World Mental Health Day: Covid-19 has disrupted or stopped services in 93% countries, vulnerable most affected
Mental health services have been disrupted or halted in 93% of countries globally due to the Covid-19 pandemic even as reports have emerged that people are struggling with mental health issues stemming from the pandemic. A survey of 130 countries by the World Health Organization (WHO) provides the first global data showing the devastating impact of coronavirus on access to mental health services.
According to experts, as countries observe World Mental Health Day on October 10, the study underscores the urgent need for increased funding for mental health services.
Countries reported widespread disruption of many kinds of critical mental health services: over 60% reported disruptions to mental health services for vulnerable people, including children and adolescents (72%), older adults (70%) and women requiring antenatal or postnatal services (61%). An estimated 67% saw disruptions to counseling and psychotherapy, 65% to critical harm reduction services and 45% to opioid agonist maintenance treatment for opioid dependence.
More than a third (35%) reported disruptions to emergency interventions, including those for people experiencing prolonged seizures, severe substance use withdrawal syndromes, and delirium, often a sign of a serious underlying medical condition. The analysis also reveals that 30% had disruptions to access medications for mental, neurological and substance use disorders.
Around three-quarters had at least partial disruptions to school and workplace mental health services (78% and 75% respectively). Other MNS-related interventions/services with complete disruption in more than 20% of countries were suicide prevention programs (24%), home or community outreach services (24%) and interventions for caregivers (21%).
"Good mental health is absolutely fundamental to overall health and well-being. Covid-19 has interrupted essential mental health services around the world just when they're needed most. World leaders must move fast and decisively to invest more in life-saving mental health programs — during the pandemic and beyond," suggests Dr Tedros Adhanom Ghebreyesus, WHO Director-General.
About one in five adults in the US experience mental illness in a given year and about 1 in 25 experience serious mental illness each year, according to the National Alliance on Mental Illness (NAMI). An estimated 1 in 6 US youth aged 6-17 experience a mental health disorder each year. While 50% of all lifetime mental illness begins by age 14, 75% start by age 24, says NAMI.
According to a recent analysis by the US Centers for Disease Control and Prevention (CDC), an estimated 11% of adults in the US have seriously considered suicide in June, approximately double the percentage of those who did so in 2018. Symptoms of anxiety disorder and depressive disorder also increased considerably in the US during April-June of 2020, compared with the same period in 2019.
Overall, 40.9% of 5,470 respondents who completed surveys during June said they were struggling with at least one adverse mental or behavioral health condition, including those who reported symptoms of anxiety disorder or depressive disorder (30.9%).
Covid-19 itself can lead to neurological and mental complications, such as delirium, agitation and stroke. People with pre-existing mental, neurological or substance use disorders are also more vulnerable to Covid-19 infection and they may stand a higher risk of severe outcomes and even death, says the WHO. The agency has identified mental health as an integral component of the coronavirus response.
The current survey was completed during June-August 2020. It provides information about the extent of disruption to mental, neurological, and substance use services due to Covid-19, the types of services that have been disrupted, and how countries are adapting to overcome these challenges.
While the vast majority, 116 or 89% of responding countries, reported that mental health and psychosocial support is part of their national Covid-19 response plans, only 17% of these countries have ensured full additional funding for covering these activities.
"This highlights the need for more money for mental health. As the pandemic continues, even greater demand will be placed on national and international mental health programs that have suffered from years of chronic underfunding. Spending 2% of national health budgets on mental health is not enough. International funders also need to do more: mental health still receives less than 1% of international aid earmarked for health," write authors.
On World Mental Health Day, the WHO has invited the global community to take part in "the big event for mental health". It is an online advocacy event that will call for increased investment in mental health at all levels — from individuals to businesses to countries to civil society ̶ so that the world can begin to close the gaps highlighted by the currnet WHO study.
Among other findings, the authors identified differences in the types of service affected by closure, with outpatient services in mental and general hospitals as well as community-based services predominantly more affected. For example, community-based services were more impacted compared with inpatient facilities, with full or partial closure in more than 40% of countries and home care and day care services reaching levels of full or partial closure in 60-70% of countries.
Outpatient services in mental hospitals and general hospitals were fully open in fewer than 60% of responding countries. Disruptions in outpatient services at mental hospitals seem to be linked to the stage of transmission of the virus, with countries in the community stage showing the highest level of disruption, with services partially open in 47% of countries, around 40% within the clusters and sporadic stages and fewer than 30% of outpatient services either fully closed or partially open in countries in the "no cases" group.
While many countries (70%) have adopted telemedicine or teletherapy to overcome disruptions to in-person services, there are significant disparities in the uptake of these interventions. Researchers found that more than 80% of high-income countries reported deploying telemedicine and teletherapy to bridge gaps in mental health, compared with less than 50% of low-income countries.