The good, the bad and the ugly: Lessons from around the world on mental health and COVID-19
The last several months have been unprecedented. COVID-19 has impacted on all areas of our lives. We have seen large-scale devastation of incomes and economies across affected countries, with millions more facing greater poverty as a result. And we have also witnessed the unfolding of an extremely difficult mental health situation across the globe.
Three months ago United for Global Mental Health, with partners The Lancet Psychiatry, Mental Health Innovation Network (MHIN) and MHPSS.net, launched a weekly webinar series to bring together mental health experts and service providers to share the latest information, experiences and lessons from the frontlines of the pandemic around the world. We have heard from ~60 speakers from ~30 countries and ~40 organisations including WHO, UNICEF, UNHCR, IOM and a host of civil society organisations, lived experience advocates and some businesses focused on workplace mental health.
So, what have we learnt? It’s a mixed picture, as ever.
In reverse order, firstly, the bad. COVID-19 has had a huge detrimental impact on mental health across populations and societies, with studies showing a doubling or tripling of some mental health conditions across many parts of the world. From the outset, in the first webinar on 7th April, Devora Kestel, the WHO Director of Mental Health and Substance Use, stressed the extent of the mental health burden of COVID-19: “there is on the one hand fear of falling ill and dying, but also of losing livelihoods, and losing loved ones, and being socially excluded, isolated, and separated from family and caregivers”.
It also soon became apparent that the mental health challenges were not going to pass quickly. Already by 5th May, Taha Sabri, Speak Your Mind campaigner and Co-Founder of Taskeen in Pakistan, was saying that “initially, we planned for a COVID-19 mental health strategy for 1-2 months, now we are planning for two and half years”; and at least in the context of refugees and migrants, Peter Ventevogel from the UN High Commission for Refugees believes that “the worst is yet to come”. At the same time, misinformation and stigma abounds, as we heard at a webinar on COVID-19, mental health, and humanitarian crises from Deborah Magdalena of the IOM. This makes a cohesive and ordered national and global response more difficult.
On top of this, the funding of a response to the mental health challenges has not been commensurate with the burden or need: most countries are not yet prioritising mental health support in COVID-19 response plans (as we heard in a webinar on COVID-19 and mental health financing). Nor is it clear that, where funds have been promised, they are filtering through effectively. As Akiko Hart, from the UK National Survivor User Network, explained: “the new COVID-19 funds are not filtering down to new peer support initiatives”.
Next, the ugly. COVID-19 has perpetuated and augmented existing inequalities (whether due to health, economic status, immigration status, gender, age, ethnicity, etc.). In this context, the mental health, and at times the very lives, of the most vulnerable people in society has been particularly put at greater risk.
For instance, many people with pre-existing mental health conditions have had their life-saving services and medication supplies disrupted. Also worryingly, existing human rights abuses against people living with mental health conditions, such as chaining in institutions , have been perpetuated, but with the added risks of COVID-19 attached. “We found 300 people in one religious centre in Nigeria - lined up from ages 10 to 86 - chained in close proximity in overcrowded facilities with no soap and water and in conditions that were very unhygienic", as Shantha Rau Barriga, from the Human Rights Watch reported.
Similarly, COVID-19 has magnified economic inequalities – both in terms of loss of livelihoods, and in terms of being able to access the required mental health support and services in the “new normal”. In India most of the economy is generated by the informal sector, and with heavy reliance on migrant workers, who have limited protection and social security. “It is a perfect storm for risk factors among a large section of the Indian population. COVID-19 demonstrates mental health is an issue for so many – it is a wake-up call", shared Sudipto Chatterjee, from the National Institute of Advanced Studies, Bangalore and Parivartan Trust, India.
Economic inequality, in addition, can broaden the gap in access to mental health services, especially during COVID-19. As Matias Irarrazabal, from the Chilean Ministry of Health, explained, in relation to services provided to young people: “There is a huge inequality in access to technology. Many young people who were receiving some support are now receiving no support at all”.
The situation is particularly dire for refugees and asylum seekers, where COVID-19 has been overlaid on an already existing humanitarian emergency. Based on WHO modelling, there are likely more than 7 million in Yemen who require mental health support as a result of these factors. As Lynne Jones, OBE powerfully put it, describing the situation of refugees in camps in Europe: “The conditions are dire: no access to soap and water; one toilet for 200 people; no ability to isolate or quarantine. … While we quarrel, we keep refugees in inhumane and degrading conditions. I am ashamed to be European, given that this is the state of affairs in Europe”.
And, finally, the good. The pandemic has in many places been countered by compassion and empathy, mutual support, and great leaps in innovation. As a youth mental health campaigner from New Zealand, Josiah Tualamali’i, explained, young people are helping maintain each other’s wellbeing by “providing support in their schools and learning environments, using apps like house party, and creating facebook groups”. Akiko Hart, from the UK National Survivor User Network, similarly commented that many mutual aid and peer support groups have sprung up organically during COVID-19. In the words of Fizza Yasmeen, the CEO of BasicNeeds Pakistan: “Fear divides, hope mobilises. We should keep hope high”.
COVID-19 has also forced many mental health organisations to adapt how they work at incredible speed. The ingenuity with which many organisations – across different resource settings – met this challenge is inspiring. MHIN and WHO have been collaborating to document these innovations. Operating in Uganda, THRIVEGulu, were unable to see their service users in person so went on radio, using talk shows and spot messages to provide correct information on mental health issues to the communities. And to ensure that the most disadvantaged households (who might not own a radio) were not left behind, they also started driving a van mounted with loudspeakers with pre-recorded messages on mental health and wellbeing around the communities.
In a high-resource setting, too, the transformation rate of established models of care has been exceptionally quick. In Ireland St Patrick’s Mental Health Service, who serve about 10% of the population, were able to revolutionise how they deliver care within a matter of weeks. Within just two and a half weeks all outpatient appointments were transitioned to remote attendance, and about a quarter of inpatients are now being treated via a home care service. “We plan to continue this into the future as it has been surprisingly effective,”as Paul Fearon explained.
COVID-19 gives us a chance to go much further, as a number of our webinar panellists pointed out. “The pandemic has helped raise the profile of how important mental health psychosocial support (MHPSS) is and how cross-cutting it is”, stressed Florence Baingana, from the WHO Africa Region. Whilst Dainius Puras, the former Special Rapporteur on the Right to Health, pointed out that “COVID-19 should be a good opportunity for mental health and human rights”.
It is up to all of us to make good on that opportunity.
Please join us for our discussion on 21st July 2020, 14:00-14:45 BST, covering the topic of: No health without mental health: integrating mental health into health systems
Speakers will include:
Devora Kestel - Director of the Department of Mental Health and Substance Use, WHO
Githinji Gitahi - GCEO, AMREF Health Africa and Co-chair of UHC2030
Peter Yaro - Executive Director, BasicNeeds Ghana
