Table 3.
Emerging findings and recommendations going forward.
| I OVERALL KEY FINDINGS |
| • Fundamental human rights of the elderly, individuals living with mental illness or disabilities, and other vulnerable populations are disproportionately affected due to COVID restrictions. These rights violations are compounded by significant levels of discrimination and stigma |
| • HCWs experienced stigma and discrimination in addition to neglect in their working conditions putting them and their families at risk |
| • Most of the empirical studies covered COVID-19 restrictions which, when protracted, lead to significant human rights violations |
| • Gender based violence and income inequities increased as a result of lockdown contributing to loss of livelihood and socioeconomic strains and disproportionately affecting women and girls |
| • Limited access to enhanced alternative services (such as m-learning or e-health support) whether educational, vocational or health to populations most disproportionately impacted by the pandemic |
| • Significant loss of education and social protection to children in vulnerable contexts due to closure of schools and other related servicers |
| • Socioeconomic and health costs of worsening mental health of vulnerable individuals—the motto of “do no harm” flouted during pandemic restrictions meaning restrictions meant to protect should not worsen health or harm |
| II OVERVIEW OF IMPACT AND RECOMMENDATIONS TO POLICY MAKERS AND RELEVANT STAKEHOLDERS |
| •Mental health is a fundamental human right and irrespective of race, class, gender, ethnicity, or age, needs to be prioritized during emergencies. If considerable populations become scarred as a result of this pandemic, their worsening mental health would deteriorate their own and nations' recovery from the pandemic |
| •Health systems strengthening approach: human rights violations tend to increase when systems are under-resourced and poorly managed. A holistic health system strengthening approach and adequate response to human rights is needed |
| •Equity and justice through health: one of the ways of upholding CRPD and CRC and related conventions is to address systematic, structural inequities by providing health services and prioritizing multidimensional needs of the vulnerable |
| •Protect civil liberties. It is also important to inform the affected population of the exact substantive, territorial and temporal scope of the application of the state of emergency and its related measures as suggested by the ICCPR guidelines. Additionally, it is important to value individual and community's right to expression of their concerns and voices |
| •Legality of enforcement of bans/closures/restrictions: As recommended by ICCPR and other international rights guidance, legality of state action and role of state actors on lockdown, restrictions and delays in services/opportunities needs to be kept in mind. Protracted restrictions run the risk of increasing levels of apathy and increasing violations by people in charge |
| •Human rights violations would lead to increased mental distress: abrasively implemented state actions can make individuals and families prone to mental distress and illness; these effects can be long lasting |
| •Have a pandemic and post-pandemic human rights approach infused with mental health: building back nations and economies requires developing community level solutions through champions who can address needs and identify strategies to build back better. State level funding and resource allocation is needed to address mental health during and after the pandemic |
| Recommendations include – |
| •prioritizing protecting lives and valuing marginalized and vulnerable populations' interests, helping people anticipate and address their health, and improved service access and livelihood challenges •address discrimination and stigma in time, rapidly train government and civil services in what needs to be a human right informed response to the pandemic •keep an eye on efforts to reducing inequality and disparities during and post-pandemic to make systems stronger |
| For certain specific vulnerable populations: |
| °Improve access to telepsychiatry services, home delivery of medications, and online psychiatric resources to minimize relapse of or worsening of symptoms by psychiatric patients
°Offer moral and financial support to HCWs, especially those under quarantine °For elderly, adopt measures to ensure they are keeping informed, accessing health and social services, and guarantee food and medical supplies °Use trusted sources in racial or ethnic minority communities to disseminate information and ensure job security •Create a multi-stakeholder dialogue and discussion for policy action so it is well-informed, consultative and transparent in decision making, based in equity, with access and needs of most disenfranchised prioritized, with human rights elements relevant to COVID made part of mission statements of organizations, and learns from success stories within your own country and from other countries •Actions to embrace for HICs: racial, ethnic and religious minorities are more vulnerable and so upholding their civil liberties and quality services and enhanced access is critical to reduce disproportionate ill-health burden. There needs to be a coordinated response between resourceful governments on supporting other countries by example and leading mobilization of action around inequity, stigma and discrimination both of mental illness as well as COVID-19 related fear and phobic responses. Gender and income inequity remain the key areas of action •Actions to embrace for LMICs: enhanced investment and improved access to quality health services including mental health. Universal health coverage (UHC) needs to be prioritized and mental health care has to be an integral part of the UHC. Countries should actively develop policy and programmatic response that would reduce gender and income inequality. Given that the pandemic would impact a large number of informal workers in LMICs, services need to be offered without discrimination. Stigma and discrimination have to be actively addressed and focus on key vulnerable populations should receive policy and programmatic prioritization |
| III RECOMMENDATIONS TO MENTAL HEALTH PRACTITIONERS |
| • Giving a voice to the prioritization of psychosocial needs of vulnerable and at-risk highly marginalized populations including a trauma-informed approach. Development of low intensity interventions that can be rolled out with strategies such as task-sharing and task-shifting. Psychotherapy support should be promoted through social works and community volunteers |
| • Integrate system level human rights approach in delivering essential health services and in specialist health care: training health personnel, teachers, social, and other essential workers in basic psychological first aid and human rights-based service provision and system thinking |
| • Recognize how inequities and inequalities have exacerbated global burden of mental disorders and actively develop policy, programmatic and research level instruments to combat these disparities and improve mental health conditions of populations. Identify conceptual models and theories that guide intervention development targeting improved mental health outcomes, equity, emancipation, and social justice as key themes |
| • Develop solutions such as public information programs to address and caution against stigma and discrimination and use media platforms to disseminate anti-stigma and discrimination messages |