Let’s Invest in Mental Health for an Inclusive and Resilient Recovery from COVID-19

“I believe more than ever that we have the power to help change the world for people who have mental illnesses and addictions, and for all of those whose lives are touched by these brain diseases—which is to say, all of us.”- Patrick J. Kennedy, A Common Struggle (2015)

In this midst of a global pandemic, this year’s World Mental Health Day campaign is calling for greater investment in mental health. This focus is timely and justified. Recent estimates suggest that most low- and middle-income countries spend less than $2 per person on the treatment and prevention of mental and substance use disorders – and this was prior to the global outbreak of the novel coronavirus.

The pandemic has brought social isolation, bereavement, financial hardship, and interrupted health care services – which are negatively impacting the mental well-being of people.  New research also shows that substance use disorders, including opioids, alcohol, and smoking, are tied to an increased risk for COVID-19 and serious adverse outcomes, including hospitalization and death.

A fundamental rethinking is needed to overcome the false dichotomy between physical health and mental health in health services. Mental health parity must be placed at the core of human capital development. The social cost of mental illness and substance use disorders – which compound the impact of poor physical health – are terribly high, for individuals, families, communities, and the economy. But the cost of effective treatments is surprisingly low.

Integrating mental and physical health services

Faced with the global economic fall-out as the COVID-19 pandemic rages, budgetary capacity of governments and international assistance coffers are stretched. What can be done to deliver on this year’s World Mental Health Day call? 

We must be wary of siloed approaches to increased mental health funding. Rather, governments can mobilize new resources and leverage existing funding streams by integrating mental health interventions into existing service delivery platforms across sectors.  

There are numerous potential cross-sectoral entry points that would align funding, service provision, and population needs:

• Experiences in Chile, Colombia, Ghana, and the United States demonstrate that national mandates to cover mental and substance use disorders prevent the use of preexisting conditions clauses to deny health insurance coverage.  In Peru, the inclusion of mental health services as part of the benefits package offered by the Integrated Health Insurance (SIS) scheme was an important step towards the achievement of mental health parity, and for helping vulnerable people access these services when needed without incurring high out-of-pocket expenditures. This measure was complemented by the development of a fee schedule to reimburse health facilities for services rendered, and a 10-year results-based budget allocation by the Ministry of Economy and Finance exclusively to support community-based mental health services.

• Projects funded under the World Bank Group’s $6 billion COVID-19 Global Health Emergency Response Program in countries such as Bosnia and Herzegovina, Cambodia, Ecuador, India, Lesotho, Liberia, Morocco, Marshall Islands, Mongolia, Nigeria, Sri Lanka, and Turkey support psychosocial interventions to help people deal with negative psychological effects associated with stressors such as lockdowns, self-isolation and quarantines, infection fears, inadequate information, job and financial losses, and stigma and discrimination.     

• Existing funding streams for maternal and child health, such as those under the Global Financing Facility (GFF) in support of Every Woman, Every Child, can be leveraged to deal with maternal depression, especially postnatal, and the associated stunting in children.  

• School-based interventions are critically important because 75 percent of mental and substance use disorders begin before age 25 and suicide is a leading cause of death among youth. Programs of social and emotional learning along with promotion of physical health, work and study support, and alcohol and other drug services, have a positive impact on healthy development, well-being, and academic performance. Integrating school and clinic-based services is an effective approach to improve human capital outcomes by investing earlier in life.

• Similarly, integrating mental health into wellness programs in the workplace can mobilize  private companies to invest in health promotion activities such as cognitive-behavioral therapies to reduce stress. These programs generate significant benefits for workers, their families, and employers, improving productivity and competitiveness, and tackling stigma surrounding mental disorders.

• Programs in fragile and conflict-affected settings can be leveraged to mainstream integrated physical and mental health interventions alongside other social services to address the needs of displaced populations and refugees who have been exposed to high levels of stress. For example, in the Horn of Africa, a World Bank Group-funded project supported counseling services for Somali women and children impacted by gender-based and sexual violence as part of a primary care package offered in refugee camps in Kenya and Ethiopia. Likewise, in Afghanistan and Yemen, psychosocial support services are provided to people who have personally experienced or witnessed traumatic events.

• Pro-health taxes, such as those on tobacco, alcohol, and sugar-sweetened beverages can help expand the tax base and collect additional public revenue for priority social investments and programs, including mental health services at primary care and community levels, and reduce health risks associated with substance use disorders. Botswana, Colombia, Moldova,  Philippines, and Ukraine offer good examples of the use of this fiscal policy  for public resource mobilization and health objectives. 

• Microcredit schemes, such as Rise Asset Development in Canada, which provides low-interest, small business loans, training, and mentorship to entrepreneurs with a history of mental health or addiction challenges (including former prisoners), facilitate reintegration into the community.

As the saying goes, a crisis should not go to waste. During the COVID-19 pandemic and beyond, renewed efforts and dedicated funding are needed to achieve mental health parity across sectors. A sustained focus on mental health will contribute to a more resilient recovery and develop more equitable societies.