Dr Hans Henri P. Kluge, Regional Director & Dr Natasha Azzopardi-Muscat, Director of Country Health Policies and Systems at WHO/Europe, lift the lid on mental health in light of the COVID-19 pandemic
Irishman Neil Kelders has struggled with mental ill-health for many years, even contemplating suicide, and is now a mental health coach. “On the outside, it looked like I had everything; but on the inside, I was dying. I was battling, I was struggling every single day,” said Neil. “I didn’t speak up – I masked it all. I didn’t tell anyone because I didn’t want to be judged. And I’m not the only one. There are many more like me we don’t know about. People out there need help.”
Neil’s story is a reality for millions of people across Europe and the world, and the pandemic has only made matters worse.
Before COVID-19 emerged and changed the world as we know it, an estimated 150 million people in the WHO European Region suffered from a mental health condition, with only a small minority receiving any treatment. And this is a conservative estimate.
As it swept across the globe sparing no country, COVID-19 altered the mental health landscape – in two main ways. In one respect, the fear and anxiety associated with the risks of becoming infected and the psychological effects of lockdowns, school closures, self-isolation and joblessness have left their mark on people. The psychosocial impact of some of these restrictive measures has been deep, and the most vulnerable among us are likely to suffer for a long time to come.
In another, but equally important way, COVID-19 has led to a catastrophic disruption of public mental health services. Closures, staff shortages and the diversion of funds have meant that when people needed mental health support the most, these were simply not
available to them. Studies show that the disruption in services was significant in about 40% of countries in our Region, with one in two countries seeing services cut down by as much as half.
Time to act for those most affected
Throughout the pandemic, we have made it a commitment to reach out to and hear from those most affected – children sitting in their kitchens interacting with their friends and teachers on screens, young people struggling with joblessness and the elderly coping with isolation away from their children and grandchildren.
And the testimonies we heard were unequivocal. Young people spoke of the services being denied to them because “things weren’t bad enough.” Young students struggled with limited online schooling and the absence of those extracurricular activities that are so essential to children’s social and developmental well-being. Women, ethnic minorities, migrants, refugees and people from LGBTQ+ communities have seen the inequality gaps become even wider.
We now stand at a turning point. In many ways, the pandemic has been a wake-up call. It has exposed the shortcomings in mental health services, while reinforcing the message that mental health matters and must not be relegated to the bottom of priorities in national health systems.
Mental health was a priority area for the WHO Regional Office for Europe even before the pandemic, and the window of opportunity for us to act is now. Experiences of past crises tell us that once a crisis is over, commitments made, and lessons learned are either forgotten or replaced by the next crisis. But the mental health and well-being of our people cannot wait, for three main reasons.
First, we have the political commitment now that we didn’t have before. At the 71st session of the WHO Regional Committee for Europe in September, the 53 governments of our Region adopted an historic resolution establishing an innovative European Framework for Action on Mental Health. This framework outlines specific actions to increase awareness of mental health issues, promote equitable access to services, mobilise investments and develop adequate mental health policies. The framework is a true blueprint for action.
This political capital has been months in the making. Just a few weeks ago, WHO/Europe and the Government of Greece co-hosted a high-level summit on the COVID-19 impacts on mental health in Athens. The joint declaration adopted by the 53 delegates at the summit calls for “mental health promotion and support to be at the heart of the post-COVID-19 recovery agenda” and “for this to be a redefining moment in the history of mental health, with stigma and discrimination being tackled through integration of mental health into the mainstream healthcare agenda.”
Second, this political commitment is gradually transforming into coordinated action. WHO/Europe recently launched the pan-European Mental Health Coalition, an ambitious undertaking that will bring together governments, civil society, academia and the wider public, to exchange ideas and views on how to move forward with mental health reform. The coalition will create a mental health data lab, build resilience for children and adolescents, and support the mental health of older adults.
Finally, this is the time to act for the simple reasons stated above. Once the pandemic is over, the cost of inaction will be far too high. Unless we commit to the lessons taught by COVID-19, we risk going back to business as usual. This means a world in which mental health is at the bottom of our health systems, a world where only one in three people with depression are getting care, a world where the cost of mental ill-health amounts to around 4% of GDP for most countries in the European Region.
“At the end of every mental health workshop or talk that I give, the main question I get from participants is ‘how can I help someone?’ and this tells me two things,” explains Neil Kelders. “First, people want to help people, but they don’t know how. Second, a lot of the people asking this question, are in fact asking for themselves, they want to know how they can help themselves, because they are afraid to speak out, afraid to be judged. We need to help people ‘win from within’ where they can help themselves to maintain good mental health and well-being, from the cradle to the grave.”
