The ongoing lockdown is exacerbating the already dire mental health situation around the world especially among youths.
On the 14th of May 2020, the World Health Organization (WHO) released a worrying report showing the devastating impact of COVID-19 on the mental wellbeing of the people all over the world: anxiety, irritability, insomnia are just a few of the mildest symptoms.
Titled COVID-19 and the Need for Action on Mental Health, the paper calls for a “whole of society” approach to mental health in order to “promote, protect and care for mental health” within the national health system, ensuring emergency mental health care services are provided during the pandemic, and advocates for a recovery from COVID-19 that can build mental health care services for the future.
With lack of proper care and support, individuals already suffering from mental health conditions are having an even harder time in what is not just a physical lockdown but also, with lack of support, is turning into a mental siege.
It is an emergency everywhere from the most developed nations to the least developed ones.
Even a country like Finland that weathered the crisis with a limited number of deaths and whose effective and generous welfare system is often praised, experienced an almost 15% spike in suicide deaths during the lockdown.
The data highlights a broader trend of mental health distress especially among youths in Europe, and those from more vulnerable backgrounds were impacted the most as confirmed by the Health Behavior in School-aged Children (HBSC) released by the WHO on the 19th of May, 2020.
If mental health is often neglected and overlooked in general even in some of the most advanced economies, it is easy to imagine how worrying the situation can be in developing nations, lacking strong primary health care systems.
According to the WHO, a study carried out in Ethiopia shows a threefold increase in symptoms related to depression compared to data before the pandemic.
This scenario applies to many other developing countries and the situation in Nepal is worrisomely similar.
A survey conducted by Transcultural Psychosocial Organization (TPO) Nepal, one of the most authoritative organizations in matter of mental health in the country, during the peak of the ongoing lockdown, showed that 18 percent of the respondents experienced restlessness while 37 percent was exposed to anxiety.
A developing country with a weak national health care system, Nepal can count on a very limited number of mental health specialists, mostly in the Kathmandu Valley, who are unable to meet the demand even in normal times.
In addition, there have been several not-for-profit organizations like TPO Nepal and Koshish Nepal, trying their best to mend the vast gulf between the pressing needs and availability of assistance, often by providing direct essential services for people suffering from a variety of mental conditions.
While all these initiatives are praiseworthy, how can their efforts be sustained, supported, and even more importantly, scaled up?
Obviously the government at all the levels, should understand how investing in mental wellbeing is going to be essential, but the real challenge in Nepal and elsewhere in the developing world, is how to ensure that mental health, amid a myriad of pressing issues including extremely weak traditional primary health care services, receive due importance.
The only way to generate interest on mental health, perhaps, is to really go mainstream, finding creative ways to enlist youngsters as well as adult citizens realizing that each one of them is not immune from potential mental health conditions in the future.
The challenge is how we can expand this conversation not only in these times of COVID-19 driven anxiety, but also hopefully in soon to be better times, involving larger part of the society.
The WHO came up with a Special Initiative for Mental Health for 2019-2023 that builds on a potentially revolutionary Mental Health Action Plan 2013–2020 adopted on May 27, 2013 that defines mental health as “a state of well-being in which every individual realizes his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to her or his community.”
But no one would be surprised if most of the strategic goals and recommendations still remain unfulfilled.
However, lack of implementation should not dampen the hopes for a major overhaul of mental health care within the developing and developed nations as well.
First, mental health should be embedded in the primary health care, and partnerships with not-for-profit sector and for-profit service providers should be established with clear co-financing lines.
Second, we need to create interest and engagement across the sectors.
Educators should play a very important role as schools can become a fertile ground to talk about mental health, linking it to other pressing issues.
For example, while discussing gender equality, we can easily relate it to the unequal impact of mental health faced by women because of the structural aspects of the society that perpetuate a cycle of violence and oppression that have a negative impact on their mental wellbeing.
Mental health awareness could, particularly in the developing countries, be included together with social emotional learning in the national curriculum, equipping all children with the right tools to navigate their future lives.
Having champions at global, national and even local levels can prove to be very important.
Recently, American actress Emma Stone came forward to raise awareness on mental health, announcing a new digital mental health initiative in the United States which also celebrated the Mental Health Awareness Month in May.
Unfortunately, cultural factors prevailing in many developing countries, mired by conservative mindsets that are extremely protective of any personal stories that could bring shame to a family, prevent a person from coming forward and sharing his/her feelings and situation.
That’s why peer-to-peer support can be a first fundamental step to bring relief and help break embedded taboos.
Even the WHO is recognizing the importance of peers in dealing with mental health as it is promoting the Self-Help Plus (SH+) intervention package based on group support.
Reckoning with vulnerability, as author Brene Brown says, is a first essential step, admitting that each of us, no matter the status and power, can face difficult situations that must be shared, discussed with friends, family members before being dealt with specialized personnel if needed.
One of the key lessons stemming from this pandemic will be a universal understanding that it is imperative to invest much more effectively in public health.
Mental health care is a core part of it and the WHO calls it universal health coverage for mental health, and it is aimed at all people achieving the highest standard of mental health and wellbeing.
There is a unique chance, for many countries, especially in the developing world, to rebuild from scratch a health system that is too unequal and too dysfunctional now.
In the official statement, Dévora Kestel, Director of the Department of Mental Health and Substance Use at WHO, highlighted the importance of “developing and funding national plans that shift care away from institutions to community services, ensuring coverage for mental health conditions in health insurance packages and building the human resources capacity to deliver quality mental health and social care in the community.”
Leveraging the peer-to-peer support that could be easily offered by those persons who have experienced mental health conditions themselves, involving and engaging the broader members of the society in the mission to turn mental health into a global priority can truly make the difference, helping move forward the ambitious goal set by the WHO to guarantee access to quality and aﬀordable mental health care to 100 million more people by 2023.
(Galimberti is the Co-founder of ENGAGE and Sharma is the Co-founder of Paaila and a mental health advocate who has dealt with severe depression, and is a suicide survivor)