World Mental Health Day 2020: The Value of Investment

Crisis volunteer Florian Walter works a shift for the crisis text service Shout 85258. Manchester, United Kingdom, June 04, 2020. Image: Leon Neal/Getty
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Crisis volunteer Florian Walter works a shift for the crisis text service Shout 85258. Manchester, United Kingdom, June 04, 2020. Image: Leon Neal/Getty

Investing in mental health.

The theme for this year’s World Mental Health Day—held every year on October 10—speaks to the growing acknowledgment of a massive global need.

While gaps in mental health care have been exacerbated by the isolation, anxiety, and service disruptions of the pandemic, they existed long before COVID-19.

Policymakers and others directing investment in mental health should consider these key issues:

The pandemic is disrupting mental health services just as demand skyrockets:

  • 93% of countries worldwide have had mental health services disrupted or halted altogether.
  • In the WHO Africa region, 37% of countries’ mental health response plans are partially funded, and 37% reported having no funds at all.
  • 89% of countries surveyed by WHO have mental health and psychosocial support in their national COVID-19 response plans; but only 17% of these plans are fully funded.
  • A study of women in Uganda and Zambia found a rise in persistent stress, anxiety, and depression. 

Wealthy countries are feeling it, too:

  • Suicides in Japan jumped 15% in August as the pandemic raged, with a marked increase among women, school-aged children, Bloomberg reports.
  • The number of Americans reporting symptoms of mental illness has skyrocketed to 40% in July. Calls to suicide hotlines are up.
  • And if the Affordable Care Act is scrapped in an upcoming Supreme Court battle, that would leave Americans’ coverage for mental health services in a very precarious position, Kaiser Family Foundation reports.
  • However, in wealthy countries, better internet access has helped telemedicine fill in gaps in mental health care—whereas only about half of lower-income nations have been able to make the switch, CIDRAP reports.

Services in low- and middle-income countries were already scant before the pandemic:

  • In LMICs, upwards of 90% of people with mental health conditions receive no treatment.
  • Before the pandemic, on average just 2% of WHO countries’ health budgets were going to mental health.
  • International development assistance for mental health has never exceeded 1% of all development assistance for health.

Refugees and migrants are often cut out of that tiny budget:

  • That’s despite the international community’s promise, “enshrined in international law,” to ensure the highest attainable standard of mental health for everyone, Amnesty International warns.
  • Immigration policies also highlight a disregard for mental health—for example, family separations that “amount to torture” at the US border and in Australia, the detaining of refugees that led to a rise in suicide attempts.

“Investing” isn’t just about spending, but also resourcefulness—particularly when specialists are few and a health system overhaul isn’t immediately in the cards.

  • In low-resource settings where specialists are rare, “task sharing”— training general health care providers to take on basic mental health interventions and referrals—aims to free up specialists for the most serious cases.
  • Nigeria, where a quarter of people suffer from a mental illness but there just 250 psychiatrists, is currently testing the task sharing approach with some promising results, as Devex reports.

There are promising innovations and research efforts:

  • A network of research “Hubs” have been deployed to support the implementation of evidence-based mental health services in LMICs—and they have adapted to the challenges of COVID-19, In India, this means training teachers to manage students’ pandemic-related anxiety, and in Colombia, it takes the form of deploying mobile mental health technologies.

And it’s not just LMICs that benefit from these “frugal innovations forged out of necessity”: 

  • Mental health strategies developed in Sierra Leone be give “by refugees, for refugees” are being adapted for the US, as a group of researchers explain in The Lancet Psychiatry.
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