This is the third part of a IH Blog series, Global Mental Health: Burden, Initiatives and Special Topics.
Part III – Global Mental Health Initiatives and COVID-19
Mental health issues pose a significant public health burden and in the context of COVID-19 this burden is growing substantially. In low- and middle-income countries, 76%-85% of people with mental disorders do not receive needed treatment. Many countries do not have the infrastructure, resources and/or political support to adequately ensure that all persons have access to high quality mental health services. Therefore, there is a large gap between the need for mental health treatment and available services.
One important indicator of a country’s capacity to address the growing mental health burden is the availability of adequately trained personnel to provide treatment and care. In 2010, the World Health Organization (WHO) released the results of a study that found that low- and middle-income countries in the African Region and the South-East Asian Region reported fewer mental health professionals than the Americas or the European Region. According to the 2017 Mental Health Atlas country profiles, this trend still exists. For example, India reported 1.93 total mental health workers per 100,000 population, Rwanda reported 2.01, and China reported 8.75, whereas Germany reported 144.87, France reported 173.63, Finland reported 250.55 and the United States reported 271.28. In order to meet the increasing demand for mental health care globally adequately trained mental health care providers are critically needed.
One initiative aiming to reduce the burden of mental health issues globally is the Mental Health Gap Action Programme (mhGAP) which was launched in 2008. This program uses evidence-based tools, training, and interventions to expand mental health service provision in resource-poor, low-income countries around the world. The original 2010 mhGAP Implementation Guide has been used in over 100 countries and translated into more than 20 languages. The program directs its training towards health-care providers who do not have specialized training in mental health. For instance, in 2017, to address the mental health needs of persons affected by conflict in Borno State, in northeastern Nigeria, the Federal Neuro-Psychiatric hospital and governmental authorities launched the mhGAP program. This program trained primary care workers to identify and provide care for persons with mental disorders. The story of Aisha, a girl directly impacted by this conflict who received mental health treatment through mhGAP can be found here.
In the World Health Organization’s (WHO) most recent global targets and goals (Sustainable Development Goals (SDGs)), mental health was explicitly included as a part of SDG Target 3.4. In December 2019 WHO held a meeting to accelerate progress on SDG Target 3.4 on Noncommunicable Disease and Mental Health in Oman. The goal of this meeting was to have countries come together to share success stories and challenges in order to develop innovative ideas on how to scale up national interventions to reach SDG target 3.4 by 2030. There were sessions titled: “Mental health and psychosocial support in emergencies” and “Story-telling and mass media for mental health.” Video of panels held during the meeting can be viewed here.
As part of their QualityRights Initiative, WHO has developed training and guidance modules that are meant to empower all stakeholders to promote mental health recovery and human rights in mental health facilities, improve service delivery, and change mindsets around mental health. The modules are designed to be used in low, middle, and high-income countries. Updated modules were introduced in November 2019. QualityRights has been introduced into 31 countries, with Ghana being the first to introduce the program country-wide in early 2019. A total of 22 member states of the European Region formally agreed to carry out mental health related activities during 2018-2019, and a majority stated they would use WHO QualityRights toolkit and guidance materials.
Another WHO initiative, WHO MiNDbank, is a free online platform that contains a wide variety of international and country-specific resources covering behavioral health. MiNDbank is a part of WHO’s QualityRights campaign and aims to facilitate dialogue, advocacy and research surrounding human rights violations against people experiencing mental health challenges and disabilities.
Current Initiatives Focused on COVID-19
New global initiatives are being implemented to address the mental health burden of the COVID-19 pandemic. Many initiatives are focused on disseminating educational resources out to the public. In direct response to the COVID-19 pandemic, WHO released a list of mental health and psychosocial considerations for different groups, such as people in isolation, carers of children, and healthcare workers. To support research efforts on behavioral insights related to COVID-19, the WHO Regional Office for Europe developed a survey tool for European Member States to use.
