A survey of 130 countries has provided the first global data showing the devastating impact of Covid-19 on access to mental health services, underscoring the urgent need for increased funding. The survey was published ahead of WHO’s Big Event for Mental Health, a global online advocacy event held on 10 October that brought together world leaders, celebrities and advocates calling for increased investment in mental health in the wake of the pandemic. WHO has previously highlighted the chronic underfunding of mental health services: prior to the pandemic, countries were spending on average less than 2% of their national health budget on mental health and, as a result, were struggling to meet their populations’ needs. What’s more, Covid-19 is further increasing the demand for these services. Bereavement, isolation, loss of income and fear are triggering mental health conditions or exacerbating existing ones. Many people may be facing heightened levels of alcohol and drug use, insomnia and anxiety. Meanwhile, the virus itself can lead to neurological and mental complications, such as delirium, agitation and stroke. People with pre-existing mental, neurological or substance use disorders are also more vulnerable to Covid-19 and they may stand a higher risk of complications or even death.
“Good mental health is absolutely fundamental to overall health and well-being,” said Tedros Adhanom Ghebreyesus, director-general of WHO. “Covid-19 has interrupted essential mental health services around the world just when they’re needed most. World leaders must move fast and decisively to invest more in lifesaving mental health programmes – during the pandemic and beyond.”
The WHO survey was conducted from June to August 2020 in 130 countries across six regions. It evaluates how the provision of mental, neurological and substance use services have changed due to the pandemic, the types of services that have been disrupted and how countries are adapting to overcome these challenges. Countries reported widespread disruption in many kinds of critical mental health services. Some of the findings included:
- Over 60% reported disruptions to mental health services for vulnerable people, including children and adolescents (72%), older adults (70%) and women requiring antenatal or postnatal services (61%).
- 67% saw disruptions to counselling and psychotherapy; 65% to critical harm reduction services; and 45% to opioid agonist maintenance treatment for opioid dependence.
- More than one-third (35%) reported disruptions to emergency interventions, including those for people experiencing prolonged seizures; severe substance use withdrawal syndromes; and delirium, often a sign of a serious underlying medical condition.
- 30% reported disruptions to access for medication for mental, neurological and substance use disorders.
- Around three-quarters reported at least partial disruptions to school and workplace mental health services (78% and 75%, respectively).
While many countries (70%) have adopted telemedicine or teletherapy to overcome disruptions to in-person services, there are significant disparities in the uptake of these interventions. More than 80% of high-income countries surveyed reported deploying telemedicine and teletherapy to bridge gaps in mental health services, compared with less than 50% of low-income countries. WHO has issued guidance to countries on how to maintain essential services, including mental health services, during Covid-19. It recommends that countries allocate resources to mental health as an integral component of their response and recovery plans. The organisation also urges countries to monitor changes and disruptions in services so that they can address them as required.
Although 89% of countries reported that mental health and psychosocial support is part of their national Covid-19 response plans, only 17% of these countries have full additional funding for covering these activities. This all highlights the need for more money for mental health services. As the pandemic continues, even greater pressure will be placed on national and international mental health programmes that have suffered from years of chronic underfunding. Spending 2% of national health budgets on mental health is not enough. International funders also need to do more: mental health still receives less than 1% of international aid earmarked for health.
Social media campaign
Those that do invest in mental health will reap the rewards. Pre-Covid-19 estimates reveal that nearly $1trn in economic productivity is lost annually from depression and anxiety alone. However, studies show that every $1 spent on evidence-based care for depression and anxiety returns $5. To mark World Mental Health Day on 10 October, WHO, in collaboration with United for Global Mental Health and the World Federation for Mental Health, encouraged people from all countries to support a global movement calling for greater investment in mental health.
The #MoveforMentalHealth challenge asked people around the world to post videos showing what they do to support their mental well-being – whether it be dancing, walking, doing yoga, cooking, painting or something else entirely – on their favourite social media platforms.
Social media platforms such as TikTok, Facebook and Instagram are supporting the #MoveforMentalHealth challenge and helping kickstart broader conversations about mental health and the importance of investment.
