I have no doubt that around the world we will soon be facing an increase in mental health issues in the wake COVID-19. The impact of the pandemic, and the measures taken to contain it, may well be long lasting on our mental well-being, and this is now being acknowledged by the United Nations.
Prolonged mental distress will be fuelled by the direct threats associated with the spread of disease, requirements of distancing and isolation, economic and social downturns, and unemployment. These are then exacerbated by massive attacks of disinformation, fake news, and conspiracy theories. This unprecedented combination of adversities presents a serious threat to the mental health of entire populations, and especially to groups in vulnerable situations. However, I am encouraged at the emergence of some protective factors such as mobilization, solidarity, resilience of communities and societies, and in many countries more trust than usual between authorities, civil society, and businesses.
When humans face an external threat, and in the current circumstances this can be said about everyone, our initial coping mechanisms may work well, and, for example, rates of suicides can stabilize or even decline. But as time goes on the cumulative stress in many people is replaced by prolonged distress, which has detrimental consequences on mental and physical health. Loneliness can also be a serious risk factor, as is family violence when everyone has to “stay at home”.
This unprecedented, prolonged, and unpredictable crisis is clearly posing many increased risks to the mental health of children and adults. So we must consider how to address the pandemic to mitigate its impact on mental health.
There are two areas I wish to consider in relation to protecting mental health in this crisis: first, what should be done beyond mental health services, and second, what should be done within mental health services.
Regarding the first issue, universal human rights principles should be reactivated, revitalized, and strengthened. The main determinants that threaten mental health and well-being are inequalities, injustice, discrimination on any grounds, and violence. Even before COVID-19, many governments had been undermining the key human rights principles of equality and non-discrimination. There is a serious danger that the measures taken to combat the pandemic (especially when they are disproportionate and discriminatory) will lead to an exacerbation of those main determinants of mental distress.
The best way to promote good mental health is to invest in protective environments in all settings. This starts with the protection of children and women from violence at home and extends to the protection of space for civil society and freedom of expression. Beneficial human relationships should be promoted and protected through wise policies that mitigate the effects of existential, social, and economic insecurity.
The best “vaccine” for the protection of good mental health is the use of human rights-based approaches in all policies. It can mitigate the consequences of an economic crisis by ensuring people who lose their income and others in financially precarious positions are protected by government support packages, or that people do not lose their homes, and that all social rights are protected. These and similar measures are always the most effective way to protect mental health, and especially in today’s COVID-19 environment.
Turning now to the second issue, mental health policies and services must also respond appropriately to the pandemic’s effects on mental health. Globally, mental health services were facing challenges before the pandemic. The size and scale of these challenges has now been amplified.
Now, more than ever, there is a need for a major transformation and paradigm shift in mental health. I have outlined this need and the responses required in thematic reports to UN Human Rights Council (2017, 2019). The current public health crisis offers an opportunity for such a transformation. This requires the following actions.
Firstly, governments must prioritize and increase investment in mental health and acknowledge it is a part of universal health coverage. But it is not enough just to invest more in the same mental health services. Presently, mental health policies and services are too reliant on over-medicalization, institutionalization, and coercion. The World Health Organization focus on the “global burden of mental disorders” and reducing the treatment gap has sidelined a human rights-based approach to mental health, and has lead to further medicalization, reinforcing the vicious cycle of helplessness, social exclusion, and discrimination.
An alternative approach that focuses on the global burden of obstacles to the realization of the right to mental health needs to be adopted. These obstacles include the huge power asymmetries between providers and users of mental health services, the overuse of biomedical interventions, and a biased use of knowledge when research is translated into practice.
Because we now expect to see many more people needing mental health support as a result of the stresses of COVID-19, it is imperative we take this chance to alter the mainstream approach to mental distress, and we do not offer psychotropic medications and confinement to psychiatric institutions as a first response.
The pandemic offers mental health an opportunity to focus on innovative forms of support and care, including remote ways of providing services. It can promote awareness that mental distress does not necessarily require psychiatric intervention or psychotropic medications and institutionalization.
These are not new challenges, but the pandemic is exacerbating them and putting entire systems, models, and values to the test. Mental health issues that are amplified by the COVID-19 pandemic cannot be addressed effectively with systems that are dependent on medicalization and coercion, that target brains more than relationships, and that undermine the major determinants of mental health–inequalities, injustice, discrimination, insecurity, and violence. Now is the time for global mental health systems, including academic psychiatry, to embrace human rights-based approaches and to translate non-biased evidence into everyday practice in our dramatically changing world.
Dainius Pūras is the UN Special Rapporteur on the right to physical and mental health