COVID-19 and global mental health service delivery and financing

The COVID-19 pandemic has taken a significant toll on people's mental health. Since March 2020, the prevalence of both major depressive and anxiety disorders has doubled and even tripled in some European countries.¹ A similar pattern was found in many low- and middle-income countries (LMICs). In comparison to high-income countries, LMICs have a higher prevalence of comorbidities with less available universal healthcare and social support systems.² As the world enters into the third year of the COVID-19 pandemic, the mental health aftermath of this global crisis will likely prove long, compounding and deepening the impacts of social and economic disruptions that were already underway before the pandemic.

The mental health pandemic is a multifaceted problem with various causes. COVID-19 has claimed more than 6 million lives globally, and the actual death toll is likely higher than the reported number. The loss of lives imposes widespread grief and suffering on affected individuals and communities. This grief can lead to longer term mental health conditions without proper care and support. The COVID-19 virus is associated with neurological manifestations that can contribute to mental health issues.³ The implementation of strict disease control measures (e.g. school closures, social distancing, and isolation periods) can greatly increase levels of stress and disrupt usual coping mechanisms and social supports.⁴ Amplified feelings of loneliness, isolation, and stress are strongly associated with anxiety, depression, and insomnia. In addition, the pandemic induced economic recessions in many countries and drove small and large enterprises out of business, which affected the daily life of numerous households. The resultant financial insecurity introduced significant mental health concerns. Meanwhile, the pandemic has interfered with the delivery of routine, in-person mental health, and psychosocial support services. A study reported that 93% of countries had disruptions in mental health services.⁵

Recognizing increasing demand for mental health and psychosocial support (MHPSS) services while facing the disruptions, countries have developed various strategies to facilitate the delivery of MHPSS services. The strategies span from detecting mental health problems to delivering mental health care, from raising awareness of available mental health support among the general population to providing training in mental health care for health and/or non-health professionals.⁵ Clearly, digital health has vastly expanded in many countries. Artificial intelligence was deployed to help detect budding mental health issues and alert patients to seek care, and online consultations became a popular way to deliver cognitive behavioral therapy for mental health disorders.⁶ Despite these advances, there were growing concerns about equity and access to care in rural areas where access to technology is sparse. To combat this, community health workers were trained to deliver basic psychosocial support and conduct home visits, whereas helplines were introduced/reintroduced to provide basic mental health consultations in some limited-resource settings.⁵ These strategies, to some degree, reduced the mental health service gap that would have been even larger during the pandemic.

Sustaining the delivery of routine and innovative mental health services requires significant financial support. However, global investments in mental health have been disproportionately low. Only an average of 2% of total health spending is on mental health globally, compared with 12% of the total disease burden due to mental health disorders.⁷ Even in humanitarian settings (e.g. forcibly displaced populations), where people are particularly vulnerable to mental health risks, the funding for mental health is scarce. The pandemic has clearly raised the awareness of global mental health investments among international donors and domestic health systems. The donor community has begun investing specifically in mental health in recipient countries. Mental health support was put to the forefront to help communities adjust to the pandemic in the COVID-19 response funded by the United States Agency for International Development.⁸ The World Bank, one of the largest funders of the COVID-19 response in LMICs, initiated programs that directly supported psychosocial interventions to address psychological problems during the pandemic,⁹ besides its commitment in calling for reimagined primary health care to integrate MHPSS services and in supporting countries' actions toward this direction.¹⁰ Domestically, the national COVID-19 emergency response plans in many countries added mental health support as a critical component in mitigating the short- and long-term effects of the pandemic, although the financial commitment to ensure the delivery of mental health services remains uncertain.⁵

As new innovations for delivering mental health services emerge and mental health investments increase, it is critical for governments, with donors’ support, to enhance mental health service delivery and financing and to leverage investments across sectors as part of building a more inclusive and resilient post-pandemic health system. Integrating mental health initiatives into both international and national emergency response strategies and public health strategies serves as a good start.

Disclaimer

The views expressed in this letter are those of the authors, and no official endorsement by their respective organizations.