COVID Has Caused ‘Mass Trauma,’ Worsening Mental Health Globally World Health Assembly 74 31/05/2021 • Madeleine Hoecklin Share this:Click to share on Twitter (Opens in new window)Click to share on LinkedIn (Opens in new window)Click to share on Facebook (Opens in new window)Click to email this to a friend (Opens in new window)Click to print (Opens in new window) Empty streets in downtown Medellin, Colombia after people were urged to stay home in March 2019. Physical distancing measures to control COVID-19 can lead to greater isolation and the deterioration of mental health. “Mass trauma” from COVID-19 has worsened mental health worldwide, WHO officials said at the 74th World Health Assembly (WHA) on Monday. The long neglected issue received special attention on the Assembly’s closing day, with member states expressing broad support for more action – after a year that saw new mental health issues emerge even while mainstream mental health services were disrupted. “I think [mental health] has been a hugely under-recognized and under-responded-to element of this epidemic, as it is in all health emergencies,” said Dr Mike Ryan, WHO Director of Health Emergencies. “We’ve seen the terrible toll taken on mental health and psychological well-being in communities, among health workers and others,” Ryan said. Public health measures to control COVID-19 have caused isolation and disrupted daily activities. These changes heightened distress in many people, particularly healthcare workers and those with pre-existing mental health conditions, WHO experts and member states agreed. Malaysian Prime Minister Muhyiddin Yassin told delegates at the closing of the 74th WHA: “There is nothing natural about self-isolation and the toll it takes on our global citizens, young and old [with] disruptions to education, work and social norms. It will require us to endure a healing process that will take time.” Tan Sri Muhyiddin Yassin, the Malaysian Prime Minister, at the 74th World Health Assembly on Monday. Speakers noted how the pandemic contributed to various adversities – unemployment, financial instability, missed education, social isolation, domestic violence, fear of a life-threatening disease, and loss of loved ones. All of these put individuals at greater risk of developing short- or long-term mental health disorders. “One day this pandemic will be over – but many of the psychological scars linked to the pandemic will stay with us for a long, long time,” said Dr Tedros Adhanom Ghebreyesus, WHO Director General. “The impact of this pandemic on mental health is very palpable; paying attention to mental health will be very central. Please, let’s give mental health a serious priority,” Tedros urged. Mental Health Action Plan A proposal to extend WHO’s 2013-2020 Mental Health Action Plan for another decade, but including updated indicators and targets, received wide support among member states at the WHA, where they adopted a draft decision endorsing the updated Action Plan. The updated Action Plan will include a greater focus on: suicide prevention, workplace mental health, universal health coverage, mental health of children, mental health across the life course, and the involvement of people with lived experience of mental health conditions. New global targets for 2030 also include: 80% of countries developing or updating their policy for mental health by 2030; Mental health integrated into primary health care services by 80% of countries – and increased mental health service coverage by 50%; 80% of countries with at least two national mental health promotion and prevention programmes; Reducing the rate of suicide by one third; 80% of countries with a system for mental health and psychosocial preparedness for emergencies; Doubling the output on global research on mental health. “It is crucial to prioritize the actions to minimize mental health consequences of the pandemic and incorporate these actions into emergency and disaster risk management strategies,” said Asim Ahmed, Permanent Representative at the Permanent Mission of the Maldives to the UN in Geneva. “We welcome the work done by WHO in the area of mental health resulting in the updated Mental Health Action Plan 2013-2030,” the European Union said in a statement on Friday. “This plan is an essential tool for strengthening mental health and psychosocial support and preparedness at country level, for current and future public health emergencies.” “We support the review of the action plan on mental health 2013-2030 to make sure that it is better integrated and that it provides us with the tools that are necessary to become more resilient at the international level,” said Isabel Padilla de Stenvold, Counsellor at the Permanent Mission of the Dominican Republic to the UN in Geneva. Isabel Padilla de Stenvold, Counsellor at the Permanent Mission of the Dominican Republic to the UN in Geneva Responding to the Mental Health Impacts of COVID-19 In the short term, the WHO Secretariat plans to support countries to strengthen community-based psychosocial services for those experiencing pandemic-related adversity, address the needs of at-risk populations, including health workers, and increase access to affordable care for mental health conditions. The WHO Europe Regional Office has established a technical advisory group to evaluate mental health service development and system strengthening as a component of the COVID-19 recovery. The findings will be used to develop a new European framework for mental health. In addition, the Pan European Mental Health Coalition will be launched in October to “break barriers and advocate for mental health rights,” announced Dr Hans Kluge, WHO Regional Director for Europe. Dr Hans Kluge, WHO Regional Director for Europe. “A silver lining of the crisis is the opportunity to forge a new pathway for mental health promotion and care,” said Kluge. “Now is the chance to drastically transform mental health care. Let’s grasp it.” Rise in Mental Health Symptoms Symptoms of anxiety, post-traumatic stress disorder, depression and psychological distress have been among the most common reported among the general populations of several countries during the pandemic, according to WHO’s report on Mental Health Preparedness and Response published in January. A US-based study published in February found that the proportion of adults who reported symptoms of anxiety or depressive disorder increased from one in ten from January to June 2019 to four in ten in January 2021. Throughout the pandemic, symptoms of anxiety, depression, sleep disruptions, and thoughts of suicide increased for many young adults in the US, according to a survey of 8,943 individuals aged 18-24. A study from late 2020 conducted by European researchers found 50% of respondents across 78 countries had only moderate mental health during the first year of the pandemic, and around 10% had low levels of mental health. Disruptions in Mental Health Services Mental health services were among the health services worst-hit by the pandemic, partly due to lack of mental health funding nationally. According to a WHO survey, 120 out of 130 countries reported significant service disruptions for mental, neurological and substance use disorders in 2020. And while 89% of countries surveyed incorporated mental health and psychosocial support into their COVID-19 response plans, only 17% fully funded these mental health response plans. “COVID-19 exposed the limited investment in mental health preparedness and infrastructure in all countries before the pandemic,” said Dr Ren Minghui, WHO assistant director-general for Universal Health Coverage and Communicable and Noncommunicable Diseases. Dr Ren Minghui, WHO Assistant Director General for Universal Health Coverage and Communicable and Noncommunicable Diseases. WHO responded to service disruption reports by deploying experts in 12 instances to help coordinate psychosocial support in the context of COVID-19. The organization also developed operational guidance on continuing essential services that address mental, neurological, and substance use disorders. A Global Forum on Neurology and COVID-19 is documenting neurological conditions associated with COVID-19 to enhance clinical practices. “We will continue to work with donors and partners to ensure that the WHO technical capacity, particularly in the regional and country levels, could be strengthened in order to better provide technical support to the member states [and to assist in] integrating evidence based primary and community mental health services and psychosocial support in COVID-19 responses,” Ren said. Image Credits: Flickr: Nicola, Diego Zapata , WHO. 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