COVID-19 Webinar 4: Mental health and Covid financing
The Lancet Psychiatry, Mental Health Innovation Network, MHPSS.net and United for Global Mental Health have launched a series of weekly webinars designed to provide policy makers and the wider health community with the latest evidence on the impact of COVID-19 on mental health and how to address it.
Chair: Niall Boyce, Lancet Psychiatry
Panellists:
Sarah Kline, United for Global Mental Health (UnitedGMH)
Danielle Kemmer, International Alliance of Mental Health Research Funders (IAMHRF)
Rajvi Mariwala, Mariwala Health Initiative
Dr. Nasri Omar, Focal Point Mental Health System and Services, Mental Health Division, Ministry of Health, Government of Kenya
Niall Boyce opened the meeting thanking the speakers. He asked Sarah Kline; what are the trends so far in funding for mental health as part of the COVID response?
Sarah Kline, United for Global Mental Health
UnitedGMH exists to help raise the profile of, and encourage greater political and financial support for, mental health at national and global level. Nationally, mental health has been (prior to COVID-19) chronically underfunded - an average of 2% or less of health budgets. Some countries have announced additional mental health related funding in relation to COVID-19 including New Zealand, Australia, UK; most countries are not yet prioritising additional support. To change this we need public demand for public mental health services and the funds available. Globally, mental health is overlooked in COVID-19 response plans. It is not a significant part of global plans - either the WHO or UN - but it is part of some UN agency plans. We need a comprehensive, well coordinated global and national approach. We anticipate the case for support for MH in time of COVID-19 will grow and more funds will be dedicated to it over time - but the first step is to get it into COVID-19 national and international strategies and plans.
Niall Boyce, Lancet Psychiatry
Why should mental health be a priority for funding?
Sarah Kline, United for Global Mental Health:
Member states want the most effective public health information campaigns possible: making sure the public adhere to the public health messaging on social distancing and on hygiene. Mental health professionals can help guide this. As we learnt in a previous webinar, some of those most vulnerable to contributing to the spread of COVID-19 are also those with poor mental health including those in psychiatric institutions, the homeless and those with long-term addictions. We need a mental health based response to address their needs and prevent the spread of COVID-19 effectively. And, as also covered in another seminar, ensuring the good mental health of health workers is essential. We need to tackle this now if we want a workforce that is sustained throughout this response and recovery.
Niall Boyce
Now over to Nasri: what are the funding needs of a country like Kenya? How is the Kenyan government responding to mental health at this time and how does it fund its work?
Nasri Omar, Ministry of Health, Government of Kenya
As the focal point for mental health during the COVID-19 response, I can report there are plans underway to hire a psychologist for each of the 47 counties to support MHPSS activities (this is the first time this has happened). Already the government COVID-19 response team has helped develop and disseminate MHPSS materials and conduct virtual trainings on MHPSS and psychological first aid. The government has done a psychiatric review for those in quarantine and provided free psychiatric drugs; and mental health workers have been recognised as front line workers who need PPE. The government has started doing tele counselling - which is relatively new in Kenya - and doing group tele counselling using Zoom. Based on this experience the plan is to have a national tele counselling service: this is a long term investment to develop a national suicide hotline to support people now and after the crisis.
The MHPSS team are pushing to get funds from the government for their work on COVID, and collaborating with other government agencies to increase capacity. Right now they are using police counsellors to help meet capacity gaps and working with partners including the private sector and the Kenyan Red Cross.
Danielle Kemmer, IAMHRF
We are a dedicated funders’ forum who unite different types of funder, for example large government, philanthropic and fundraising charities. IAMHRF recently conducted a survey of what funders are doing as a response to the COVID-19 pandemic. This survey reported a mixture of immediate priorities, including crisis management, and also early thinking of long term strategies that might stick around. The high income country (HIC) government mental health research funders (who are part of the IAMHRF) reported they are part of their government COVID-19 response plans and part of the COVID-19 management plans. They are reporting that all the non-COVID19 activities have been put on hold. These funders are mostly extending deadlines and enabling bridge funding to keep people afloat. Current funding calls are being recycled and they are now trying to tailor these to address the COVID-19 immediate needs.
There has been a big push for the development and adoption of standards in the mental health research sector, as there is now increased activity due to the high number of research questions that need to be answered. There has been an ongoing discussion on long term strategies, as it is in everyone's interest to prioritise the things that work, to create evidence, and find effective solutions.
The philanthropic sector acted very fast, reaching out to their funded communities to understand the needs and quickly responded with increased funding, and extended deadlines.
[In answer to a specific question] Youth mental health has always been front and centre in research funding, but suddenly [with the advent of COVID-19] we all have some kind of lived experience. Therefore the mental health needs that occur are broader than just young people. The impact on young people is hard, as peer interactions are incredibly important. It is interesting to see the demographic impacts, as young people are likely to be better at working remotely using social media tools [than older people], however disruptions to schools is a major thing.
Rajvi Mariwala, Mariwala Health Initiative:
COVID-19 has thrown up some very important fault lines across society; not just as a pandemic with a public health dimension, but also linked to human rights, livelihoods, access to social care and justice. In India the lockdown was somewhat unplanned, and migrant workers got stuck overnight without shelter. There have been 43 reported deaths due to migration related accidents, 15 of these have been road accidents from people who are trying to walk or cycle back to their home states and at least 35 deaths by suicide due to mental health issues likely linked to fear, COVID-19 stigma and/or substance withdrawal.
