Opinion Editorial by WHO Representative to Maldives, Dr Arvind Mathur, on the occasion of World Mental Health Day 2020
Globally, 10th October marks World Mental Health day each year and this year it comes at a time when our daily lives have changed remarkably as a result of the COVID-19 pandemic.
The spread of COVID-19 and its accompanying safety measures have understandably disrupted people’s routines and daily lives, leading to stress and anxiety. The struggle to return to a new normal itself can be overwhelming. Our frontline health-care workers across the country continue to provide care in hard-hitting circumstances, still serving the nation despite the fear of bringing COVID-19 home to their own families. Our students and teachers are adjusting to study and teach classes through virtual means, while missing their fellow classmates and colleagues, and sharing the uneasiness about their own futures.
Our local and migrant workforce whose livelihoods and steady income have been threatened throughout the pandemic and many may fall into poverty. People with mental health conditions have been experiencing even greater social isolation than ever before. And all this cannot even equate to managing the grief of losing a loved one to COVID-19, sometimes without being able to get any closure, or without being even able to say their last goodbye. The economic consequences of the pandemic can be seen and felt, as major companies and smaller local businesses have let their staff go, to save their businesses or some may have shut down completely.
In Maldives, there have been increased reports of COVID-19 related psychological distress. It is expected that the necessity for mental health and psychosocial support will substantially increase in the coming months and years. Therefore, investment in mental health programmes at the national and international levels, is now crucial more than it has ever been. Accordingly, the slogan of this year’s World Mental Health Day campaign is ‘increased investment in mental health’.
Around the world, close to one billion people have a mental disorder and anyone, anywhere, can be affected. A term often heard but misinterpreted; ‘Depression’ remains still one of the leading causes of illness and disability among adolescents and adults worldwide. Suicide is claiming the lives of close to 800 000 people every year (meaning; 1 person every 40 seconds) and is the second leading cause of death for young people aged 15-29 years. This is a particularly alarming number, as Maldives itself is home to a large youth population; with majority falling into the same age criteria.
In low- and middle-income countries, more than 75% of people with mental health conditions receive no treatment for their condition at all. The serious gaps that still exist in mental health care are a result of chronic under-investment over many decades in mental health promotion, prevention and care. But there is positive news associated with Mental Health too even though several people might not realize that the most common mental health conditions such as depression and anxiety, can be in fact, treated with talking therapies, medication, or a combination of two.
In recent times, The Republic of Maldives has been making great strides in Mental Health and Mental Health services. In 2019, His Excellency President of the Maldives inaugurated the Centre for Mental Health at Indira Gandhi Memorial Hospital. With a multi-disciplinary team, the center offers emergency care as well as outpatient and inpatient services including diagnostics, treatment, rehabilitation and occupational therapy which are now also covered under the local health insurance scheme Aasandha. The center also conducts outreach programmes in the atolls and seek to raise awareness among the public to evoke behavioral change towards mental health issues.
WHO is privileged to extend technical assistance to the Government of Maldives in development and continuing support in implementing the Mental Health Policy 2015-2025 and the National Mental Health Strategic Plan 2016-2021 which outlines a robust governance structure for mental health with financing requirement for implementation of strategies and proposes to develop a network of community-based mental health services which are integrated to the general health services. The focus is on preventing mental disorders and promoting mental health in collaboration with other stakeholder sectors, and advocate for better mental health and human rights of people with mental disorders at all levels of society and enshrine this in legislation, policies and plans. With promising policy and program decisions by the Ministry of Health, one hopes for accelerated actions in bridging the financial and implementation gaps.
WHO advocacy for provision of Psycho-social support (PSS) benefited the people who were quarantined and isolated at an early stage of outbreak. Building on the experience and recognizing Mental Health and Psycho-social support (PSS) as emerging priority need in evolving outbreak; we advocated for focused service delivery. This was translated into setup and establishment of mental and psychological support cluster with the Health/National Emergencies Operation Center- an example of multi-player collaboration with more than 30 partners, establishment of psycho-social support hotlines operated by civil society organization with outreach services. The training needs were identified and WHO supports the development of guidelines and training package on Mental Health and PSS during emergency. Also, from the onset of the pandemic, WHO continued to collaborate and partner with Ministry of Health and Ministry of Gender, Family and Social Services not only in provision of PSS to vulnerable population but also for provision of essential care items at a time of need, which proved to be greatly linked to their physical but importantly their mental wellbeing.
The experiences during COVID-19 also highlighted the importance of simple steps that one can take by oneself to cope with stress. We must recognize that it is normal to feel sad, stressed, confused or even angry during a crisis. Talking to someone you trust through virtual means, maintaining a healthy diet, getting adequate rest, and staying active through regular exercise can do wonders to our physical and mental wellbeing. We must ensure avoiding tobacco consumption and illicit substances to deal with the stress, as this can only make it worse. In a time of a global pandemic and equally with an ‘infodemic’; it is essential to only gather facts and information from credible sources such as WHO and Health Protection Agency, and to limit exposing yourself to news or social media posts that you perceive as upsetting. It is important to seek help especially if you feel overwhelmed, consult a local health worker or counselor.
Despite all, stigma, discrimination and human rights abuse of people with mental health conditions remain widespread still. It is now more crucial than ever to support one another, at both personal and community level, to protect and nurture each other’s mental health and wellbeing. As support, WHO has partnered with the Government of Maldives in our joint Solidarity Ekugai Emmen Campaign (‘All Together Campaign’), as an extension of WHO Director General’s global call for Solidarity during COVID-19.
Let me make an economic case as I urge leaders, partners and stakeholders for investment in mental health as for every US$ 1 invested in scaled-up treatment for depression and anxiety, there is a return of US$ 5. For every US$ 1 invested in evidence-based treatment for drug dependence, there is a return of up to US$ 7 in reduced crime and criminal justice costs. Primary health care workers can be trained to identify and manage mental health conditions. Regular health checks of people with severe mental disorders can prevent premature death. The quality of life of people living with conditions such as autism and dementia can be greatly improved when their caregivers receive appropriate training. These are all doable, impactful actions that benefits not only the health of our nation, but the economic stature as well.
On World Mental Health Day, I reiterate WHO’s support to the Government and people of Maldives to Move for Mental Health. The fact is, there is ‘No Health’ without ‘Mental Health’. The COVID-19 pandemic is not only a global health and socio-economic crisis, but a mental health crisis which serves as a reminder that investment towards Mental Health services is central, essential and mutually inclusive part of Universal Health Coverage.
We must ensure Mental Health services for all, to achieve Health for All.