Just months ago, who could have imagined that the world would be looking down the barrel of a spiraling health crisis and economic recession unlike any witnessed in our lifetime? Now, in a world gripped by the fear of a marauding virus, mental health is emerging as a key concern.
Diverse pathways to poorer mental health
The reaction of the media and governments to the epidemic served to fuel anxiety. The dramatic way the term “pandemic” was announced by the WHO after weeks of watching the epidemic unfolding around the world was a hair-raising moment. Apocalyptic messaging about millions of dead bodies littering our cities followed, even though experts had identified vulnerable populations — people who are elderly or chronically ill, and those who live in group facilities like nursing homes — early on.
The breathless questions mounted. When, if ever, would life return to a semblance of what we used to experience? Within the torrent of mixed messages about the science, what was real or fake? What might the post-lockdown scenario for containing the virus look like? All of this played on an endless daily newsreel, rounded out by rising figures on illnesses, hospitalizations, and deaths around the world and close to home.
Not surprisingly, experiences of anxiety, fearfulness, sleep problems, irritability, and feelings of hopelessness are widespread. These are mostly the rational responses of our minds to the extraordinary realities that we are facing. But economic recession, widening inequalities, continuing uncertainty about waves of the epidemic still to come, and the emotional impact of physical distancing policies will continue to bite deeper into our mental health. A rise in clinically significant mental illnesses and suicides may well follow.
Unemployment, acute poverty, and indebtedness are strongly associated with poor mental health. A recent report documents “deaths of despair,” mostly through suicide and substance use, as the cause for increased mortality and reduced life expectancy in working-age Americans following the 2008 economic recession. The profound inequality in the US, coupled with its weak social security net, deeply polarized society, and fragmented health care system, are a toxic recipe for a similar surge of deaths of despair on this occasion.
Emerging evidence suggests that the lockdowns and the pivot of health care services to this one virus has seriously disrupted mental health care in many parts of the world. Access to mental health care — including vital continuing care — has not been available for many people experiencing new-onset episodes of depression and anxiety, or exacerbations of pre-existing mental health problems.
Transforming mental health globally
Fortunately, we know what needs to be done and how to achieve it. Further, we know the resources invested are excellent value-for-money. The pandemic presents a historic opportunity to reimagine mental health care.
The GlobalMentalHealth@Harvard initiative was launched in 2017 to marshal the rich, inter-disc
