How do we truly leave no-one behind?
Substance use, mental health, and COVID-19
By Shekhar Saxena and Maxim Polyakov
Earlier in the week, we had the pleasure to welcome our viewers to a webinar entitled Substance use and mental health: challenges, opportunities and first lessons during the COVID-19 outbreak. The session was part of the ongoing series, co-hosted by United for Global Mental Health and its partners, and was organised with the support of the WHO.
This critically important and timely discussion was led by a stellar panel:
Alex Baldacchino: Professor of Medicine, Psychiatry and Addictions, St Andrews University Medical School, President-Elect of International Society of Addiction Medicine
Vladimir Poznyak: Unit Head (Alcohol, Drugs and Addictive Behaviours), Department of MH and Substance Use, WHO
Olga Belyaeva: Program Coordinator of the Eurasian Network of People who Use Drugs
Nirvana Morgan: President, Network of Early Career Professionals working in the area of Addiction Medicine
Over the last 12 months, 2 billion people drank alcohol. A quarter of a billion people used drugs. Even in normal times, this group of people are particularly vulnerable (socially, and in terms of co-morbidities, including mental co-morbidities). At the same time, they are particularly badly provided for. In the context of COVID-19, the situation has only become more dire.
As Alex Baldacchino elucidated, COVID-19 has caused “a reduction or total loss of signposting of where to find help; physical obstacles to attend usual services e.g. crisis centres; reduction in contingency plans; and increases in stigma”. Unsurprisingly, this has had devastating consequences on people who use substances, with the most extreme manifestation of this the rise in overdoses and suicides. As Olga Belyaeva told the audience, “70 people died in Dnepropetrovsk in Ukraine during the 1 month of quarantine”. Furthermore, as Vladimir Poznyak commented, it is likely that drugs and alcohol may “negatively impact COVID-19 prevention and treatment”, making users increasingly prone to COVID-19 as well.
When told from the point of view of medical professionals working in addiction medicine, the story is equally complex, as stigma (even within the health service) affects not just service users, but also service providers. As Nirvana Morgan told us, early career professionals the world over reported needing to “fight for equal space in the health sector during the pandemic”, including having less access to PPE (despite working with a higher-risk population); seeing services interrupted, because senior managers did not deem them essential; and losing bed space, with no guarantee that they will be returned after the end of the pandemic.
So, what can be done about this? The panellists made a number of suggestions:
Crisis management: Make increased efforts to implement the relevant WHO guidelines, including ensuring that the services for people who use substances are continued throughout the pandemic, and are appropriately adapted (e.g. regarding policies on take-home medicines, or availability of medicines in different clinical settings). At the same time, learn from the experience of COVID-19 by putting in place business continuity and contingency plans
Crisis recovery: Build back better after the crisis, including integration of substance use and mental health in health systems (as, for example, is happening through the WHO Special Initiative for Mental Health). More tactically, increased regional collaboration and best-practice sharing would be helpful and welcome in many contexts
Rights and inclusion: Continue to advocate for the rights and dignity of people who use substances. We heard that there are still doctors who say things like, “get on your knees and apologise, and then you can get methadone”. In addition, ensure that the perspective of service users is front and centre whenever policies and services are designed. Indeed, the process for the creation of WHO guidelines explicitly requires the inclusion of people with lived experience – in this case, people who use substances
Ultimately, as our panellists put it, it is impossible to speak about mental health without speaking about substance use. The world needs to work towards a situation where drug and alcohol issues are treated as a public health issues, and are addressed on parity within mental health and other health conditions.
The full notes can be found here.