The government has worked to put in place a lockdown and quarantine, but each state’s response varies and therefore levels of infection are varied. The government focus has been on testing and quarantine; very few states have added a mental health response. Those that have included a mental health response have done so because there was a quick reaction from a vibrant mental health community that has stepped up to offer helplines, work with the state and offer resources.
The response from philanthropic funders was also quick; philanthropic leaders asked; a donor response for effective COVID-19 support, and strengthened non profit partners that philanthropy and CSR can work with; and long term loosening of restrictions on grants e.g. converting current project grants to a longer term framework.
The central government COVID-19 task force does not include mental health experts, although some states have included them, and the Indian Council for Medical Research will include a Mental Health and COVID-19 study.
Niall: Have there been any coordination challenges?
Raj Mariwala:
State and central governments have their own task force and ways of coordinating. Civil society has been working on PPE, ventilators and mental health support, but front line workers are not receiving mental health support and the mental health workers themselves seem to be invisible, as they are not considered as front line support.
Niall: What advice would you give to people looking for funding for mental health projects related to COVID-19?
Sarah Kline:
UnitedGMH have just launched an open access website where you can look at financing in different contexts from different kinds of donors, this site includes a brief on financing and COVID-19. If you are a national government looking for international funding from multilaterals and bilaterals, then you must make the case for mental health and demand funding for it. Fundraising will be much harder for NGOs, as much of the funding we have discussed so far has not trickled down to NGOs yet (from the UN system); trusts and foundations are a much better bet. We will, however, see a lot more opportunity over the coming weeks and months.
Danielle Kemmer:
In terms of research funding, it is really important to keep an eye on the evidence, to identify what works in this situation for everybody. A silver lining of this situation is that everyone is learning to adapt quickly to a new normal. The volume of research has increased tremendously, but with this we need to keep an eye on due diligence and ensure when allocating funding we maintain high standards of quality.
Nasri Omar:
In Kenya we need mental health to be a funding stream on its own.
Raj Mariwala:
As mental health research funders it is our responsibility to help advocate to get more funding, so we need to talk about success stories. For example Kerala got the situation under control very quickly. Had already learnt to integrate mental health into their outbreak response from nipah. Each of the 14 districts already had a mental health helpline which helped assuage fears and build trust, helping the state government gain control of COVID-19. Some amount of mental health funding will make other interventions more rigorous and effective.
Niall: How can we share the lessons learned by Kenya’s response elsewhere?
Nasri Omar:
We need researchers on board to work with policy makers to develop case studies and help share the lessons learnt.
Niall: The international medical response to this pandemic has suffered from a more fragmented community than we have had for some decades - how can we coordinate a mental health response to this crisis that is international in the face of this fragmentation?
Sarah Kline: Coordination is needed through WHO, as the UN agency leading on mental health globally, and the UN - through their networks both regionally and internationally. As well as this we need to strengthen the cluster system in crisis and humanitarian emergency settings; WHO would normally lead the sub-cluster on mental health, and therefore help coordinate the response with the local Ministry of Health.
Organisations such as WHO, other UN agencies, and international NGOs with global and regional networks should be looking at the best practices across regions and sharing those effectively. For example community healing dialogues - which were utilised after the Rwandan genoicde - were adapted and used in the post-ebola response in Liberia to help integrate survivors into their communities. We need a combination of global and national actors to work together and use the networks available to share best practice. MHIN is gathering COVID-19 best practices - encouraged by WHO.
Question from the audience: I agree that youth mental health has been front and centre but this feels like it has only been in high income countries, how do you think funders can better support low income countries, and support and engage young people currently and after the situation?
Danielle Kemmer:
I think this is an extremely important question, not just now but also before the pandemic. Most young people in the world are in low resource settings, and youth is an important priority, as well as including more and more partners from LMICs.
Question from the audience: What is or can be done for specific suicide prevention funding to be available, as this can get lost within other funds?
Raj Mariwala:
The leading cause of death among young men is death by suicide. There is increasing funding going into this research and sharing the data, but data is lacking as up until 2017 suicide was criminalised in India. There is no national policy on suicide prevention, so this is not seen as a priority for the governement. At the first level - before advocating for more action on suicide prevention and funding - we need to collect data in order to advocate for funds and policy.
Niall Boyce: Suicide is definitely a challenging issue to collect accurate data for. To conclude, what would you say to policy makers to convince them to fund mental health at this time?
Sarah Kline:
Funding mental health makes the COVID-19 response more efficient and effective: the public adheres better to public health information, and health workers feel supported enough to sustain their work.
Danielle Kemmer:
If you look at the many surveys on this topic, it is clear there is a lot of need for mental health support.
Nasri Omar:
When people started asking for support, that is when people started looking for us. The demand for support is very high and the impact of COVID-19 is both physical and mental; this is the time to invest, as we will see a great Return on Investment in the future [mentioning the new report by United for Global Mental Health].
Raj Mariwala:
COVID-19 has thrown up the fault lines in our system’s structure and policy, let's join the dots - mental health is a development issue and cannot be considered in isolation.
Niall Boyce:
Thank you to all the speakers. There is consensus of a need for a long-term view as well as immediate funding support through the COVID-19 crisis. The recording and notes of the session will be posted on the UnitedGMH.org website very shortly.
For anyone wanting to learn more about funding for mental health, UnitedGMH has just launched a new financing section on its website where you can find a wealth of reports and donor profiles to help the mental health community find funding. It includes a briefing on funding for mental health during the COVID-19 response. You can find it on their website via the news section.
