Dr Devora Kestel Director of the Department of Mental Health and Substance Use, WHO, stresses the importance of government programmes to reduce the burden

The scale of the impact of COVID-19 on the mental health and well-being of people across the globe is only now becoming apparent. There has been a particularly heavy burden placed on children, adolescents and young people, including disrupted education, uncertainty about the future and limited economic opportunities. These are unfortunate truths that are impacting young people during critical times of development.

The WHO has been actively responding to the pandemic and urging governments to scale up actions to address the mental health needs of young people who are suffering from stress, isolation and anxiety. This is particularly critical because of the fact that many mental health conditions develop early in life, with nearly half of all disorders beginning by age 14, a statistic that may increase during and after a large-scale emergency.

“We know that in any humanitarian situation, the number of people with mental health issues increases,” says Dr Devora KestelDirector of the Department of Mental Health and Substance Use, WHO.  “These trends are confirming what we thought would happen.”

We know that 1.58 billion learners (more than 90 percent  of the world’s student population) have been affected by national closures.  Around 40 per cent of young people have reported psychological problems during the pandemic and, as a result of the uncertainty, there are high levels of hopelessness, which is a hallmark of depression.

The Big Event for Mental Health

The WHO hosted the first global online advocacy event for mental health – The Big Event for Mental Health– on October 10, World Mental Health Day. World leaders, mental health experts and celebrity guests joined WHO Director-General, Dr Tedros Adhanom Ghebreyesus, to discuss the ways we can improve our own mental health and ensure that quality mental health care is available to everyone who needs it.

Host award-winning journalist, Femi Oke, was joined by mental health advocates and performers including Cynthia Germanotta, President and Co-Founder (with her daughter Lady Gaga) of Born This Way Foundation and WHO Goodwill Ambassador for Mental Health;  Alisson Becker, goalkeeper for Liverpool Football Club and the Brazilian National Football Team and WHO Goodwill Ambassador for Health Promotion; Natália Loewe Becker, medical doctor and WHO Goodwill Ambassador for Health Promotion; Korede Bello, founder of the Korede Bello Foundation, mental health advocate, and singer and songwriter from Nigeria; and Klas Bergling, father of DJ, musician and producer Tim Bergling, aka Avicii, and Co-founder of the Tim Bergling Foundation.

HM Queen Mathilde of the Belgians; Ibrahim Mohamed Solih,President of Republic of Maldives; Epsy Campbell Barr, First Vice-President of Costa Rica; António Guterres, United Nations Secretary-General were also present, among others.

Anxiety around COVID-19

Emerging data from across countries indicates that youth, along with women, experienced the highest toll on their mental health during COVID pandemic, with many of them reporting emotional distress in the past months.  School closure, social isolation and limitations in opportunities to interact, family stress, and loss of lives had huge repercussions on young people, their families and peers.  Widespread misinformation about the virus and prevention measures and deep uncertainty about the future are additional major sources of distress. Coupled with concern about the economic impact too, the WHO is expecting high rates of mental health needs in adolescents and youth if their mental health needs are not met.

This pandemic has put the young people at an increased risk of suicide, substance use and other mental health risks. According to a recent survey by the Centers for Disease Control and Prevention, in the 30 days prior to the survey, 25.5 per cent of 18-24 year old had seriously considered suicide, while 24.7 per cent were using substances to cope with pandemic induced stress or emotions. For those with existing mental health conditions, at least 40 per cent said it had made their condition worse. The likelihood of poor mental health is higher if families have experienced a deterioration of their finances during lockdown or expected one in the next 3 months.

Data shows that young people suffer more from economic downturns. They are not yet established in work and possibly have fewer transferable skills than others. This economic marginalisation and the inability to realise career ambitions also predisposes them to further mental ill-health. “This highlights that the response of government, civil society and communities to COVID-19 must include a focus on the mental health of all, but particularly young people,” says Devora.

Treating mental health conditions

Unsurprisingly, the pandemic has placed mental health issues further down the priority list.  Yet governments are aware of the great strains placed on young people by the situation, so the WHO is urging ministers to focus their efforts on today’s youth.

“It’s hard for governments to invest in suicide prevention, yet suicide is the second leading cause of death in between 14 and 29s worldwide,” says Devora.  “One in five children and adolescents has a mental health disorder, and people with severe mental health disorders tend to die 10-20 years earlier than others.”

According to the WHO, on average, countries spend less than 2 per cent of their national health budgets on mental health.  Despite an increase of development assistance for mental health in recent years, it has never exceeded 1 per cent of development assistance for health.

Yet some of the most common mental health conditions, depression and anxiety, can be treated with talking therapies, medication, or a combination of these. The quality of life of people living with conditions such as autism and dementia can be greatly improved when their caregivers receive appropriate training. General health workers can be trained to diagnose and treat mental health conditions, while regular health checks of people with severe mental disorders can prevent premature death.

“If I cut my finger on paper, I won’t go to the best surgeon in town,” Devora comments. “Similarly with mental health issues, many are resolved with talking therapies and can be managed effectively in this way.  There is the famous example of the Friendship Bench in Zimbabwe where grandmothers were given evidence-based cognitive therapy training to provide support in the community.”

In her opinion, mental health training should be mandatory in medical schools.  “There is no reason why a gynaecologist cannot support a mother who is suffering with a mental health condition around pregnancy and childbirth,” she says.  “Or why a nurse cannot offer support if she sees the need.  It’s question of placing mental health in the right place holistically for the patient.”

The economic impact

In the table of the global economic burden of noncommunicable diseases, mental health issues lie at the top and account for 35 per cent, higher than cardiovascular diseases, cancer and diabetes.

In the youth of today, the earners of tomorrow are clearly affected by reduced learning capacity, future work disability and loss of earnings, reduced productivity and time off work. Carer and health sector costs along with social welfare and disability costs rise as a result, while suicide is a tragic and potentially avoidable consequence. Young people with mental health conditions are also more likely to have contact with the criminal justice system.

For every US dollar invested in scaled-up treatment for depression and anxiety, there is a return of US$ 5, according to WHO figures. For every US$ 1 invested in evidence-based treatment for drug dependence, there is a return of up to US$ 7 in reduced crime and criminal justice costs.

The rights of people living with mental health conditions can be protected and promoted through mental health legislation, policy, development of affordable, quality community-based mental health services and the involvement of people with lived experience.

The WHO has launched new guidelines on the promotion of mental health initiatives, including interventions for adolescents. In collaboration with other agencies, they have also produced a book that explains COVID-19 to younger children with the aid of a fantasy figure Ario. “My Hero is You, How kids can fight COVID-19!” explains how children can protect themselves, their families and friends from coronavirus and how to manage difficult emotions when confronted with a new and rapidly changing reality.  There are over 126 language versions available, making it one of the most translated books in world history!

“There is a still a lot of stigma and ignorance about mental health conditions,” Devora says.  “Here at WHO we are determined to overcome this and to get people talking across the world about mental health.”

https://www.who.int/campaigns/world-mental-health-day/world-mental-health-day-2020

INTERVIEW BY  SARAH CARTLEDGE, Publications Director, Public Policy Projects