COVID-19 - Sounding the alarm again that mental health intervention is an indispensable health service

Mental wellbeing has always been an integral part of human health.
Over 84,000 people in China have fallen sick with COVID-19 since the outbreak began, and countless more have suffered from the mental health effects resulting from the epidemic. Over one third of people had experienced psychological distress by mid-February, according to a nation-wide survey conducted.
Some groups of people were affected more than others, including women, people aged between 18 and 30 years and over 60 years, people with higher education, migrant workers, and people living in the middle region of China.^[1]

Health authorities have been responding to the need for mental health support and services since early February to ensure the wellbeing of people suffering mental disorders during the epidemic, and to provide mental counselling services to patients, their families and the broad community including through APPs, hotlines and website, and through public education activities.^{[2],[3],[4],[5],[6],[7]} As part of these efforts, national mental health experts were dispatched to Wuhan to help boost the local mental health system.

The following message is from Dr Ma Hong, Physician from the 6^th Hospital affiliated to Peking University, who worked in Wuhan with local colleagues for 35 days to establish a mechanism of mental health service in response to COVID-19.

But mental health issues aren’t limited only to people experiencing unexpected disasters, such as the one facing us right now.

 In fact, one in four people among us will have to deal with mental health issues sometime during their life. This means that even if you are not experiencing it yourself, there will be someone you know who is currently faced with this challenge. According to the WHO, more than 80% of people experiencing mental health conditions are without any form of affordable, quality mental health care. If left untreated, the loss of productivity caused by depression and anxiety will cost the world $ 1 trillion a year, equivalent to more than $ 130 per person per year. In China, depression-related absences, medical expenses, and funeral expenses are estimated to cost China $7.8 billion annually.^[8]

In order to tackle this challenge, we need to prioritize the accessibility and affordability of mental health services.

Based on the WHO Mental Health Action Plan 2013-2020, WHO launched the WHO Special Initiative for Mental Health 2019-2023: Universal Health Coverage for Mental Health. The core goal is that by 2023, 100 million more people in the world will be able to access affordable, quality mental health service at community level. One of the key actions is to scale up interventions and services across community-based, general health and specialist settings.^[9]

Specific requirements include:

1.     Affordable, quality mental health care scaled up across health and social services

2.     Affordable, quality mental health care integrated in relevant programmes (e.g. for HIV, gender-based violence, disabilities)

3.     Mental health and psychosocial support included for preparedness, response and recovery in emergencies

4.     Priority interventions for groups in positions of vulnerability (e.g. women, children, youth, older people, staff) are developed and implemented.^[10]

Meanwhile, mental health promotion involves actions that improve psychological well-being.  This may involve creating an environment that supports mental health. National mental health policies should be concerned both with mental disorders and with broader issues that promote mental health. Mental health promotion should be mainstreamed into governmental and nongovernmental policies and programmes. In addition to the health sector, it is essential to involve the education, labour, justice, transport, environment, housing, and welfare sectors.^[11]

 As the epidemic in China gets under control, it is time for us to reflect and identify the lessons learnt and the opportunities for improvements. This epidemic opens a window for us to realize that mental distress can happen to anybody. It is time for us to reshape our support systems to ensure all who suffer from mental disorders will be cared for.