Health emergencies as an opportunity to strengthen mental health systems

Abstract

The mental health impacts of the COVID-19 pandemic are undeniable. In addition to record-high cases, hospitalisations, and deaths, the pandemic has given rise to increased rates of mental illness and an unprecedented demand for mental health services worldwide. Across the Western Pacific region, the number of people calling mental health helplines during the pandemic has increased four-fold in low-income countries such as the Philippines. High-income countries such as Australia have not been spared. By October, 2021, Lifeline Australia reported record-breaking daily call volumes, reflecting a 40% increase compared with pre-pandemic levels. These results highlight the importance of mental health support for emergency preparedness, response, and recovery. Provision of mental health support to aid community and economic recovery is often lacking in emergency preparedness plans, such as the APSED III and APEC DRRAP. This shortcoming is despite the fact that nearly all individuals affected by health emergencies will experience some form of psychological distress. This distress might include common reactions such as sadness, anxiety, irritability, anger, and hopelessness. For most people, these feelings will naturally subside with time. But for others, they could persist and develop into clinically significant symptoms of anxiety and depression. WHO estimates that more than 100 million people are living with mental illness in the Western Pacific region. Australasia has one of the highest burdens of mental illness, including increased rates of suicide in the Pacific Islands. People with a mental illness, women, young people, and health-care workers can be particularly susceptible to psychological distress during health emergencies because of existing health and socioeconomic inequalities and increased demand for health services. The most recent WHO meeting on the future of mental health in the Western Pacific highlighted the increasing burden of mental illness in the region and the essential need to integrate mental health support into COVID-19 response and recovery plans. The strategic direction proposed to inform future mental health agendas championed mental health in everyday life through a societal shift from mental illness to mental well-being. Encouragingly, evidence of mental health system strengthening in response to the COVID-19 pandemic can be seen in some parts of the region. For example, online mental health resources have been developed and delivered through popular messaging and social media platforms in China. The Australian Government invested AU$2·3 billion in the National Mental Health and Suicide Prevention Plan, the nation's largest ever investment in mental health. Although much remains to be done, mental health system strengthening is possible if we draw the right lessons from health emergencies such as the COVID-19 pandemic. We need action at all levels to promote mental well-being. Together, we need to intensify efforts to make mental health a high priority in development assistance. To achieve this, we need to develop quality mental health metrics through intersectoral collaboration. We need to identify common challenges and goals beyond health, as well as mutual benefits to further promote engagement between sectors. We need to engage community leaders at the outset, which provides a means to address knowledge and attitudes toward mental health to tailor health promotion initiatives, including emergency response and recovery strategies. Early identification of groups susceptible to psychological distress during health emergencies and improving accessibility to mental health services for these groups ensure equitable and efficient use of services. At the individual level, accepting mental well-being as part of everyday life (eg, education about self-care practices) is central to promoting, protecting, and restoring mental health. In this light, the WHO definition of mental health “as more than just the absence of mental disorders; it is a state of well-being in which an individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and is able to make a contribution to his or her community” is truly achievable.