3 priorities for strengthening mental health services under COVID-19


WHO - Mental Health

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The theme of World Mental Health Day 2021, "Mental health care for all: let's make it a reality" is fitting in the era of COVID-19. The pandemic has not only disrupted and changed our lives, it has also exposed social and economic inequalities that have contributed significantly to the spread of the virus. These inequalities also underlie underlying health conditions that correlate with higher mortality rates in different countries. 

In addition to the risk of coronavirus infection, vulnerable populations such as unemployed adults, youth, the elderly and primary care workers have increased risk of mental health symptoms and disorders. To help address this problem, World Bank Group-supported health projects in more than 100 developing countries in response to COVID-19 include funding for psychosocial interventions to help people cope with the effects of stressors such as lockouts, self-isolation and quarantine, fear of infection, lack of information, loss of employment and finances, and stigma and discrimination.   

In addition to continued support for health systems, it is essential that governments implement sustainable policies and allocate resources to achieve universal health coverage and provide high-quality primary care that can protect and prevent disease. The persistent unmet care needs of people with mental and substance use disorders, together with the stigma and discrimination faced by affected people and their families, deserve particular attention. 

To improve the quality of mental health care at all levels, three priorities need to be considered:

1. 1. Achieve parity in mental health care coverage.

Although the burden of disease attributable to mental disorders has steadily increased globally since the 1990s, mental disorders are still treated significantly differently from physical health problems. In many countries, clauses relating to pre-existing conditions that deny or limit health insurance coverage are a common barrier to achieving equity in the treatment of mental illness and addiction.  Inadequate or limited coverage of available services is also widespread in countries with public health systems. The adoption of legal mandates and regulations can help remove these barriers, as has happened in Colombia, Chile, Ghana and the United States.

Other related issues that need careful consideration include (i) determining which states should be prioritized (e.g. common mental illnesses such as depression and anxiety disorders, addictions, or serious conditions such as schizophrenia); (ii) treatment choices at different levels of care; (iii) mechanisms for expanding equitable access to medication; (iv) how services are financed and reimbursed, reducing cost barriers and eliminating cash payments; and (v) managing quality improvement in mental health services.

2. Integrating services at the community level.

Special efforts should be made to integrate treatment for mental and substance use disorders into community-based services, move away from hospital-centered models of care, and remove the artificial separation of mental and physical illnesses by physicians - research has clearly demonstrated that "the brain is intimately connected to the body and the body to the brain." Improving service delivery requires strengthening referral pathways between formal and informal health care providers to promote communication, information sharing, education and training, and multidisciplinary teamwork.

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In supplement to developing benchmarks and assessing service performance, improvements in data collection and monitoring of mental health conditions and entry to services involving people with mental disease should be supported.

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Community mental health services in Norway are a good example of how local mental health centers, in collaboration with GPs and primary care providers in

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