On March 17, 2020, the Inter-Agency Standing Committee (IASC), a humanitarian coordination forum created by the United Nations, published an interim briefing note titled, “Addressing Mental Health and Psychosocial Aspects of COVID-19 Outbreak.” Like WHO’s list of considerations, this briefing note summarizes important mental health and psychosocial support considerations in relation to the COVID-19 outbreak. The document includes 14 recommended activities and six interventions that can be globally implemented as part of the COVID-19 mental health response. The briefing note is available in over 15 different languages.
Initiatives in the United States
The United States is implementing several initiatives that aim to address the mental health burden of the COVID-19 pandemic. Information about some of these initiatives is provided below:
Centers for Disease Control and Prevention (CDC)
- The CDC webpage – Stress and Coping. This page provides general and population specific recommendations.
National Alliance on Mental Illness (NAMI)
- NAMI published a “COVID-19 Resource and Information Guide”
Substance Abuse and Mental Health Services Administration (SAMHSA)
- A web page dedicated to COVID-19, with SAMHSA resources and information, guidance for opioid treatment programs, and additional federal guidance
- A list of SAMHSA COVID-19 funded grants organized by state
Mental Health America
- Information and resources on mental health and COVID-19. Includes tips for social distancing, quarantine, and isolation, resources for financial support, tools and information on anxiety, links to webinars and workshops, and information for parents, older adults, domestic violence survivors, and more.
American Psychiatric Association (APA)
- The APA Center for Workplace Mental Health has published a guide “Working Remotely During COVID-19: Your Mental Health and Well-being”
- More APA coronavirus resources can be found on this webpage. This page includes resources specific to psychiatrists, families, hospitalists and primary care, and healthcare and community leaders.
- The Harvard University Global Health Institute has developed a website with mental health and psychosocial support resources (including recorded webinars, podcasts, coping resources and published research) that is updated continuously.
National Child Traumatic Stress Network (NCTSN)
- The NCTSN has several facts sheets available on their webpage, COVID-19 Resources, that include tips for judges, legal professionals and court personnel, how to talk to children about COVID-19, information on how to help children with traumatic separation or grief related to COVID-19, and a parent/caregiver guide to helping families cope with COVID-19.
- ThriveNYC, New York City’s commitment to close gaps in mental healthcare, offers numerous resources on their website. Information is provided on mental health services that can be accessed from home and the page provides tips for coping and mental well-being.
About the Authors:
Elena Schatell MPH (c) MMS (c)
Elena Schatell is a current student at Arcadia University enrolled in the Dual Master of Public Health/Master of Medical Science in Physician Assistant Program. She aims to promote public health in underserved communities as a future physician assistant. Her current public health interests include access to mental health services, stigma surrounding mental illness, and the relationship between faith and mental health. She has interned at the National Alliance for Mental Illness (NAMI) national office in Arlington, Virginia, working closely with the Advocacy and Public Policy team on conducting research on service barriers and state mental health policy. During her time at NAMI, she also authored articles for the Advocate magazine and blog.
Dr. Heather F. McClintock PhD MSPH MSW
Dr. McClintock is an IH Section Member and Assistant Professor in the Department of Public Health, College of Health Sciences at Arcadia University. She earned her Master of Science in Public Health from the Department of Global Health and Population at the Harvard School of Public Health. Dr. McClintock received her PhD in Epidemiology from the University of Pennsylvania with a focus on health behavior and promotion. Her research broadly focuses on the prevention, treatment, and management of chronic disease and disability globally. Recent research aims to understand and reduce the burden of intimate partner violence in Sub-Saharan Africa. Prior to completing her doctorate she served as a Program Officer at the United States Committee for Refugees and Immigrants and a Senior Project Manager in the Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania. At the University of Pennsylvania she led several research initiatives that involved improving patient compliance and access to quality healthcare services including the Spectrum of Depression in Later Life Study and Integrating Management for Depression and Type 2 Diabetes Mellitus Study.