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The global COVID-19 response is leaving mental health behind
By Christie Kesner
“Mental health services are an essential part of all government responses to COVID-19. They must be expanded and fully funded”
UN Secretary General António Guterres
Since the WHO declared COVID-19 a public health emergency of international concern in January 2020, there has been a global effort to help countries respond, mobilising billions of dollars in the process. Governments, multilateral organisations, and private donors have committed money and resources on treatment, vaccine development, health systems strengthening and assistance to mitigate the economic consequences around the globe. How much funding from these commitments have gone to support mental health and psychosocial support (MHPSS) services? Our analysis shows that financial support continues to fall short.
COVID-19 effects on mental health
The effects of COVID-19 on mental health are extensive. The loss of loved ones, economic hardship, mitigation efforts (including physical distancing measures), and anxiety and fear of COVID-19 itself are all stressors that can upend lives and trigger mental health conditions. Compounded by the fact that COVID-19 is exacerbating pre-existing mental health conditions and inequalities, the mental health of the most vulnerable continues to be at risk. Mental health systems must be able to adapt and serve the increase in demand. In order to do that, they must be fully funded.
Unfortunately, the financial support is not there. Even before COVID-19, domestic governments in low- and middle-income countries were spending on average only 1.6% of health budgets on mental health. By June to August of 2020, a WHO-conducted survey completed by 130 countries found that despite 89% of responding countries reporting that MHPSS is part of their national COVID-19 response plans, only 17% of these countries have ensured full additional funding for it.
MHPSS in the Global Humanitarian Response Plan
The Global Humanitarian Response Plan (GHRP), is the leading strategy document for the UN’s response to COVID-19, and calls for US$10.3 billion to fund it. Money for the GHRP goes largely to UN agencies, to support efforts in 63 countries, ranging from health systems support, to famine protection, to refugee response plans and beyond. MHPSS is included in this plan, and it advocates for integration of MHPSS across all sectors to improve humanitarian coordination.
By early October 2020, the GHRP had received almost $3 billion, and according to our analysis, only US$16 million or 0.54% of funds have been directed to activities that included MHPSS. Sources of funds include the EU, country-based pooled funds, Germany, Switzerland, UNICEF, Sweden and Switzerland, with money being directed to Yemen, Syria, Ethiopia, Afghanistan, Pakistan, Jordan, South Sudan and the Democratic Republic of Congo. The US$16 million does not represent all funds directed to MHPSS, as MHPSS is usually included with other health, protection and WASH services. This means that US$16 million is a large estimate, and financial support solely to MHPSS services is lower. Our analysis was done by searching for FTS flows downloaded on 6 October, therefore, this is not a full description of all MHPSS flows due to aid transparency issues, and the quality of data available.
While analysing the financial commitments to the GHRP does not provide an accurate representation of all global support to MHPSS, it does provide a pivotal snapshot to see how small support to mental health is in the response. Unfortunately, this financial shortfall is not new. Lack of financial investment (from both domestic government and international sources) remains one of the largest threats to global mental health. Other reviews of humanitarian MHPSS flows have identified very similar findings; from 2007-2009, for example, funding for MHPSS accounted for only 1% of humanitarian financing.
United for Global Mental Health has compiled a larger resource, highlighting bilateral, multilateral and private donors’ own response, outside of supporting the GHRP. Even when analysing these announcements and public commitments, MHPSS continues to be left behind and is one of the least funded aspects of the response. If we are to build back better mental health systems after COVID-19, we must ensure adequate funding for it.
Recommendations
The historic underinvestment of mental health is one of the greatest challenges in the sector. Development assistance for mental health has never exceeded 1% of health assistance, and on average domestic governments spend only $2.5 pppa on it. The COVID-19 pandemic provides an opportunity to rethink and reprioritize funding for sustainable mental health systems around the globe. But in order to do this, a concentrated global effort must take place to increase these resources. We recommend that:
- International agencies include mental health as part of their COVID-19 response and recovery plans – adopting a multi-sector approach and integrating mental health across relevant sectors including livelihoods, social welfare, child protection and education.
- International development donors prioritize mental health – ensuring it is integrated into COVID-19 emergency response and recovery planning, with a focus on prevention, promotion, and holistic, life-course approaches. They must also improve coordination among themselves to ensure efficiency and improve impact.
- National governments allocate sufficient resources within their COVID-19 response and recovery health budgets for mental health, and for those national governments that host refugees, the mental health of those refugees must be part of their mental health planning.