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Mon 24 Aug 2020 11:51 AM

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Covid-19: A war on two fronts

The war against Covid-19 and its impact on people's mental health is both a race against the clock and a long-term battle

Covid-19: A war on two fronts

As humanity continues its fight against Covid-19, the notion that there is “no health without mental health” – one that the World Health Organisation (WHO) has championed for years – has never been more relevant.

In the aftermath of 1918’s Spanish Flu outbreak, the number of mental health issues attributed to the pandemic increased by 7.2 percent each year, and it is likely that Covid-19 will have a similar effect.

In the Middle East, as many as 25 percent of the population every year are affected by at least one mental health disorder, similar to the rates seen in developed countries.

In the recent years, GCC governments have undertaken various measures to address mental health issues, improve quality of care, and reduce the associated stigma, however, the journey is still long to address systemic problems, like the training of qualified workforce, upgrading infrastructure, and providing adapted community set-ups of care.

Until now, the focus of the current pandemic has been on the physical toll and economic impact. However, with livelihoods and daily routines disrupted, and people kept apart from one another, levels of depression, anxiety, substance abuse and self-harm are also expected to rise.

Clearly, it’s an issue that needs to be tackled swiftly and effectively. But who is most at risk, and how can they be helped?

Who needs support?

Due to the far-reaching and often devastating consequences of the virus, a large proportion of the population will be impacted. However, some groups are especially vulnerable.

Like soldiers in a war, the frontline health staff and essential workers are exposed to extremely high levels of danger and stress daily. In a recent survey of healthcare professionals in China, more than 50 percent reported symptoms of depression, 44 percent anxiety, 34 percent insomnia and 71 percent symptoms of distress. The tragic suicides of an emergency department director in New York and an ER physician in Moscow show just how heavy the toll can be.

Elderly people, along with those with pre-existing conditions, and Covid survivors are also vulnerable. In addition to the risks posed by the disease itself, social distancing measures – although put in place as a protective measure – can create feelings of helplessness, loneliness, anxiety, guilt or even anger.

In the Middle East, which has a strong collective culture, the negative impact of reduced social gatherings could be felt even more acutely.

Statistically, women and children are more vulnerable in high-stress environments, and particularly during wars and pandemics. The trauma experienced by victims of domestic violence, pregnant women, and at-risk children – coupled with inadequate support – can have mental health repercussions that last for generations.

Similarly, people with existing mental health or addiction issues can find their symptoms worsen if access to essential medication or community support is restricted.

Finally, the unemployed and those at risk of losing their jobs are susceptible. Unemployment and economic downturn is being seen in many Covid and post-Covid economies. The relationship between mental health and unemployment has long been studied: people with low socio-economic status who are more exposed to unemployment, lack of healthcare coverage and poor health conditions are more likely to develop long-term mental illnesses compared to the shorter-term mental distress experienced by the general public.

What support is needed?

To support these various vulnerable groups, different mental health services need to be urgently developed or strengthened. Healthcare providers, employers, and governments should join forces to provide help where it is most needed, using all the tools at their disposal.

First and foremost, reliable information about the disease and channels for people to seek help needs to be widely available to reduce anxiety caused by confusion and uncertainty.

Hotlines, online panels, forums and other platforms that foster social connection and relieve anxiety are essential. In the GCC, many such tools have been deployed successfully to connect with the population and ensure adequate and accurate information.

Resources should also be pooled wherever possible to ensure those at risk can connect with volunteers, professionals, and one another at an early stage of their conditions to prevent and manage the distress.

People with medium to severe symptoms, who may require treatments such as psychotherapy and medication, should be able to access these services in a safe environment so they don’t feel forced to choose between their physical and mental health.

Virtual services like digital psychiatry can be offered in the absence of face-to-face support, while new tools and applications using artificial intelligence, telepsychiatry and internet-based computer-aided mental health services should be evaluated and pushed to market quickly.

Appropriate training for primary care and ER physicians regarding mental health diagnosis is crucial as many mental health conditions can manifest in physical forms, for example as pain or gastrointestinal symptoms. Coming out of lockdown, healthcare providers should be equipped to identify and diagnose psychiatric issues through an integrated pathway that addresses both patients’ physical and mental needs.

Finally, underpinning healthcare services, strong social care services are required to provide safety net that guarantees basic access to life essentials (food, care access, medication, etc.) plays a major role in reducing anxiety and preventing mental illness and addiction.

To provide these services efficiently, governments must empower and hold accountable all players within the ecosystem – individuals, employers and healthcare providers– by providing knowledge, incentives and policy measures to safeguard citizens’ mental health. The Middle East society needs to also capitalise on its tight-knit social fabric to weather the storm.

What does the future hold?

Beyond the immediate needs surfaced by the pandemic, Covid-19 also provides an opportunity for policy makers to initiate long-term structural changes in mental health services.

With mental wellness under the spotlight, there is clear political momentum for governments to push for significant reforms, from much needed long-term rehabilitation facilities, to broader coverage of mental health services in insurance plans, and – most importantly – better education and communication to destigmatize mental health issues.

The war against Covid-19 and its impact on people’s mental health is both a race against the clock and a long-term battle. If governments and healthcare providers can work together on these transformative initiatives, the world stands a much better chance of building resilience in the long run.

Mohamed Berrada, partner and head of MEA Healthcare Practice and Younes Rahmoune, principal​, Healthcare Practices at Kearney Middle East

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