Mental Health and COVID-19

An informative editorial in the Lancet published October 10, 2020 fears that the investment in mental health has just not happened. They cite the theme of this year’s World Mental Health Day on October 10 which had increased investment in mental health, why invest and why now? – the answer is simple at the best of times good mental health is needed for society to thrive.

During this pandemic good mental health is even more important.

Without a focus on mental health, any response to COVID-19 will be deficient, reducing individual and societal resilience and impeding social, economic and cultural recovery.

The editorial goes on to cite that 2020 has been a difficult year for mental health – the threat of infection – repeated lockdowns – social isolation – economic uncertainty had created widespread fear and anxiety.

A rapid review published in the Lancet showed the negative psychological effects of enforced quarantines – many people who previously thought themselves unaffected by mental health issues have discovered that they, too are vulnerable.

Those with pre-existing mental health conditions have often found their difficulties increased.

The precise neurological and psychiatric consequences of infection, meanwhile, remain unknown, but demand careful monitoring.

However, what investment is needed from governments and non-governmental organisations to mitigate the mental health impact of COVID-19 and more importantly, to improve mental health globally?

In 2018, the Lancet Commission on global mental health sustainable development, identified mental health as an essential component of the universal health coverage and provided recommendations to improve mental health.

Unfortunately, despite commitment from world leaders to include mental healthcare in universal health coverage as part of the sustainable development goals in 2015, this pledge was not translated into reality.

Universal health coverage should have provided a lifeline for those trapped in the vicious cycle of economic hardship and poor mental health, where poverty is both a contributing factor to mental health problems and a barrier to accessing services that might help.

Great strides have been made in the delivery of telepsychiatry over the past 10 months. This telepsychiatry, however, needs to be used in an intelligent, targeted manner which also provides the appropriate support rather than being a cost saving, one size fits all measure that risks exacerbating health inequalities or inadvertently reinforcing social isolation.

According to a WHO survey, people with pre-existing severe and enduring mental health conditions have been most affected by COVID-19 related disruptions of the mental healthcare systems.

Other vulnerable groups include children and adolescents, many of whom have been impacted by school, colleges, stretched health systems, restricted access to nutritious food, breakdown in family relationships, neglect and abuse. Older adults have also been vulnerable – many with pre-existing health conditions are terrified and lonely, afraid of infection, dying and losing family members while physically distanced from loved ones and peers.

Finally, there are the healthcare workers themselves who also face a greater risk of infection, stigmatisation and stressful workloads, with the attendant psychological repercussions. Investment in mental health is also about investment in healthcare workers.

The economic argument for investment in mental health services is clear and has been made many times, but there is also the ethical imperative for investment, both to readdress historic wrong done to vulnerable communities, and to right current inequities.

On the global scale, this strategy involves the empowerment of individuals and communities, the admission that high income countries have much to learn from the innovations of low income and middle income settings, and the recognition of the central role of mental health in global health security now and in the future.

The editorial goes on to suggest that investment must be about more than just money if mental health services are to be made fit to address the challenges of the COVID-19 and post COVID-19 era and to become resilient against future public health crisis. This investment requires thought, time and a commitment to change.

The London General Practice recognises the decrease in mental health of patients from all spheres of society. It encourages patients to come forward and consult either face-to-face or with video consultations so that appropriate services can be offered to those who are vulnerable.

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