Written By: Elena Schatell PA-C MPH MMS and Dr. Heather F. McClintock PhD MSPH MSW
Over two years ago we co-wrote IH Connect’s blogs on mental health and COVID-19 (part 1 and part 2 here). Since this time the COVID-19 pandemic has continued to shape and influence so many facets of our lives. This unprecedented pandemic has created challenges with psychological ramifications for people around the world such as the loneliness from social isolation during quarantine, fear of contagion and infection, constraints on the ability to work and attend school, unemployment, financial worries, domestic violence, grief after the death of a loved one, and the emotional burdens of working on the frontlines. Furthermore the economy has been impacted, as the COVID-19 pandemic has caused a global economic recession worse than the Great Depression. Hundreds of millions around the world have lost jobs due to the inability to work remotely, businesses going bankrupt, declines in labor demand, falling export demand and supply chain disruptions.
The impact of COVID-19 on the mental health and well-being of people around the globe is substantial. A February 2021 brief published by the Kaiser Family Foundation (KFF) reported a four-fold increase in U.S. adults reported symptoms of a depressive or anxiety disorder. Parents, children, young adults, people experiencing unemployment, essential workers and communities of color are populations at increased risk for experiencing poor mental health during the pandemic. The impact of COVID-19 on mental health and well-being is not limited to any single country or region; it has impacted people in every part of the globe. In the first year of the pandemic, the World Health Organization (WHO) reported a 25% increase in the global prevalence of depression and anxiety. For more details about the global mental impact of the COVID-19 pandemic please read this WHO scientific brief.
I (Elena Schatell) spent the past year working in different medical offices and hospital systems across the country as part of my final year of physician assistant school. I have been exposed to many health care settings and various patient populations, and at every single site I have witnessed the mental health effects of COVID-19 on patients and their families. On my pediatrics rotation at a practice in a western Pennsylvania suburb, there were multiple teenage girls who came in for follow-ups after being admitted to behavioral health units for attempting suicide. Suicidality among U.S. adolescents was already a public health topic of concern, but since the start of the pandemic, rates of teen suicidality and poor mental health have increased. I heard numerous individuals talk about the hardships their families have faced since the establishment of online school, or “distance learning.” In an emergency department (ED) on the south side of Chicago I saw countless mental health emergencies and drug overdoses. I talked to individuals experiencing homelessness who came to the ED solely for comfort and shelter. I could not help but imagine all the many ways the COVID-19 pandemic has impacted these individual’s lives.
The increased prevalence of mental health problems has been accompanied by an increased disruption to mental health services, leaving large gaps in care for people who need it the most. Some of these disruptions began at the start of the pandemic, like lack of access to face-to-face care, reduced outpatient appointments and limited admissions to emergency departments. However, many of these disruptions were pre-existing and the pandemic exacerbated already struggling and taxed systems. The COVID-19 pandemic has shed light onto the critical need for accessible and well-resourced mental health care systems globally. The lack of such infrastructure has widened disparities across many sectors and dimensions of well-being (e.g. social, economic, psychological) leaving the underserved even more marginalized and disempowered. Dr. Tedros Adhanom Ghebreyesus, the WHO Director-General, stated, “This is a wake-up call to all countries to pay more attention to mental health and do a better job of supporting their populations’ mental health.”
While the COVID-19 pandemic has had a negative impact on mental health and well-being globally and has shed light on fractured and under-resourced mental health care systems; there is a silver lining. It has afforded the opportunity for growth, development and creativity to address the complex mental health needs of populations around the world. The WHO and countries around the world have been “stepping up” their mental health response. For instance, with increasing suicide death rates, the U.S. federal government has launched the national three-digit number “988” as the mental health crisis hotline. Callers who are experiencing a mental health crisis will be automatically routed to a trained mental health professional, instead of law enforcement. Telehealth has stepped up to the plate to meet mental health needs during the pandemic. An analysis from KFF and Epic Research found telehealth services for mental health and substance use increased from near zero percent in 2019 to 40% in mid-2020. Two-thirds of community health centers in the U.S. have added new mental health services, including virtual services. I (Elena Schatell) can personally attest to the enormous benefit of telehealth access for mental health care. From 2020 into 2022 I participated in telehealth counseling services offered through my university and later through an online mental health service platform. Conveniently having a mental health professional whom I could communicate with online helped me navigate stressors I was experiencing. When reliable and easily accessible, these services are effective at filling gaps in mental health care. But in resource-limited settings around the world, developing and implementing digital tools poses a challenge. WHO has been instrumental in providing guidance, tools and resources to member states, public health planners and responders, and the general public. In collaboration with partners around the world, WHO developed multilingual resources such as a stress management guide and mental wellness toolkit for older adults. As of early 2021, 90% of WHO member states reported including mental health support in their COVID-19 response plans and the number of countries with an emergency mental health support platform doubled.
WHO acknowledged global mental health as a priority when it published its Comprehensive Mental Health Action Plan 2013-2020. Just one year prior to the start of the pandemic, in 2018, the WHO Director-General acknowledged mental health as an area in which action needed to be accelerated. He established the WHO Special Initiative for Mental Health, covering 2019-2023, with the goal of 100 million more people having access to quality and affordable mental health care by 2023. Largely focused on finding innovative ways to provide support in hard-to-reach communities, the initiative was created just in time for the pandemic. It is underway in Bangladesh, Ghana, Jordan, Nepal, Paraguay, the Philippines, Ukraine and Zimbabwe. In Ukraine, which has been affected by military conflict and COVID-19, community mental health mobile teams have been developed to provide services to individuals in remote areas.
In April 2020 the publication of the storybook, My Hero is You, was produced through a collaboration of over 50 organizations, including WHO, UNICEF, the United Nations High Commissioner for Refugees and the International Federation of Red Cross. This is a picture book, available in 142 languages, that serves as a resource for helping children around the world cope with and respond to the mental health impacts of COVID-19. Found to be hugely successful, multimedia formats and additional resources were created targeting other populations. A sequel was released in September 2021, reflecting on the new challenges the world has faced in the second year of the pandemic. The sequel is based on survey responses from over 500 individuals around the world. The coordination and collaboration involved in creating these books is amazing. The pandemic has had a catastrophic impact on psychological health and well-being. However, (as evidenced by the projects described above) it has created an opportunity for collaboration and cooperation as well as highlighting the importance of nations in prioritizing global mental health care.
Elena Schatell PA-C MPH MMS
Elena Schatell is a recent graduate of Arcadia University’s Dual Master of Public Health/Master of Medical Science in Physician Assistant Program. She aims to promote public health in underserved communities as a family medicine physician assistant. Her 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 Associate 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.