But it is important to stress that the impacts of COVID-19 and mental health is not only about the now, but also needs to focus on the long-term consequences. Moreover, the linkage works both ways: not only does COVID-19 have an impact on the prevalence of mental ill health, but – in a vicious circle – mental ill health has an impact on the spread of COVID-19 as well.
In a recent paper developed for the Bond Mental Health and Psychosocial Disability Group, my co-author (Julian Eaton, CBM Global and LSHTM) and I looked at the various ways in which COVID-19 and mental health are linked, to help make the case for why it is time to invest in mental health now, if we are to build back better following this pandemic.
It is indisputable that, even before COVID-19, mental health was woefully under-resourced. Mental ill health accounted for 13% of the global burden of disease, but only about 2% of national health budgets (on average) were spent on mental health. In many countries the figure is much less.
In a matter of weeks, COVID-19 savagely exposed this systemic under-investment, putting at risk the mental health of populations – both populations at large, and especially those most vulnerable. Frontline workers, women, children, the elderly, people with pre-existing mental health conditions, economically vulnerable people, migrants, refugees – the list goes on. The world over, COVID-19 has driven an immediate and aggressive rise in the prevalence of mental ill health.
What is increasingly becoming clear is that the detrimental mental health effects are likely to be both short- and long-term. The longer-term aspects of mental ill health will be driven both by the direct impact of COVID-19 on its survivors (if the SARS / MERS epidemics are anything to go by); as well as by the broader social and economic aspects of the pandemic that will continue to act as stressors even after the virus itself is gone. Think, for example, of the likely longer-lasting impacts of the economic downturn, or the long-term developmental impact on children.
Moreover, good mental health on a population level is key to truly beating the pandemic.
To keep the healthcare system operational, we will need to ensure that frontline health (and other essential) workers are protected and supported regarding their mental health. Their mental health is paramount to sustaining the response and recovery.
To control the spread of the infection more broadly, it will be important to maximise adherence to the risk-reduction protocols across the population. This will require additional interventions and investment in support for people with poor mental health, who may be less likely to follow epidemiological guidelines than people in good mental health or without mental health conditions. According to studies of patients with HIV, TB, cancer, and even Ebola, patients with poorer mental health were more likely to exhibit higher-risk behaviour, or be non-compliant with their treatment.
Supporting mental health of populations will also be key to ensure optimal vaccine uptake, once a vaccine is produced. There is a growing body of evidence to suggest a link between poor mental health and lower vaccine uptake rates, in both high- and low-income settings (e.g. a link between maternal depression, and vaccination rates in children). By contrast, increased population anxiety and fear is likely to foster greater levels of suspicion and proliferation of anti-vaccine campaigns. Given the immense resources that are being put into vaccine development – and the hope that is being pinned on it – not taking steps to maximise its uptake is an own goal that we can ill afford.
Finally, investing in mental health will be a key part of the economic recovery for nations. Before COVID-19, poor mental health cost the world economy ~US$2.5 trillion per year. By contrast, the return on investment from programmes investing into mental health is overwhelmingly positive: a recent study found that, in some cases, scaling up of depression and anxiety treatment generated ~$4 in economic benefits for each $1 invested.
Like any crisis, COVID-19 provides an opportunity and incentive to accelerate progress. We need to take the opportunity to invest in mental health: to positively provide appropriate support for populations impacted by COVID-19; to “build back better” and improve care delivery following the pandemic; and to defeat this pandemic. We know what to do, as has been outlined in numerous plans, initiatives, and briefings. We just need the political will and commitment of resources to see it through, because now more than ever is the time for the world to invest in mental health, everywhere.
For more information, read the full document here.