Mental health will be key to the global response to the COVID-19 crisis

As the UK co-hosts a Coronavirus Global Response Summit today, mental health activists Florence Baingana, Rochelle Burgess, and Nigel Taylor argue that for an effective response, it will be critical to address the higher levels of mental illness stemming with the crisis.  They call for a mental health lens to be applied across all responses to COVID-19 to consider the mental health implications and potential mitigation action. Whilst increased investment in poorly resourced mental services will be important, responses that address the social and economic pathways to poor mental health may have greater effect. Dr Florence Baingana is a psychiatrist, public health specialist and researcher; Dr Rochelle Burgess is Deputy Director, UCL Centre for Global Non-Communicable Diseases, London; and Nigel Taylor is an independent consultant.

Today - 4 May - the UK will co-host the Coronavirus Global Response Summit. Understandably, the emphasis will be on diagnostics, treatments and a vaccine. Effective deployment of these is clearly essential if the COVID-19 pandemic is to be brought to an end, and economies and societies may start to recover. However, there is a key need to acknowledge mental health in the global response. COVID-19 and associated restrictions will worsen mental health across affected societies. In turn, as we have seen with higher levels of clinical mental illness associated with HIV and with TB, this will adversely impact personal engagement in critical activities for prevention. In the case of COVID-19, this could mean that enhanced levels of mental illness lead to less handwashing, physical distancing, participation in test-isolate-trace-quarantine campaigns and eventually, uptake of vaccination, when high levels of adherence are critical for the effectiveness of each.

Whilst there is understandable concern at socio-relational considerations for mental health, such as the direct consequences of personal trauma, isolation and loneliness, the COVID-19 crisis will emphasise the interdependency between poverty, inequalities and mental health at a societal level. COVID-19 and the lock-down responses now affecting many LMICs will significantly contribute to social determinants of poor mental health, with resultant increases in conditions such as depression, anxiety, and substance abuse. This will be mediated through, for example, the impact of the collapse of already fragile livelihoods, over-crowded living conditions, disrupted education, the loss of norms for socialising such as attending weekly religious gatherings, and increased intimate partner violence. As so often, it will be the poorest and most vulnerable whose mental health will be affected most, particularly women. And they will experience the greatest knock-on effects including deepened poverty and poorer engagement in critical public health activities. 

If these critical issues are to be addressed, then a ‘mental health lens’ must be applied across all responses to COVID-19 to consider the implications and potential mitigation action. Whilst increased investment in poorly resourced mental services will be important, responses that address the social and economic pathways to poor mental health may have greater effect. For example, well managed relaxation of physical distancing restrictions specifically to allow a return to personal cultivation and markets to reopen could have significant economic and social benefits with minimal risk to viral transmission; whilst social protection for the poorest through cash transfers, possibly funded through debt relief, could address the trauma of the loss of means of everyday survival. The UK Department for International Development (DFID) has already demonstrated its support to this broad approach through the Topic Guide on Mental Health for Sustainable Development, recognising that enhanced mental health will contribute through various pathways to attaining the SDGs. We look to DFID, and others giving leadership at this time, to adapt this understanding for COVID-19.  The slogan ‘no health without mental health’ is as valid as ever for COVID-19, and the response must acknowledge this in all its forms.

Photo Credit: © Adam Niescioruk, UnSplash.

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