COVID-19 WEBINAR 1: MENTAL HEALTH AND COVID-19 LATEST KNOWLEDGE
The Lancet Psychiatry, Mental Health Innovation Network, MHPSS.net and United for Global Mental Health have launched a series of weekly webinars designed to provide policy makers and the wider health community with the latest evidence on the impact of COVID-19 on mental health and how to address it. You can sign up to these webinars via this link, please email any questions to firstname.lastname@example.org.
April 7th: Mental Health & COVID-19 Latest Knowledge: What Do We Know? What Is The Mental Health Impact Of Social Isolation And How To Address It?
The following is a brief summary of the discussion. Please refer to the video of the session for any quotes or attribution of remarks to individuals.
Chair: Niall Boyce, Lancet Psychiatry
Devora Kestel, WHO Director of Mental Health and Substance Misuse
Simon Wessely, Kings College London
Neil Greenberg, Kings College London
Florence Baingana, WHO African Region
What is affecting people now?
Devora Kestel and other participants noted anxiety is to some extent affecting everyone as they all experience uncertainty across all countries affected. However, the most affected groups at this time that need mental health support are those with existing mental health conditions, and front line workers (who have both higher levels of anxiety and are sometimes experiencing stigma because of their role).
The other groups to be most aware of are those individuals and groups vulnerable due to social circumstances e.g. women and children at risk of violence; and those most impacted by financial hardships. COVID-19 might lead to an increase in drug and alcohol addiction problems. The speakers noted financial difficulties can exacerbate mental ill health - economic interventions to help alleviate poverty also help alleviate mental ill health.
What is the impact on those with pre-existing mental health disorders?
Simon Wessely spoke about the impact of Covid-19 on those with pre-existing mental health disorders: from the stress of social isolation to changes to everyday life and lack of access to services. He said there has been a rise in Obsessive Compulsive Disorder (OCD) already and it is anticipated this will worsen and it will be one of the delayed effects of COVID-19.
He and other speakers agreed another impact is the much higher rates of mental health disorders among front line workers - up to double the number of health workers now experiencing mental health disorders. Normal staffing shortages in mental health services across the world have been made far worse by COVID: in-patient care has been particularly difficult with mental health workers not prioritised to receive Personal Protective Equipment (PPE). Simon noted in the UK, community mental health care services have been transformed within a few weeks to switch to internet-enabled functions. However, while there has been a huge investment in talking therapies, support for severe mental health conditions has been relatively neglected. The pandemic has amplified the underlying under investment in addressing the needs of those with severe mental health conditions.
Simon said the evidence shows the immediate needs are:
Ensuring peoples’ safety i.e. sufficient equipment (PPE);
Provision and maintenance of a supply chain for the medications that may be necessary for mental health disorders;
Fairness and equity in how people are made safe and how supplies are distributed to avoid resentments now and in the future which can lead to a fractured and divided society.
What is best practice for mental health and social isolation?
Neil Greenberg highlighted the findings of the recent Lancet paper on one of the biggest current mental health concerns globally - the psychological impact of quarantine or social isolation. It was a rapid review looking at over 3000 studies and selecting 24 of the most relevant (looking at 10 countries). None looked at mass social isolation on the scale now experienced with COVID-19 but they provided useful insights on the experiences of groups who have experienced quarantine or social isolation.
The conclusion was that if national authorities manage quarantine well then although it is frustrating for people it does not cause long term mental health problems. But if it is done badly it has short and even long term mental health impacts.
What does a good social isolation policy look like?
The population understands and accepts the rationale for the measures: this is achieved where the population has access to good factual information with the message that this is an altruistic measure that is good for everyone.
The population has access to basic supplies - food, medicines, sanitary products.
As short a quarantine as possible - but most definitely avoiding multiple extensions to avoid mistrust or misunderstandings.
Health care workers were found to be specifically at risk of suffering the psychological impacts of quarantine and feeling stigmatised.
What is happening in Low and Middle Income Countries?
Florence Baingana of WHO talked about the specific impacts at present on low-and middle - income countries that have not yet experienced the pandemic but many of whom are already practising social distancing. Low income and middle income countries (LMICs) have the same mental health and psycho-social support issues including the worry and anxiety about contracting the virus. Countries are facing the same challenges regarding lack of testing and insufficient PPE. They are also grappling with the same impacts of social isolation including increasing incidences of violence against women and growing incidences of drugs and alcohol abuse.
She said the pandemic has helped raise the profile of how important MHPSS is and how cross-cutting it is. In answer to a question from a member of the audience, she said it was really important to develop culturally appropriate support for mental health - trying to identify the right technology or other ways to maintain contact and engage individuals.
Devora added that in a situation where the vast majority of the population develops some level of stress it will be important to come up with ways to address a normalisation of stress. This is a challenge not just for the health sector - other sectors also need to be involved e.g. social protection.
What can we do now?
The panelists agreed we need to learn now from what is happening (especially in high income countries currently experiencing the most intensive spread of COVID-19) and be aware that similar mental health challenges - along with the impact of poverty and financial insecurity - will face LMICs in the very near future.
Important priorities are:
Address the mental health needs of healthcare workers and other front line workers.
Proactively reach out to those likely to be at greatest risk of mental ill health to prevent them becoming a crisis case.
Build on the gains in innovation to help provide better and more effective mental health services and support for the future (do not lose that innovative approach).
Continue to advocate for access to Universal Health Coverage - physical and mental health.
Address mental health and psychosocial support as a cross-cutting issue and incorporate it within the responses to the pandemic across different sectors.
Take care of one’s own mental health - eat well, maintain physical activity, sleep, relax and keep up social connections.