The Equalisation of Mental Health Systems is Vital to Deal with the Impact of Covid-19′.

By Danny Bowman, Head of Campaigns

The current global pandemic is the largest public health emergency of the last 100 years, with the Covid-19 virus infecting over 26 million and sadly taking the lives of 900,000 people across the globe.  The virus continues to pose an exponential threat to the physical health of millions and plans to deal with a potential second wave of infection are already being put into place by many governments across the globe. Although the concern for the physical health of citizens across the globe has and must be taken into account, the psychological risk of the virus has been given less focus; and plans to address the likely mental health pandemic once the virus is over is still very much in its infancy.

The identification of an increase in anxiety, depression and other common mental health problems during Covid-19 are already starting to be uncovered by research projects from across the globe. A recent survey on the Prevalence of Depression Symptoms in US Adults Before and During the COVID-19 Pandemic found that symptoms rose 3-fold during the pandemic compared to recent population-based estimates of mental health in the US. In the UK, the recent forecast from the Centre for Mental Health said that there would be an increase of half a million more people experiencing mental health problems as a result of the pandemic.

It is hardly surprising that this is the case when we consider the catalogue of risks posed by Covid-19 and its side-effects to the mental health of citizens. The psychological implications of experiencing the virus, losing a loved one, lockdown measures and economic uncertainty. On top of all of that the complete inability to access appropriate psychological interventions during this period and the lack of early intervention will have undoubtedly seen the development of poor mental health amongst many citizens and more acute symptoms amongst those with pre-existing psychological difficulties.

In considering the likely increase in need for mental health provision during and after the Covid-19 pandemic countries should be upscaling their mental health systems to provide vital support to their citizens. However, not all countries are starting from the same point with huge disparities in spending, qualified personnel, facilities and innovation in mental health across the world. Unaddressed, these disparities could lead to an unequal recovery from the impact of Covid-19 across the globe.

Mental Health Spending Around the World

The level of expenditure on mental healthcare in low- and middle-income countries tends to be much smaller than that of those in the higher income brackets. For example, the total % spend of India’s health budget (lower-middle income economy) on mental health stood at 1.3% compared to Finland (high-income economy) who spent 5.6%. As the next part of the analysis will show, the level of spend on mental health has strong implications for the availability of a comprehensive mental health care system. The lower spending countries such as Senegal, Zimbabwe and India have fewer comprehensive workforces and facilities, whilst higher spending countries such as Finland and the Netherlands represent substantially more equipped systems.

Mental Health Workforces Around the World

The availability of a comprehensive mental health workforce in countries across the world is highly impacted by the level of spend attributed to mental health care. The world health organisation suggests that the median number of mental health workers globally is 9 per 100,000. However, lower income countries can experience less than 1 mental health professional per 100,000 indicating a substantial disparity in access to qualified professionals. In lower-income countries such as Senegal, the availability of psychologists and psychiatrists is very low at 0.020 and 0.200 per 100,000. In comparison, a high-income country with a similar population such as the Netherlands recorded 123.464 psychologists and 20.870 per 100,000.

The level of spend on mental health care makes a huge difference to the availability of a comprehensive mental health workforce, countries who are able to spend more on mental health care are also able to incentivise qualified personnel to work within their country. In Finland, the government allocates a generous level of funding to mental health services enabling them to incentivise mental health professionals to practice in their country with competitive salaries and better working conditions. Whilst in Romania, also a high-income country, they have experienced a huge migration of mental health professionals because of their inability to compete with countries such as Finland when it comes to salaries and working conditions.

The inequitable distribution of mental health professionals across the globe could see the increasing development of a postcode lottery in the availability of care for those who have experienced the psychological impact of the pandemic. These inequities are also experienced in the availability of appropriate mental health facilities across the globe, adding to the prevalence of this postcode lottery.

Mental Health Facilities Around the World

The infrastructure of global mental health systems varies considerably with some countries still very much reliant on mental hospitals to provide psychological interventions, whilst others have created a modicum of easily accessible community-based facilities.

There are concerning disparities in the availability of community based mental health facilities with lower/lower middle-income countries such as Zimbabwe and Uganda only attributing 1 such type facility, whilst a high income country like Italy attributes a much larger distribution of these type of facilities with 1,114 available. However, these types of disparities are not just exclusive to between low income and high-income countries as Europe shows. In Finland, there are 326 community based facilities, whilst in Romania there are only 41 with a much higher prevalence of old mental hospitals being used for treatment in the latter. Whilst there are considerable cultural barriers to the implementation of appropriate community-based interventions including stigma associated with mental illness, the main barrier to the development of these facilities is the inability or reluctance of certain countries to spend on mental health.

It is vital that all countries can offer community-based interventions moving forward to be able to deal with the likely increase in mental health problems post Covid-19. Without the availability of community-based interventions, inpatient wards or in some countries mental hospitals will become overwhelmed, causing countries to be unable to support their citizens mental health needs.

So, What’s Next?

The main indicator of whether a country will be able to meet the increase in need is very much dependent on the amount they are willing to spend in upscaling their mental health system. Some countries will already have the adequate spend to meet the need, whilst others, particularly low-income countries may need support from a range of international stakeholders to update their systems. This will inevitably be helped by the World Health Organisations World Mental Health Day focus on encouraging investment to scale-up mental health provision across the globe. If achieved, it is my hope that this investment will deliver a comprehensive move towards the equalisation of mental health provision across the globe. This will be vital in achieving individual, social and economic reassurance once the virus is over. If countries fail to meet the mental health needs of their citizens, they could experience substantial and long-lasting individual, social and economic costs.

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