The theme for World Mental Health Day 2021, “Mental health care for all: let’s make it happen”, is adapted to the era of COVID-19. The pandemic has not only disrupted and changed our lives, but has also exposed social and economic inequalities that have contributed to the spread of the virus to a large extent. Such inequalities are also at the heart of the underlying health problems that correlate with excess deaths in countries.
In addition to the risk of becoming infected with the coronavirus, vulnerable populations such as unemployed adults, young people, the elderly and frontline healthcare workers have experienced an increased risk of symptoms and mental health disorders. To help address this issue, as part of the World Bank Group support to more than 100 developing countries to respond to COVID-19, health projects include funding for psychosocial interventions to help people cope. the impact of stressors such as lockdowns, self-isolation and quarantines, fears of infection, inadequate information, job and financial loss, as well as stigma and discrimination.
In addition to continued support to health systems, government adoption of sustained policies and funding allocations to achieve universal health coverage and high-quality primary care that can provide protection and prevent disease is essential. . The continued unmet need for care of people with mental disorders and substance abuse, as well as the stigma and discrimination experienced by those affected and their families, deserve special attention.
Three priorities must be taken into account to develop quality mental health services at all levels:
- Achieve parity in mental health in health coverage
Although the global burden of disease attributable to mental disorders has increased steadily since the 1990s, they continue to be treated quite differently from physical health problems.Likewise, the lack or limited coverage of available services is common in countries with public health systems. The enactment of legal mandates and regulations can help overcome these obstacles, as has been done in Colombia, Chile, Ghana and the United States.
Other related issues that merit careful consideration include: (i) determining which conditions to prioritize (eg common mental illnesses such as depression and anxiety disorders, addictions or severe conditions such as schizophrenia); (ii) the selection of treatments at different levels of care; (iii) mechanisms to expand equitable access to drugs; (iv) how to finance and reimburse services, reducing cost barriers and eliminating direct payments; and (v) managing the improvement of the quality of mental health services.
- Integration of service delivery at the community level
Dedicated efforts are needed to integrate mental health and substance abuse treatment into community-level service delivery platforms, away from hospital-centered models of care, to overcome the artificial separation of mental and physical illness from the profession. medical – research has clearly shown that “the brain is intimately linked to the body and the body to the brain”..
In addition to developing benchmarks and assessing service performance, support is needed to improve data collection and monitoring of mental health issues and access to services involving people living with mental illness.
Community mental health care in Norway is a good example of how local community mental health centers, in collaboration with general practitioners and primary mental health care providers in municipalities, and psychiatrists and psychologists working in private practices, have improved service delivery. Mobile teams meeting the child / adolescent and family in their homes are part of community child and youth mental health services, and addiction and addiction services are provided in outpatient clinics as part of mental health services in health trusts; and primary health and social services managed by municipalities.
- Take advantage of new technologies to expand access to services
Digital care options through teletherapy and new applications have seen explosive growth during the pandemic. They offer alternative service delivery models that help overcome barriers that hinder access to care, such as transportation barriers, stigma associated with mental health clinic visits, staff shortages and high costs. . These platforms, especially in mobile formats, can offer remote screening, diagnosis, monitoring and treatment, facilitate distance education for lay healthcare workers, and improve online support and self-care between peers.
Other technological innovations include prescription video games, which challenge children aged 8 to 12 with Attention Deficit Hyperactivity Disorder to focus on multiple tasks simultaneously in the play environment. Or artificial intelligence (AI) chatbots that can help patients practice cognitive behavioral therapy (CBT) to become aware of inaccurate or negative thoughts so that they can clearly see difficult situations and respond to them effectively.
Online symptom tracking apps are also being used to entice patients to share data daily which is analyzed with an AI algorithm to identify patterns and alert providers in real time to any warning signs. Results from a cross-sectional survey suggest that more physical activity and less screen time are associated with better mental health for children during the pandemic, making them a potentially important target for future intervention.
Several initiatives have been launched to address the scarcity or lack of providers needed to reach people in need. The Academy of the World Health Organization aims to provide digital learning to health workers around the world on a range of topics, including mental health; EMPOWER, an initiative of Harvard Medical School, offers digital training to support the delivery of psychosocial interventions; and UNICEF’s Caring for the Caregiver program targets community workers using online and in-person training.
A major overhaul is needed
COVID-19 is forcing a mayor to rethink every facet of our life. Ensuring that people with mental disorders and substance abuse receive the care and support they need requires rethinking the organization and financing of health care along the lines outlined above. The exploitation of new scientific knowledge and new technologies will give new impetus to this task.