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Mental healthcare taking a hit in COVID-19

mental health Copyright: silentgunman / 123RF Stock Photo lack of mental healthcare concept.
Nearly 200 million Indians suffer from mental health conditions — most do so in silence. Copyright: silentgunman / 123RF Stock Photo

It is no surprise to anyone by this point that the COVID-19 pandemic has resulted in most – if not all – other health conditions have been neglected. Mental health issues are no exception. The findings of a recent World Health Organization (WHO) survey on the impact on mental healthcare underscore this.

“The COVID-19 pandemic has disrupted or halted critical mental health services in 93% of countries worldwide while the demand for mental health is increasing, according to a new WHO survey,” reads the opening paragraph of a press release from the agency. “The survey of 130 countries provides the first global data showing the devastating impact of COVID-19 on access to mental health services and underscores the urgent need for increased funding.”

The survey, entitled “The impact of COVID-19 on mental, neurological and substance use services: results of a rapid assessment”, outlines that the WHO “has identified mental health as an integral component of the COVID-19 response. Its rapid assessment of service delivery for mental, neurological and substance use (MNS) disorders during the COVID-19 pandemic, on which this report is based, is the first attempt to measure the impact of the pandemic on such services at a global level. 

“The data were collected through a web-based survey completed by mental health focal points at ministries of health between June and August 2020. The questionnaire covered the existence and funding of mental health and psychosocial support (MHPSS) plans, the presence and composition of MHPSS coordination platforms, the degree of continuation and causes of disruption of different MNS services, the approaches used to overcome these disruptions, and surveillance mechanisms and research on MNS data.” 

The report points to a significant public health issue that the pandemic has only made worse. Its findings are alarming. As the report states

“The vast majority, 116 or 89 percent of responding countries, reported that MHPSS response is part of their national COVID-19 response plans. However, only seventeen of these countries have ensured full additional funding for MHPSS covering all activities. 

“Two-thirds (65 percent) of responding countries have a multisectoral MHPSS coordination platform for COVID-19 response, and more than 65 percent of these countries include the ministries of health, social/family affairs and education and also nongovernmental organisations as part of these platforms. Almost half…of responding countries reported that ensuring the continuity of all MNS services was included in the list of essential health services in their national COVID-19 response plan, while forty percent of countries reported the inclusion of some MNS services in the list of essential health services in their national response plan.”

India has experienced a treatment gap as it pertains to mental health issues for some time, despite its considerable burden of such conditions. As Health Issues India reported last year, one in seven Indians experience mental health issues according to a study by the Indian Council of Medical Research. 

That study “found that roughly 197 million persons were affected by mental disorders in 2017. The conditions surveyed included depression, anxiety disorders, schizophrenia, bipolar disorders, idiopathic developmental intellectual disability, conduct disorders, and autism. Depression and anxiety disorders were the most common conditions. In total, 45.7 million people experienced depressive disorders. Anxiety affected 44.9 million people.” 

Yet India also struggles with a considerable treatment gap when it comes to mental healthcare. As I reported last year

“There is an enormous shortage of mental healthcare professionals across the country…dissuading many from coming forward and seeking treatment. This manifests in a treatment gap spotlighted by recent figures released by the Union Ministry for Health and Family Welfare (MoHFW). There is a fifty to seventy percent treatment gap when it comes to mental illness, the statistics suggest. Staffing shortages go some way towards accounting for this disparity. Just 898 clinical psychologists and 3,800 psychiatrists are available to service the entirety of India’s population with mental health conditions. They are heavily concentrated in urban areas. This entails that the mental health of those living in rural areas often goes neglected.”

The WHO survey highlights that “the pandemic is increasing demand for mental health services. Bereavement, isolation, loss of income and fear are triggering mental health conditions or exacerbating existing ones. 

“Many people may be facing increased levels of alcohol and drug use, insomnia, and anxiety. Meanwhile, COVID-19 itself can lead to neurological and mental complications, such as delirium, agitation, and stroke. People with pre-existing mental, neurological or substance use disorders are also more vulnerable to SARS-CoV-2 [the virus that causes COVID-19] infection  ̶  they may stand a higher risk of severe outcomes and even death.”

WHO Director-General Dr Tedros Adhanom Ghebreyesus said “good mental health is absolutely fundamental to overall health and well-being. COVID-19 has interrupted essential mental health services around the world just when they’re needed most. World leaders must move fast and decisively to invest more in life-saving mental health programmes  ̶  during the pandemic and beyond.”

Plugging the mental healthcare gap is a necessity – but it is a necessity few countries are responding to. The WHO’s findings on mental healthcare include that more than sixty percent of countries “reported disruptions to mental health services for vulnerable people, including children and adolescents (72 percent), older adults (seventy percent), and women requiring antenatal or postnatal services (61 percent)” and that “67 percent saw disruptions to counseling and psychotherapy; 65 percent to critical harm reduction services; and 45 percent to opioid agonist maintenance treatment for opioid dependence.” 

In addition, “more than a third (35 percent) reported disruptions to emergency interventions, including those for people experiencing prolonged seizures; severe substance use withdrawal syndromes; and delirium, often a sign of a serious underlying medical condition.” Thirty percent “reported disruptions to access for medications for mental, neurological and substance use disorders.” And “around three-quarters reported at least partial disruptions to school and workplace mental health services (78 percent and 75 percent respectively).”

Mental healthcare has long been neglected in the discourse and in fiscal terms. The pandemic shows us why this is dangerous. 

“This all highlights the need for more money for mental health,” the WHO says. “As the pandemic continues, even greater demand will be placed on national and international mental health programmes that have suffered from years of chronic underfunding. 

“Spending two percent of national health budgets on mental health is not enough. International funders also need to do more: mental health still receives less than one percent of international aid earmarked for health. Those who do invest in mental health will reap rewards. Pre-COVID-19 estimates reveal that nearly US$ 1 trillion in economic productivity is lost annually from depression and anxiety alone. However, studies show that every US$ 1 spent on evidence-based care for depression and anxiety returns US$5.”

These are lessons we must take onboard. 

Contact details for mental health support in India can be accessed here. 

If you are suicidal or experiencing suicidal thoughts, visit your nearest hospital or contact AASRA on 91-22-27546669 or Sneha India on 91 44 24640050 helpline. A list of other suicide helplines can be accessed here.

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