‘One Size Does Not Fit All’: Cross Country Overview of the Mental Health Response to COVID-19

While the COVID-19 pandemic is a physical health crisis, to begin with, it has the potential to become a major mental health crisis. Countries are encouraged to respond with immediate action through the inclusion of mental health policies in their COVID-19 health recovery plans. There is no doubt that good mental health is essential on an individual level, but it is just as important for the entire society to recoup the damages, resulting from this pandemic. Mental distress amidst COVID-19 stems from a wide range of uncertainties. The fear of getting infected by the virus, the fear of infecting others around, physical isolation, social distancing - all culminate and lead to varying types and degrees of psychological issues. Also besides the unpredictability of the job market, economic losses, change in lifestyle, misinformation and the prolonged nature of the virus tends to severely affect people’s mental wellbeing. The United Nations has urged countries to prioritize mental health in these difficult times and has encouraged governments to adopt a whole-of-society approach to promote and protect mental health along with ensuring widespread availability of emergency mental health and psychosocial support services.

The following country case studies highlight the mental health policy response in four countries around the world. One country from each income group was selected by random and these country categories by income groups (high, upper-middle, lower-middle, low) are according to the world bank classification. The income classification is based on Gross National Income (GNI) per capita which is the measure of national income per person. Afghanistan: Low-Income Country

Afghanistan has included mental health service provision in its national response plan to the COVID-19 pandemic. The country currently provides distant counselling services through telephone helplines and online web portals. The helpline services are equipped to provide information on COVID-19 in terms of physical and mental health impact. They offer advice on managing stress related to the pandemic as well as psychosocial support for those with more severe mental health issues. The online web portal is limited to individuals with a stable internet connection who are able to access counselling services and long-term support. Nevertheless, Afghanistan is developing content and material for widespread awareness programs centred around self-care for mental health. They are preparing content on mental health management, targeting specific populations groups, such as frontline healthcare workers, children and the elderly. India: Lower-Middle Income Country

The National Institute of Mental Health and Neurosciences (NIMHANS) has been coordinating closely with the Ministry of Health and Family Welfare, to support the mental health service delivery within the wider health response to COVID-19, in the country. NIMHANS has set up an emergency Mental Health task force to aid in the development and implementation of several interventions. They have set up national helplines, strengthened telemedicine facilities, and established a continuum of care service for patients with pre-existing mental health conditions. The NIMHANS Digital Academy has stepped up their services by implementing training facilities for doctors, counsellors, nurses and other health professionals to provide psychosocial support during the COVID-19 crisis. The department of psychiatry has developed tailored guidelines for the management of mental health in general medical and specialized medical settings. These tools will be used to support and advise the general public to look after their mental health, but will also focus on patients suffering from pre-existing mental illness. China: Upper-Middle Income Country

In China, the public sector, academia and the third sector collaborate to facilitate nationwide mental health interventions. China has released a 24/7 telephone hotline, text-message support services, app-based interventions, webinars, and psychoeducation materials. According to the National Health Commission mandate, the government has prioritized mental health support during COVID-19. Academic institutions in psychology and psychiatry, develop evidence-based guidelines and train professionals for psychosocial support. There has also been an urgent nationwide call for college counsellors to volunteer on hotline services at the epicentre of the outbreak in Wuhan. Hospitals, government organizations and academic institutions have been working closely to administer mental health services at the point of care during and post COVID-19 treatment. Resources have also been mobilized from other regions of China to Wuhan, narrowing any treatment and support gap in mental health. The Ministry of Education and the Chinese Society of Psychiatry recruited several professionals from across the country to subsequently train frontline mental health volunteers. The COVID-19 response and recovery plan in China were strengthened by task-sharing, pooling of professionals, supervising and training volunteers and finally using artificial intelligence and telemedicine to combat resource limitations (Miu, 2020). New Zealand: High-Income Country

New Zealand has recently designed a recovery framework to address the mental health challenges arising from the COVID-19 pandemic. Their focus lies in prevention and early intervention to improve mental well-being. The interventions are a combination of mental health and social policies to deal with the problem in a multi-dimensional manner. Therefore, the plan begins with grassroots level interventions addressing the fundamental problem by ensuring delivery of accurate information, basic needs and community connection. These social policies are supplemented with improved delivery of specialist mental health and addiction services. The framework is also designed to allow for transparent and effective coordination among national, regional and local parties. There is a strong focus on community-led solutions along with attention to self-care and individual responsibility towards self-management of mental wellbeing. The plan was established for implementation over the next 12-18 months with scope for amendments as required. The ultimate government priority through the recovery framework is aimed at giving every New Zealander the access to high-quality essential services, a healthy home environment and a safe community living. The details of New Zealand’s COVID-19 Psychosocial and Mental Wellbeing Recovery Framework are highlighted in the image besides (New Zealand Ministry of Health, 2020). Summary of the Mental Health Response Discussed Above

As seen in the country case studies above, mental health centred solutions are critical for the functioning of every society - now, more than ever before. It is important that policy makers prioritize and integrate mental health in their existing COVID-19 response plans to ensure long-term recovery and better overall health outcomes for the population. Shreya Agoramurthy

Young Leaders for Health

References: Department of Psychiatry, NIMHANS, 2020. Mental Health In The Times Of COVID-19 Pandemic Guidance For General Medical And Specialised Mental Health Care Settings. Bengaluru, India: National Institute of Mental Health & Neurosciences. Available at: https://www.mohfw.gov.in/pdf/COVID19Final2020ForOnline9July2020.pdf [Accessed 16 July 2020].

Emro.who.int. 2020. WHO EMRO | Afghanistan: Mental Health And Psychosocial Support During #COVID19 | News | Mental Health. Available at: http://www.emro.who.int/mnh/news/afghanistan-mental-health-and-psychosocial-support-during-covid19.html [Accessed 16 July 2020].

Miu, A., Cao, H., Zhang, B. and Zhang, H., 2020. Review of Mental Health Response to COVID-19, China. Emerging Infectious Diseases, 26(10). Available at: https://wwwnc.cdc.gov/eid/article/26/10/20-1113_article#suggestedcitation [Accessed 16 July 2020].

New Zealand Ministry of Health, 2020. Kia Kaha, Kia Māia, Kia Ora Aotearoa: COVID19 Psychosocial And Mental Wellbeing Recovery Plan. Wellington: Ministry of Health. Available at: https://imhcn.org/wp-content/uploads/covid-19-psychosocial-mental-wellbeing-recovery-plan-15may20203-2.pdf [Accessed 16 July 2020].

United Nations, 2020. United Nations Policy Brief: COVID-19 and the need for action on mental health, 2-8. Available at: https://unsdg.un.org/sites/default/files/2020-05/UN-Policy-Brief-COVID-19-and-mental-health.pdf [Accessed 16 July 2020].