One of the biggest global crises in generations, the COVID-19 pandemic has had severe and far-reaching repercussions for health systems, economies and societies. Countless people have died, or lost their livelihoods. Families and communities have been strained and separated. Children and young people have missed out on learning and socializing. Businesses have gone bankrupt. Millions people have fallen below the poverty line.
As people grapple with these health, social and economic impacts, mental health has been widely affected. Plenty of us became more anxious; but for some COVID-19 has sparked or amplified much more serious mental health problems. A great number of people have reported psychological distress and symptoms of depression, anxiety or post-traumatic stress. And there have been worrying signs of more widespread suicidal thoughts and behaviours, including among health care workers.
Some groups of people have been affected much more than others.
Faced with extended school and university closures young people have been left vulnerable to social isolation and disconnectedness which can fuel feelings of anxiety, uncertainty and loneliness and lead to affective and behavioural problems. For some children and adolescents being made to stay at home may have increased the risk of family stress or abuse, which are risk factors for mental health problems. Women have similarly faced greater stress in homes, with one rapid assessment reporting that 45% of women had experienced some form of violence, either directly or indirectly during the first year of the pandemic.
While mental health needs have risen, mental health services have been severely disrupted. This was especially true early on in the pandemic when staff and infrastructure were often redeployed to COVID-19 relief. Social measures also prevented people from accessing care at that time. And in many cases, poor knowledge and misinformation about the virus fuelled fears and worries that stopped people from seeking help.
Esenam Abra Drah lives with bipolar disorder in Ghana, where fear of the virus has been an unprecedented stressor to the mental health of many individuals. “I have many friends who had relapses in their mental health because of the increased levels of fear and panic,” says Esenam. “It was almost as if fear was contagious.”
Esenam explains that most people are afraid to seek help because they think that if they visit the hospital, they might end up getting infected with COVID-19. “I myself did not go to the clinic for therapy for an entire year partly because of this fear,” she says.
At that time Esenam, like so many others, was unemployed and did not have the funds for treatment. Even before the pandemic, cost of care was known to be a major barrier to people with mental health conditions seeking help.
“I have been privileged to have a good system of support,” says Esenam. “My pensioner parents managed to make sure my medications were always refilled.”
“But it is not the same for others,” she adds. “Some people could not afford treatment. It was and still is a very difficult time for a lot of people.”
Recommendations for response
Since the start of the pandemic, mental health service providers have tried to mitigate service disruptions, for example by delivering care via alternative routes when public health and social measures were in place.
Community-based initiatives were often faster to adapt, finding innovative ways to provide psychosocial support, including through digital technologies and informal supports. And international organizations have also provided guidance, tools and resources to help responders, public health planners and the general public.
WHO recommends integrating Mental Health and Psychosocial Support (MHPSS) within all aspects of preparedness and response for all public health emergencies. To minimize the mental health consequences of the COVID-19 pandemic, WHO also recommends that countries:
• Apply a whole of society approach to promote, protect and care for mental health, including through social and financial protection to safeguard people from domestic violence or impoverishment, and by communicating widely about COVID-19 to counter misinformation and promote mental health.
• Ensure widespread availability of mental health and psychosocial support, including by scaling up access to self-help and supporting community initiatives.
• Support recovery from COVID-19 by building mental health services for the future.
The COVID-19 pandemic, like other ongoing crises, has made strengthening mental health systems more urgent all over the world. “The impact of COVID-19 on mental health cannot be underestimated. It cannot be made light of,” says Esenam. Change is possible.