The Movement for Community-led Development

Moderators

• Gunjan Veda – Movement for Community-led Development, and Nelly Mecklenburg – Institute for State Effectiveness

When this series first launched more than a year ago, we sought to explore the implications of COVID-19 and necessary adaptations. However, we did not know or expect the pandemic to be with us for so long and have such lasting implications. With the widespread proliferation of the pandemic, we transitioned into a space where we are now discussing long-term implications and adaptations of the pandemic. On our last call, in March, participants identified a number of key themes that have emerged during the pandemic that will – or should – be more significant focuses of our work moving forward. In this call, we explored issues surrounding mental health that have surfaced during COVID-19. 

COVID-19 and Mental Health

Presenters

• Dr. Fahmy Hanna – Technical Officer at World Health Organization (WHO) for Mental Health and Substance Abuse, Co-Chair of Inter Agency Standing Committee on Mental Health and Psychological Support and Emergency Settings (IASC)
• Dr. Emma Chademana – Head of Programs at One to One Africa

The COVID-19 pandemic has both created and exacerbated various mental health struggles around the globe. In terms of its direct effects, COVID-19 can increase rates of depression, anxiety and post-traumatic stress disorder (PTSD) for those infected with the virus. Moreover, people with pre-existing mental health conditions are likely to experience greater rates of COVID-19 infections and COVID-related morality in comparison to the rest of the population.

There is also a plethora of indirect effects associated with the virus. For instance, physical distancing measures can foster feelings of isolation and loneliness, which are predisposing factors for various mental health conditions. Moreover, the pandemic has affected livelihoods through the creation of fear, stigma and economic hardship. As Dr. Hanna noted, “we know very well that the impact on livelihoods is actually having a negative effect on mental health” as well.

COVID-19, Community Workers and Mental Health

Although COVID-19 can impact anyone’s mental health, a key and underappreciated impact is on community workers, and community healthcare workers in particular. In addition to concerns surrounding their physical health, many community workers suffer from stressors relating to increased workload, the pressure to support communities with little information and resources, the fear of being a vector of infection for their families or the households they visit, and the lack of recognition for their role in combating COVID-19.

Dr. Emma Chandemanay (One to One Africa) explained how in South Africa, like in many countries, One to One Community workers not only provide basic health services, but also extend their support to address gender-based violence, substance abuse and poverty; all of which have also been aggravated during the COVID-19 pandemic. 

One to One Africa has adopted a number of measures – during COVID-19 and even before – to support their community-based teams to deal with the emotional and mental pressures of this work. The adaptations to continue programming during the lockdown in South Africa has added new challenges. One to One Africa adopted a telehealth approach where workers provided services to beneficiaries from home. This was quite challenging, however, as many of them live in large households with limited personal time and space. 

In response to these difficulties, One to One Africa conducted a psychosocial wellbeing assessment using a validated tool developed by the University of KwaZulu-Natal. The assessment revealed the following concerns: 

• Fear of the pandemic and/or fear of losing a loved one
• Anxiety surrounding vaccine availability, children being out of school and inability to support patients 
• Fear that they would contract and/or spread COVID-19 to or from their clients as they move from house to house

Global Responses

Despite the universal and urgent nature of these concerns, mental health is often overlooked and underfunded on a global scale. In most countries around the world, the budget spent on community-based mental health services is less than two percent of its health budget. Similarly, as Dr. Hanna noted, “there is one mental health professional for every ten thousand people around the world, but there is one person in need of mental health services out of almost every four of us”. 

In regards to these global concerns, the WHO assessed the impact of COVID-19 on mental, neurological and substance abuse between July and August of 2020. The findings revealed that an increasing amount of countries are prioritizing mental health and placing it on their policy agenda. Out of 130 countries, two-third established a multi-sectoral mental health and psychosocial support (MHPSS) coordination platform which engages education, health and social sectors. Although these statistics are hopeful, the findings also revealed that only 17% of countries have allocated full resources to implement these plans.

The Way Forward

In order to effectively address the concerns of COVID-19 and mental health, the UN Secretary General and the WHO Executive Board developed the following set of recommendations: 

IASC Briefing Note on COVID-19 Outbreak Readiness and Response Operations

IASC Guidance on Operational Considerations for Multisectoral Mental Health and Psychological Support Programmes during the COVID-19 Pandemic

Breakout Groups

Separating into breakout groups, participants discussed the IASC recommendations in relation to their local contexts. 

Group 1

This group focused on the inability of community workers to reach patients, uncertainty about schools opening and general fear surrounding COVID-19. Their solutions to these issues included creating smaller study groups, providing stress training and employing intersectoral approaches towards addressing mental health. 

Group 2

This group focused on burnout, fear of job loss and stigma surrounding mental health. Their solutions to these issues included providing mental health services for team members, being flexible while disseminating information and creating specific counselling training for staff. 

Group 3

This group focused on anxiety surrounding vaccines, fear of job loss and the creation of crime.Their solutions included creating support groups, combatting conspiracy theories surrounding the vaccines and HR training on technology to address stressors around working remotely.

Important Resources

As Dr. Hanna explained, “if you are going to address the wellbeing of the population, it is very difficult for you to do so if you do not address your own wellbeing”. A number of multilingual MHPSS resources are available to the general public, clinical providers and agencies. Some of these resources include: 

• My Hero is You, How kids can fight COVID-19 Storybook
• Doing What Matters in Times of Stress: An Illustrated Guide
• Living With the Times MHPSS Toolkit
• Basic Psychosocial Skills: A Guide for COVID-19 Responders

To access or download the slides, clidk the >> at right.