The coronavirus disease 2019 (COVID-19) pandemic is bringing to light the long-neglected area of mental health. Current evidence demonstrates an increase in mental, neurological and substance use conditions globally. Although long-established as a leading cause of disease burden, mental health has been historically grossly underfunded. This analysis seeks to demonstrate the extent to which funding for mental health has been prioritised within the international COVID-19 response.

The authors analysed the development and humanitarian funding through data provided by the International Aid Transparency Initiative. Project-level COVID-19 data from January 2020 to March 2021 were reviewed for mental health relevance. Relevant projects were then classified into categories based on populations of concern for mental health and the degree of COVID-19 involvement. Financial information was assessed through project transaction data in US Dollars.

Of the 8319 projects provided, 417 were mental health relevant. Mental health-relevant funding accounted for less than 2% of all COVID-19 development and humanitarian funding. Target populations which received the majority of mental health relevant funding were children and humanitarian populations, and 46% of funding went towards activities which combined COVID-19 responses with general humanitarian actions. Over half of mental health relevant funding was received by ten countries, and ten donor organisations provided almost 90% of funding.

This analysis shows that the international donor community is currently falling short in supporting mental health within and beyond the COVID-19 pandemic. As the pandemic continues, sustainable country-led awareness, treatment, and prevention for mental, neurological and substance use conditions must be prioritised

Mental health has recently gained increasing attention on global health and development agendas, including calls for an increase in international funding. Few studies have previously characterized official development assistance for mental health (DAMH) in a nuanced and differentiated manner in order to support future funding efforts.

Data from the Organisation for Economic Cooperation and Development Creditor Reporting System were obtained through keyword searches. Projects were manually reviewed and categorized into projects dedicated entirely to mental health and projects that mention mental health (as one of many aims). Analysis of donor, recipient, and sector characteristics within and between categories was undertaken cumulatively and yearly.

Between the two categories of official DAMH defined, characteristics differed in terms of largest donors, largest recipient countries and territories, and sector classification. However, across both categories there were clear and consistent findings: the top donors accounted for over 80% of all funding identified; the top recipients were predominantly conflict-affected countries and territories, or were receiving nations for conflict-affect refugees; and sector classification demonstrated shifting international development priorities and political drivers.

Across DAMH, significant amounts of funding are directed toward conflict settings and relevant emergency response by a small majority of donors. Our analysis demonstrated that, within minimal international assistance for mental health overall, patterns of donor, recipient, and sector characteristics favor emergency conflict-affected settings. Calls for increased funding should be grounded in understanding of funding drivers and directed toward both emergency and general health settings.