London School of Hygiene & Tropical Medicine

Mental health is beginning to get the recognition it needs during public health emergencies, and COVID-19 resulted in more attention on its impact from policymakers, the media and the public. Now policymakers and mental health actors must capitalise on this increased attention, to prioritise mental health as much as physical health in outbreak response.

As a psychiatrist who took part in the COVID-19 response, I am acutely aware of the impact COVID-19 has had and the lives lost as a result of deprioritising mental health. In the midst of the COVID-19 pandemic, while working in Egypt, some of the patients in COVID-19 wards took their own life by suicide. I have seen psychiatric wards being shut down or turned into COVID-19 wards and mental health professionals asked to leave their job providing care to psychiatric patients to work in COVID-19 wards. People with mental health conditions who were admitted to a COVID-19 ward were left without adequate care as frontline healthcare workers lacked the experience and training to manage mental health problems. A lack of awareness and understanding also perpetuates the stigma surrounding mental health. I saw doctors fearful of dealing with people with mental health conditions who developed physical illnesses. After witnessing all of this I, alongside other mental health professionals, responded by carrying out risk assessments and administering training to prevent it from happening again. Training can enable health professionals to act in less stigmatising ways and help them to feel equipped to care for those who show signs of distress during treatment for COVID-19.

Before the COVID-19 pandemic, resources allocated to mental health were scarce, with a median of 2% of government expenditure allocated to mental health across the world and with more resources being shifted towards managing COVID-19 infections, the care gap became wider. In a global survey by the World Health Organization (WHO), 93% of the 130 countries that responded to the survey reported substantial disruption to their mental health services during the pandemic. Pre-existing mental health conditions worsened and new cases of those experiencing mental health problems rose on a global scale. There was an estimated additional 53.2 million cases of major depressive disorder globally and 76.2 million cases of anxiety disorders due to the COVID-19 pandemic in 2020 alone.

It has taken an emergency like COVID-19 to bring these shortcomings to light and prompt the United Nations (UN), the WHO, and other stakeholders to recommend the inclusion of mental health and psychosocial support (MHPSS) in the COVID-19 response.

Over the last year, and as a Mental Health Research Fellow for the UK Public Health Rapid Support Team (UK-PHRST) at the London School of Hygiene & Tropical Medicine (LSHTM), I had the chance to work with a consortium of public health institutions in Africa including the Africa Centre for Disease Control (Africa CDC), World Health Organization African Region (WHO AFRO) and WHO Regional Office for the Eastern Mediterranean (WHO EMRO), Western African Health Organization (WAHO), and The East, Central and Southern Africa Health Community (ECSA-HC) on the Strengthening Public Mental Health in Africa in Response to Covid-19 (SPACE) programme to help integrate MHPSS into African countries’ emergency responses. We explored the extent to which MHPSS was included in the national response to the COVID-19 pandemic in African countries, and what the barriers and enablers are to MHPSS integration in the COVID-19 response.

Based on our research findings, we recommend five key areas to target for improving mental health integration into the response to public health emergencies:

1. Establish an MHPSS component as a part of future emergency response

During emergencies, mental health is often overlooked, or included as a sub-category under other issues, such as case management. It is crucial to sensitise policymakers to the impact of emergencies on mental health and ensure there is an MHPSS component with allocated resources and funding, alongside physical disease control and prevention efforts.

2. Build the capacity of emergency responders

During the pandemic, millions of people developed mental health conditions, some of whom had to be admitted to COVID-19 wards for further treatment. It is essential to train frontline workers during emergencies on basic MHPSS interventions and self-care practices, to help them realise how and when help is needed.

3. Increase community engagement to reduce mental health stigma

By increasing public understanding of the impact of crises on their mental health, and engaging with communities and people with lived experiences, their needs can be addressed whilst also tackling the stigma around mental health.

4. Sustain the collaboration and networking between different stakeholders

COVID-19 offered a unique opportunity to create collaborations between different sectors, and this should be carried beyond the pandemic. Regional networks between different countries and stakeholders and learning platforms could be used to share experiences between stakeholders facing similar challenges, as well as solutions.

5. Draw from lessons learned in previous public health crises

Despite lessons learned from previous emergencies with high reported mental health impacts, like the West Africa Ebola outbreak, MHPSS has not been given the attention that is commensurate with its burden. We must take advantage from our experiences, extract lessons and build on what has been initiated during COVID-19 to put emphasis on integrating mental health into our global response to crises.

We believe that by taking on these recommendations and bringing mental health to an equal standing with physical health, African countries can learn from one another and set a precedent for the rest of the world to follow. It needs to be a global effort from policymakers and stakeholders across the world to learn the lessons of COVID-19 and consider mental health when responding to any future threats to public health.

***The UK Public Health Rapid Support Team is funded by UK aid from the Department of Health and Social Care and is jointly run by UK Health Security Agency and the London School of Hygiene & Tropical Medicine. The views expressed in this publication are those of the author and not necessarily those of the Department of Health and Social Care.

***In the UK, Samaritans can be contacted 24 hours a day, 365 days a year on 116 123 or by email at jo@samaritans.org. You can also get support from Young Minds