Messenger apps are providing support too. On World Mental Health Day, WHO launched an online stress management guide on the WhatsApp chat platform. Based on its stress management guide, ‘Doing what matters in times of stress’, the digital resource includes short, easy-to-follow guided exercises. In addition, Facebook Messenger will be launching a new sticker pack designed with the support of WHO to facilitate conversations around mental health.
“As we continue to live through a global pandemic, we need movement on mental health, perhaps more than we have ever needed it before,” Tedros said. “We need to move for our own mental health, the mental health of our families, friends and colleagues, and more importantly, so that there is a massive increase in investment for mental health services at national and international levels.”
Widespread impact
The magnitude of the mental health burden faced around the world is not being matched by the investment it requires. The extraordinary increase in demand for mental health services, exacerbated by the added challenges of Covid-19, is taking its toll on already overburdened and under-resourced services.
“Our world wasn’t set up to respond to the growing mental health needs before Covid-19, and it certainly isn’t now,” said Elisha London, CEO and founder of United for Global Mental Health, in a press release that accompanied the event. “That’s why now more than ever we need the world to move for mental health, and as individuals, communities, businesses, governments and funders, we must prioritise action on and investment in mental health.”
Close to a billion people globally have a mental health disorder, and those with severe mental disorders tend to die ten to 20 years earlier than the general population. Suicide is claiming the lives of close to 800,000 people every year – one person every 40 seconds – and is the second leading cause of death for young people aged 15–29 years. Relatively few people around the world have access to quality mental health services, especially in low and middle income countries where 75% of people with mental, neurological and substance use disorders receive no treatment for their condition at all.
“Mental health is affected by many factors and circumstances,” said Dr Ingrid Daniels, president of the World Federation for Mental Health. “It touches on everything – poverty, equality and development – which is why we need to ensure greater investment and greater access to mental health services for all.”
For the next generation
Meanwhile, new guidelines from WHO recommend a set of psychosocial interventions to promote mental health and prevent mental health conditions among adolescents between the ages of ten and 19.
The recommendations are based on the results of intervention studies – both universal, delivered to all adolescents and for selected individuals perceived to be at risk of mental health conditions. These studies will help inform the development of policies and programmes to improve young people’s mental health services. Particular attention is given to adolescents at increased risk of mental disorders or self-harm due to exposure to adversity, young people going through challenging life circumstances such as pregnancy, and those with early signs or symptoms of emotional or behavioural problems.
The interventions recommended can be delivered in school and community settings and through digital platforms. Mental health is a major issue for adolescents: up to half of all mental health conditions start before the age of 14. Poor mental health is the leading cause of disability in young people, and accounts for a large proportion of the global disease burden during adolescence. Suicide is the third leading cause of death in 15–19-year-olds. Poor mental health in adolescence is one of a number of factors influencing risk-taking behaviour, including self-harm, the use of tobacco, alcohol and drugs, risky sexual behaviours and exposure to violence. Their effects are persistent and can have serious implications throughout life.
Young people are facing increasingly complex social, cultural and economic environments, with challenges resulting from changing family environments, employment instability and unemployment in their households, and in some countries, forced displacement. Some groups are more at risk than others. Young people from minority and migrant communities are disproportionately affected by mental health conditions, while adolescent girls are twice as likely as adolescent boys to be affected by common mental disorders. Sociocultural factors, such as lower education levels, poverty, exposure to domestic violence and abuse, and low decision-making power, tend to increase the risk of depression in girls and women. WHO and Unicef are developing a toolkit to facilitate the implementation of the new mental health guidelines. The kit will include strategies for both supportive policies and laws, and the implementation of interventions in different settings.
60%
Reported disruptions to the mental health services for vulnerable people across 130 countries, between June and August this year.
30%
Reported disruptions to access of medication for mental, neurological and substance use disorders.
WHO
$1trn
Pre-Covid estimate of how much economic productivity is lost annually from depression and anxiety alone.
World Mental Health Day
75%
People in low and middle-income countries with mental, neurological and substance use disorders that receive no treatment for their condition at all.
WHO
