Mental Health in Post-Pandemic Healthcare: A Case for Reappraisal

The COVID-19 pandemic has had a whole range of unexpected consequences, some of which, like increasing levels of mental distress, deserve better management—and, in some cases, immediate attention. 

Concerns about the increasing prevalence of mental health disorders—and the subsequent need to reprioritise mental health in the overall picture of the global disease burden—had already started to be voiced in the years before the pandemic, and different initiatives and strategic plans have been developed by different health organizations and governments to begin tackling these challenges.

Prior to the pandemic, we saw efforts to improve wellbeing and embrace healthier behaviours in the general population. The great hope was that this would reduce the symptom burden associated with non-communicable diseases like cardiovascular disease and Type 2 diabetes.

We are already seeing some evidence that this is indeed the case with regard to cardiovascular disease, as well as mild cognitive impairment and Alzheimer’s. What was not expected however, was that mental health issues, particularly in young people, would increase so steeply, both in severity as well as in prevalence. The COVID-19 pandemic has only exacerbated this situation.

The Impact of COVID-19 on Mental Health

The lockdowns and the associated isolation, lack of personal face-to-face contact and feelings of missing out on important life events have fuelled issues like loneliness, anxiety, depression and substance abuse, especially in vulnerable groups. Even though such challenges are now openly being discussed, with notable reductions in the levels of stigma in some countries, action to deploy solutions has not had the same level of attention globally. 

Of course, most health and care systems are still totally concentrated on trying to manage waves of COVID-19 infections and all the concurrent care and hospitalisations that ensue, so this is not surprising. However, this does not excuse the lack of urgency to find solutions to an impending crisis. 

The COVID-19 pandemic has had a far-reaching effect on mental health services. A direct result of the world's response to the pandemic was that delivery of such services including inpatient psychiatric care as well as psychotherapy and other services within primary and secondary healthcare units, were disrupted or de-prioritised to a lesser or greater extent in different jurisdictions. This was despite the fact that there are a myriad of opportunities, many of which utilise digital modalities as the form of communication and intervention, could have at least helped to forestall the inevitable upsurge in symptomatology we saw in the first months of the pandemic.

Also, whilst the need for increased resourcing of care for the healthcare workforce has been acknowledged and even deployed in some instances, the same cannot be said for services for better management of mental health, especially when it comes to protecting and improving the health of the most vulnerable groups in the population—including youth, older people and people with pre-existing conditions. Fortunately, the curve of adverse mental health impacts from the pandemic seems to be flattening out in the general population, but this doesn't make this topic less important moving forward.

Investing in, scaling up and increasing access to support through digital tools and solutions can be an important and effective way to reach and engage people. An example of such interventions, which have a strong evidence base behind them, are digital therapeutics and stepped mental care programs based on cognitive-behavioural principles. These are typically consisting of different modules tailored towards specific conditions, challenges and needs, which the user engages with on a weekly basis. Such programs can be self-guided, or guided by a therapist—depending on the conditions, preferences and needs of specific individuals or groups.

Another example is mobile applications aimed to track and monitor mental health symptoms, guide journaling exercises for emotional processing or teach different types of self-care practices on a daily basis. The use of chatbots to prevent infodemics and stimulate sharing and reflection around emotional health is another emerging solution which can be of benefit, especially in low resource settings where the access to both healthcare professionals and to more advanced technologies are more limited. In such settings, where smartphones might not always be available, something as simple as SMS-campaigns, can also be an effective way of preventing infodemics, increase health literacy and reduce stigma and misconceptions. 

The use of such technologically enabled interventions and tools can help equip people, especially young people, with important skills to change their dysfunctional thought and behavioural patterns, and help them take steps towards a healthier way of relating to themselves and the world around them. This can help make people more resilient and capable to navigate external challenges like pandemics, and to tackle different life challenges in general.

A big advantage with digital interventions and solutions is that they are easier to tailor towards each individual’s specific challenges and needs—including the mental, emotional, physical, behavioural and lifestyle aspects of health and wellbeing.

Digital approaches thus hold the potential of healing the current fragmentation within healthcare, and help make health and care more integrative and personalized.

Investing in Mental Health Moving Forward

The reprioritization and increased efforts towards mitigating the rise in mental health conditions is not only a task for our health systems, it is also something that should be on the agenda of schools and workplaces across the globe. Investing in solutions aimed towards making mental health, inner work and personal development an integral part of everyday life, will not only help increase the wellbeing of each individual and increase the sense of empathy and support in the overall society—it may also help reduce the associated adverse burden and costs on our societies.

There is no health, without mental health and it needs to be put on our agendas now more than ever. Moving forward, we must strive towards ensuring equal access to quality healthcare for all, and digital health interventions and solutions can play an important role in this. But no country can act alone, we need to unite and collaborate as a whole towards these goals and commitments. Only then can we achieve a healthier and more sustainable world for all.

Updated July 26, 2020