Committee on Environment, Public Health and Food Safety

“(Mental) health crisis: according to the WHO, the COVID-19 pandemic has disrupted or halted critical mental health services in 93% of countries worldwide. How can the EU ensure the continued provision of mental health services to its citizens despite the ongoing battle against the virus?”

By Júlia Aguilera (ES)

Relevance of the topic

The COVID-19 pandemic has affected societies, economies but especially individuals in each and every aspect. Beyond the obvious health impact on those who have contracted COVID-19 throughout these past months, the personal well-being and mental health ¹ of the entire European population has also been affected negatively. At the same time it has also created new barriers for people already suffering from mental illness and substance use disorders. 

Despite having clear evidence of the consequences the virus has had and is having on citizens, the World Health Organization (WHO) recently published the results of a  survey showing that out of 130 countries, 93% suffered from disruptions in mental health services during the pandemic. Furthermore, the WHO has previously highlighted the chronic underfunding of mental health;  prior to the pandemic, countries were spending less than two percent of their national health budgets on mental health. Therefore they have not been able to meet their populations’ needs.

The pandemic is increasing demand for mental health services even further. Bereavement, isolation, loss of income and fear are triggering mental health conditions or exacerbating existing ones. Many people may be facing increased levels of alcohol and drug use, insomnia, and anxiety. Meanwhile, COVID-19 itself can lead to neurological and mental complications, such as delirium, agitation, and strokes. At the same time, people with pre-existing mental, neurological or substance use disorders are also more vulnerable to a COVID-19 infection  ̶  they may stand a higher risk of severe outcomes or even death. 
As Dr. Tedros Adhanom Ghebreyesus, Director-General of the WHO, states: “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 life-saving mental health programmes  ̶  during the pandemic and beyond.”

Key actors

The World Health Organization (WHO) is an organisation that works worldwide to promote health, keep the world safe, and serve the vulnerable. Since the virus struck the world, the WHO has urged countries to allocate resources to mental health as an integral component of their response and recovery plans.
The European Commission is an EU institution that has the competence to suggest policies on how to tackle mental health during a pandemic. Until now it has only presented the JRC study acknowledging the impact that the pandemic has had on the mental health of individuals.  
The European Union has a shared competence with Member States when it comes to public health. Member States are responsible for deciding upon the health services they want to offer to their citizens, in response to the needs of their populations.
The United Nations (UN) is an international intergovernmental organisation which promotes international peace, security and cooperation. It has mediated in the cooperation of countries to fight against the pandemic and has presented online guidelines for those in need of mental health support related to COVID-19. 
Mental Health Europe (MHE) is a European non-governmental network organisation committed to – among other things – the promotion of positive mental health and advocacy for social inclusion and the protection of the rights of (ex)users of mental health services, persons with psychosocial disabilities, their families and carers. MHE works closely with European Institutions and international bodies to mainstream mental health in all policies and end mental health stigma. Together with its members, MHE formulates recommendations for policy makers to develop mental health-friendly policies.

Key conflicts

Prior to COVID-19, the world was not equipped to respond to the mental health needs of citizens. Mental health was not a political priority and was chronically underfunded in most countries, ignoring the fact that mental health conditions account for 13% of the global burden of disease. According to the WHO, before the virus there were an estimated 264 million people with anxiety, and 322 million with depression worldwide. In addition, there are nearly 800,000 suicides per year globally, and suicide is the second leading cause of death in young people aged 15-29. Due to the pandemic, these figures have increased considerably. 
There is a growing body of evidence of the effect that public health emergencies such as COVID-19 have had on the health, safety, and well-being of  individuals, causing, for example, insecurity, confusion, emotional isolation, and stigma. At the same time, it may also have an impact on communities, owing to economic loss, work and school closures, inadequate resources for medical response, and deficient distribution of necessities. These effects tend to  translate into a range of emotional reactions (such as distress or psychiatric conditions), unhealthy behaviors (such as excessive substance use), and noncompliance with public health directives (such as home confinement and vaccination) in people who contract the virus and also in the general population.
COVID-19 has had a particularly detrimental impact on the mental health of certain groups; for instance, frontline workers. They are vulnerable to increased stress, burn-out, depression, and post-traumatic stress disorder (PTSD). This impacts the individual but also the collective response to COVID-19 due to the incapacity or reduced capacity of the frontline workers affected. As reported recently in the British Medical Journal, in the context of comparison between Ebola and COVID-19: “Burnout is associated with a suite of negative outcomes in addition to workforce departure: provider depression; reduced quality of patient care; interpersonal conflict, among others. In the midst of a pandemic, we simply cannot afford this”.
COVID-19 patients have also suffered from this mental health impact. They have been very affected by the fear, anxiety and uncertainty about their condition, as well as the physical discomfort and separation from loved ones. A study among hospitalised patients in China showed that 35% of patients had symptoms of anxiety and 28% of depression. At the same time, women are under particular stress during the pandemic as carers of the sick, principle bearers of the burden of childcare, and as people continuing to hold down jobs. In addition, isolation and lockdown have also resulted in increases in violence against women, with estimates that globally, “31 million additional cases of gender-based violence can be expected to occur if lockdown continues for at least six months”. It is imperative that Member States’ governments learn from the impact that pandemic measures have had on citizens’ mental health and strive to leave no one behind as the crisis continues.

Despite acknowledging the many mental health conditions prior to the pandemic and at the same time the impact of COVID-19 on individuals’ mental health, the results of the WHO’s survey show that most countries paused mental health services at the outbreak of the virus. In most Member States’ health systems, only urgent visits and inpatient treatments for severe cases are provided, and, where possible, online treatments (instead of face‐to‐face ones) have been recommended.  Over 60% of the countries in the world 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%).

Measures in place

On the 13th May 2020 the UN released a policy brief on the need for action on mental health as well as a set of guidelines. In this document it highlighted the fact that the mental health and wellbeing of whole societies have been severely impacted by the pandemic and are a priority to be addressed urgently.
On the 1st June of 2020 the WHO issued a guide for 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 WHO also urges countries to monitor changes and disruptions in services so that they can address them as required. They also hosted The Big Event for Mental Health on October 10th which highlighted the need for increased investments in mental health in the wake of COVID-19.
At the same time, initiatives such as The Help Hub in the United Kingdom have adopted telemedicine or teletherapy to overcome disruptions to in-person services due to the virus. Other non-governmental organisations (NGOs) such as Mental Health Europe have provided online services and helplines to support European citizens who are suffering mentally during COVID-19. 
Lastly, the Inter-Agency Standing Committee has developed a guide of basic psychosocial skills for COVID-19 responders, a group very affected by the mental health services disruption, to help them deal both with their own mental health conditions during the pandemic and the people who interact with them. COVID-19 responders include health professionals, first responders, food suppliers, pharmacists, funeral workers and managers of volunteers.

What now?

– To what extent is telemedicine or teletherapy sufficiently developed to provide mental health patients with their needed treatments?
– How should the WHO ensure widespread availability of accessible emergency mental health and psychosocial support?
– After having lived through months of the pandemic, how can we use the knowledge and experience gathered to change and adapt measures to avoid such negative impacts on citizens’ mental health as the pandemic continues?

Links for further research:

Mental health services disrupted due to COVID-19 – WHO
The intersection of COVID-19 and mental health – The Lancet
The impact of the pandemic on suicide rates – QJM: An International Journal of Medicine
The global COVID-19 financial response is leaving mental health behind – United for Global Mental Health

1. Mental health conditions include mental, neurological and substance use (MNS) disorders, suicide risk and associated psychosocial, cognitive and intellectual disabilities