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Global humanitarian response to COVID-19 highlights need for innovative ways to address mental health

06 May 2020

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A worker on a UNHCR helpline in Jordan. Credit: UNHCR

Shortly after a lockdown for COVID-19 was enacted last month, a family of six in rural Aleppo, Syria, faced a dilemma. Two brothers, Atallah and Mohammed,* ages 19 and 21, had run out of the essential medications they need to manage a severe mental health condition they developed in recent years.

The brothers were not sleeping well and had difficulty with the most basic daily tasks. Their parents worried they would leave the apartment to obtain treatment, putting themselves at risk of coming into contact with the virus or unexploded ordnance and other conflict-related hazards that remain a threat in the area.

Fortunately, the local mental health team considered the brothers’ situation a priority. A newly established mobile crisis mental health team delivered the treatment and provided psychosocial support to Atallah, Mohammed and other family members, while observing protocol to prevent transmission of the virus. The team is supported by Al-Ihsan Charity, a partner of the UN Children’s Fund (UNICEF), the UN Refugee Agency (UNHCR), the UN Population Fund (UNFPA), the World Health Organization (WHO) and other aid agencies working to alleviate suffering in the area. 

But this is just one case in a country where millions of people need mental health services after nearly 10 years of brutal conflict.

The threat alone of COVID-19 is taking a toll on people’s mental health across the globe. Particularly susceptible to the stress and anxiety stemming from the pandemic are the tens of millions of women, men and children already impacted by war, hunger, poverty and natural disasters, including older people, persons with disabilities, internally displaced persons, refugees, asylum seekers and migrants.

That is why mental health is among some of the essential needs addressed in the Global Humanitarian Response Plan (GHRP) for COVID-19, which was initially launched by the UN Secretary-General in March and will be updated this week.

The added threat of COVID-19 comes at a time when mental health and psychosocial support services are either interrupted or suffering from limited resources in country after country, according to the GHRP May Update, which was coordinated by OCHA with input from the Inter-Agency Standing Committee (IASC) of leading UN and non-UN humanitarian organizations. 

Alcohol-related incidents, including domestic violence, have increased in communities throughout the world. Pre-existing severe mental health, neurological and substance abuse conditions have been exacerbated.

And in camps or settlements for displaced people, it is often impossible to adhere to measures such as physical distancing. This increases the risk for COVID-19 and generates high levels of stress.

Even before the pandemic and resultant lockdowns and livelihood losses, at least one in five people in conflict zones suffered from a mental health condition.

“The COVID-19 pandemic has exposed the extremely limited availability of mental health and psychosocial services for people living in conflict zones and other crises,” said Dr. Fahmy Hanna, a WHO expert and co-chair of the IASC’s Mental Health and Psychosocial Support Reference Group.

Across the globe, there is only 1 mental health professional for every 10,000 people. In South Sudan, there are only 3 mental health professionals for 12 million people and they are all in the capital, Juba. Without remote services, a person from Malakal in the north would need to take a dangerous 30-hour, 2,000-mile journey for services – and may need to repeat the journey every two to four weeks.

Elsewhere, including in Yemen, the stigma of mental health conditions has meant that where there are institutions, people have often been left to languish in them. “The basic needs and human rights of people with mental health conditions in institutions should never be overlooked during emergencies,” said Dr. Hanna.

Now, IASC’s reprioritization of work in mental health in the COVID-19 context includes a shift from field missions to more remote provision of technical support and advice, new guidance materials for all humanitarian responders and production of a children’s book, My Hero Is You, to explain COVID-19 and how to deal with it. The book resulted from 1,700 interviews with children and teachers across the globe and is being distributed in more than 100 languages.

The cover of the children's book "My Hero Is You" produced by the IASC. Credit: IASC

The GHRP recommends that existing mental health and psychosocial support services be maintained, including through telephone calls, and that services developed as part of the COVID-19 response should be accessible to people with disabilities, migrants, asylum seekers and other vulnerable groups.

Mental health and psychosocial support services are already being provided remotely, through hotlines and other modalities, such as the mobile health teams. In war zones such as Idlib in north-west Syria, mental health workers already have experience in remote provision of technical advice and consultation for people suffering from mental disorders.

Dr. Hanna noted that the humanitarian system had been increasing its focus on the importance of addressing the need for mental health and psychosocial support in emergencies – from the very young to older persons. This past October, for instance, the Netherlands hosted the first International Conference on Mental Health and Psychosocial Support in Crises Situations in Amsterdam.

“I hope that the experiences of the COVID-19 pandemic remind the world that mental health and psychosocial needs requires the same level of attention and support as physical ones,” said Dr. Hanna.

* Names changed to protect identities.