Global collective action in mental health financing: Allocation of development assistance for mental health in 142 countries, 2000-2015

Collective action between international donors is central to the mobilisation of global solidarity in global health. This is especially important in mental health where resources remain extremely limited. In this paper I investigate global collective action in mental health financing, looking at the responsiveness of international donors to mental health needs in low- and middle-income countries (LMICs). I analyse factors at the level of recipient countries (needs, interests, policy environment) associated with allocation of development assistance for mental health (DAMH) using a two-part regression model applied to a time series cross-sectional dataset of 142 LMICs between 2000 and 2015. Findings reveal that international donors' disbursements are not well aligned with mental health needs of recipient countries, and, moreover, contextual factors might be playing more prominent roles in resource allocation. Countries are more likely to receive DAMH if they experience significant outbreaks of infectious diseases or have lower gross domestic product (GDP) per capita and lower market openness. Selected recipient countries are more likely to receive higher DAMH amounts per capita if they have lower GDP per capita, higher government health expenditure, or higher mortality rates due to conflicts or natural disasters. Past DAMH recipients are more likely to be selected and, when selected, to receive higher DAMH amounts per capita. My results demonstrate that more holistic collective action amongst international donors is required to address mental health needs in LMICs. Investments should better reflect needs, particularly during and after emergencies such as COVID-19, and could be amplified by leveraging synergies across other health conditions and sectors.