, Howard Catton said:

"ICN congratulates WHO for its work on mental health and this new report. The world is witnessing increasing mental health needs but this remains a shockingly underfunded area. We believe that nurses are a major part of the solution to support mental health needs and we call for a concerted effort and investment to address this mental health crisis. Committing to improving mental health is an investment into a better life and future for individuals, communities and the world.

'Mental health nurses 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 is currently developing a report on the mental health workforce, highlighting some of the issues affecting mental health nursing and effective and responsible solutions to address this workforce crisis. Strengthening mental health care starts with adequately equipping and resourcing the nursing workforce.”

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 well-being. 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 use socialization, activation and communication with their patients to create a safe, comfortable environments that promotes positive change.

Growing, strengthening and investing in the mental health nursing workforce is one of the pillars that underpins and effective health system capable of addressing the mental health burden of disease. This will require addressing multiple areas including nursing education, retention, overseas recruitment, service delivery models and clinical governance.

¹WHO (2022). World mental health report: transforming mental health for all. Available at:

²Trautmann, S., J. Rehm, and H.U. Wittchen, The economic costs of mental disorders: Do our societies react appropriately to the burden of mental disorders? EMBO reports, 2016. 17(9): p. 1245-1249.

³National Mental Health Commission, Equally Well Consensus Statement: Improving the physical health and wellbeing of people living with mental illness in Australia. 2016, NHMC: Sydney.

⁴Liu, N.H., et al., Excess mortality in persons with severe mental disorders: a multilevel intervention framework and priorities for clinical practice, policy and research agendas. World psychiatry : official journal of the World Psychiatric Association (WPA), 2017. 16(1): p. 30-40.

Download the press release here