Massive Spike in Mental Health Issues During Pandemic, Govts Not Doing Enough: WHO Report

New Delhi: The COVID-19 pandemic has caused a sharp increase in mental health disorders around the world. A report published by the World Health Organization (WHO) has said that the worst affected were low- and middle-income countries (LMICs). India, by the way, belongs to the category of LMIC.

The report, which the WHO has touted as “the largest review of global mental health since the turn of the century,” said initial estimates show a jump to 246 million for major depressive disorders and 374 million for anxiety disorders. This represents a jump of 28% in the first and 26% in the second.

The report says that even two years into the pandemic, COVID-19 continues to disrupt essential health services and widen the treatment gap for mental and other health conditions. The WHO conducted a survey among 223 countries, territories or areas in the last quarter of 2021 to understand the magnitude of this disruption in all general health care services, including mental health services. In total, 129 countries responded to the survey. As much as 65% of these countries reported one or another impairment due to interruptions in seeking mental health care even after two years of COVID-19

As India did not participate in the WHO inventory exercise, we do not know the extent of the problem in the country.

Pre-pandemic screenplay

Before the pandemic, in 2019, approximately 970 million people in the world were living with a mental disorder. This was a higher number than the then total population of all of Europe.

Up to 82% of these 970 million people lived in LMICs.

Of the total of 971 million people who suffer from mental health problems, about a third suffer from anxiety disorders. This is the highest ratio of the entire range.

These disorders were followed by depressive disorders, developmental disorders, hyperactive disorder and attention deficit (first diagnosed mainly in children who find it difficult to concentrate or show impulsive behaviors), Bipolar disorder (conditions in which people have alternating manic episodes of increased activity or depressive moods), behavioral disorders (behavioral disorders found mainly in children and adolescents), autism spectrum disorders, schizophrenia (disorders characterized by deficiencies in the way patients perceive reality and suffer from problems such as delusions and hallucinations) and eating disorders (persistent disturbance in behaviors, ranging from binge eating to starvation, that are associated with distressing thoughts).

In fact, two of these mental conditions, depressive and anxiety disorders, are also among the top ten health problems for being the causes of what is called ‘years lived with disability’. This metric measures the number of years a person lives with an impairment caused by any health condition.

Politics and Funds: A Story of Chronic Neglect

The report also said that while the majority of member states said they had a mental health policy or plan, only 23% reported investing resources in following up on these projects. In fact, half of the countries did not even bother to estimate the financial resources needed to implement such plans.

Unsurprisingly, spending on mental health was found to be appalling, given the magnitude of the problems. On average, the WHO report found that countries spend less than 2% of their healthcare budgets on mental health.

The resource gap also extends to human resources. About half of the world’s population lives in countries where there is only one psychiatrist to care for 200,000 people. People with high rates of socioeconomic deprivation have the lowest access to mental health services. In low- and middle-income countries, the entire focus is more or less on serving the adult population. Therefore, a child and adolescent mental health workforce is almost non-existent.

“Within broader health policies and plans, most LMICs give mental health a low priority compared to other burdensome health conditions,” the report says.

Furthermore, regardless of the resources that are devoted to mental health, 70% of them go to psychiatric hospitals. These are places that only serve those with severe mental health conditions. Therefore, the rest has to fend for itself. It is no wonder then that only a quarter of member states have told the WHO that they have integrated mental health care at a primary level. People refrain from long and expensive trips to cities to seek treatment and the problem goes on a loop.

The net result of all this neglect is that 1 in 8 lives with a mental health condition, yet 71% of people do not receive mental health care.

Even access to medication is a big concern. Here again, low- and middle-income countries are in the spotlight.

“[There is] Limited availability of essential psychotropic medications, especially in LMICs. And when they are available, many more people in LMICs also end up paying for these drugs out of pocket,” the report says. Low-income countries fare no worse. For decades, they did not include essential drugs on their respective national essential drug lists. Their non-inclusion would mean that they would invariably remain very expensive, making it impossible for people to buy them.

The treatment of mental health problems in itself costs a lot, since governments barely attend to those needs. But it would be a mistake to interpret that a blatant neglect of mental health services only affects those who suffer from those conditions. Citing an analysis of the Philippines, for example, according to the report, the country had to suffer a loss of $1.3 billion in 2019 due to premature death, disability, and reduced productivity at work. Combined with the direct costs of care (about $53 million), this equates to 0.4% of the country’s gross domestic product.

Adding up the cost of treatment and the costs incurred in terms of lost productivity, the report says, the total global cost to society due to mental health conditions is expected to reach $6 trillion by 2030. Now, that’s more than the researchers projected for the combined costs of cancer, diabetes and chronic respiratory disease.

Mental health conditions have never received their fair share of attention, but these projections definitely make a strong case for our governments and society to wake up. The report has a wealth of recommendations to offer, only if governments decide to follow suit.