The path to global equity in mental health care in the context of COVID-19

Abstract

The path to global equity in mental health care in the context of COVID-19The theme of the 2021 World Mental Health Day is "Mental Health in an Unequal World", highlighting unequal access to mental health care across the world. This situation has been further worsened by governmental and public responses to the COVID-19 pandemic. The response of many high-income countries (HICs) and institutions to the pandemic has been the reverse of equity, exemplified by inequitable access to COVID-19 vaccines and widening inequities in wealth. 1 A crucial consideration in this context is the imbalance in social and economic factors that shape onset and outcomes of mental health across communities and countries. 2 Looking through a lens of equity, some individuals and populations need greater-not equalintensity of mental health promotion, prevention, and treatment efforts because of the constellation of adversities, social marginalisation, and burden of ill health they experience.The growing inequity in systems of health and wealth has profound implications for a vision of mental health for all. Although pre-existing mental health inequities are being exacerbated by the COVID-19 pandemic in many settings, the data needed to call out inequity in the impacts of COVID-19 on mental health care are inequitably distributed, with scarce data available from refugee populations and low-income countries. As a group of clinicians, researchers, educators, and people with lived experience of mental illness, we call for services that are responsive to the different circumstances of individuals and communities rather than a system that offers the same, or equal, care for all. We propose that mental health in response to COVID-19 has to be framed around equity, particularly in relation to human rights and universal health coverage (UHC).Future efforts to achieve equity in mental health should address the domains shown in the panel and include four key actions. First, financial investment needs an equity focus on areas with the greatest exposure to risk factors of mental illness and the least access to mental health services. The UN movement for UHC, which complements the Sustainable Development Goals, captures this focus with its call for equitable distribution of health-care workers rather than a one-size-fits-all approach to health care. Sadly, we are far from global equity in financial investment for mental health services. Compared to other health conditions in low-income and middle-income countries (LMICs), mental disorders receive the least amount

Hidden within a pandemic: how is international funding supporting mental health during COVID-19?

“…Mental health is an important element of COVID-19 response, alongside laboratory facilities, vaccine development and delivery, and acute health care provision, to lessen long-term social and economic costs to society together with a reduction in individual suffering (UN, 2020). The mental health impacts of the COVID-19 pandemic are predicted to be significant, enduring, and to further exacerbate inequity in global mental health (Kola et al 2021, Kola et al 2021b). Considering the populations who are recipients of humanitarian funding are also those who are historically under-resourced for mental health, there needs to not only be a continuum of funding but an increase in investment for mental health during and post the pandemic.…”

“…These estimates are the basis for the wide consensus that mental health requires larger funding (UN 2020, WHO 2020. While increased investment in mental health, nationally and globally, was called for prior to the pandemic, particular consideration must now be given to financial investment to areas of greater risk and lower access to services (Kola et al 2021, Kola et al 2021b There is a well-established consensus on the detrimental impact of the COVID-19 pandemic on mental health. It is known that individual quarantine has negative psychological effects, as seen prior to the COVID-19 pandemic with severe acute respiratory syndrome (SARS), influenza, Ebola and Middle East Respiratory Syndrome (MERS) (Brooks et al 2020).…”

Psihičko zdravlje geekova

“…Podatci o psihičkom zdravlju geekova prikupljeni su tijekom pandemije COVID-19 te je zbog toga bilo važno naći uzorak koji je usporediv s obzirom da je pandemija utjecala na psihičko zdravlje (17,32). U sklopu dvaju istraživanja prikupljeni su podatci o psihičkom zdravlju u Hrvatskoj u sličnom razdoblju [svibanj (18) i srpanj 2020 (17)], čime je ostvarena sličnost u fazi pandemije i kulturalnom kontekstu, odnosno u dva faktora za koje je utvrđeno da su važne odrednice psihičkog zdravlja tijekom pandemije (17,32). Ajduković i sur.…”

“…The data on mental health of geeks was collected during the COVID-19 pandemic so it was important to find a comparable sample, since the pandemic affected mental health (17,32). Two studies collected the data on mental health in Croatia at a similar point in time (May (18) and July 2020 ( 17)), thus assuring the comparability of the phase of the pandemic and cultural context, which are both important determinants of mental health in the pandemic (17,32). Ajduković et al ( 17) used probabilistic stratified quota sampling as to achieve a nationally representative sample regarding basic sociodemographic characteristics.…”

“…The amount of variance explained was not large for any of the mental health indicators, indicating that geek activities contribute to mental health, but not strongly. This is not surprising, given the complexity of mental health, and even more so given the pandemic context that itself had a great influence on mental health (17,32).…”