Ensuring equity in mental health and psychosocial support during the COVID-19 pandemic and beyond

Abstract

Populations affected by armed conflict and other humanitarian crises are at elevated risk for mental health problems. While the COVID-19 pandemic has had broadly deleterious effects on livelihoods, economic well-being, and population health worldwide, vulnerable groups have been disproportionately impacted by the pandemic. Providing mental health and psychosocial support (MHPSS) services during these times to vulnerable groups, especially in low- and middle-income countries and humanitarian settings, is essential. In an effort to comply with the public health response to the pandemic and mitigate COVID-19 transmission, significant implementation adaptations were made to service delivery during the pandemic. This short report describes several strategies to ensure that equity was central to these adaptations and public health responses, and provides recommendations for ensuring continuity of this progress post-pandemic. Examples and key lessons learned are given related to strategies to increase access to MHPSS services, improve meaningful stakeholder engagement, develop and support community networks, and implement community-based psychosocial support groups. They come from diverse settings of Bangladesh, Colombia, Ecuador, and Lebanon. The COVID-19 pandemic has highlighted the importance of preventing and treating MHPSS issues. It also has created opportunities for innovative programming to address overlooked problems, improve the quality of services provided, and increase focus on equity. It is vital that we use the momentum and attention generated around MHPSS services during the COVID-19 pandemic to continue to build and improve existing MHPSS services in more equitable ways for vulnerable populations.

Improving Retention in Mental Health and Psychosocial Support Interventions: An Analysis of Completion Rates across a Multi-Site Trial with Refugee, Migrant, and Host Communities in Latin America

“…However, other reasons for participants enrolling in the intervention but never attending any session and being classified as unreachable must be considered. Access to certain populations can become difficult in contexts in which women share their phone or own a phone that is controlled by male family members [27]. Also, relying on technology to maintain contact can be difficult because of unstable internet access or network coverage, lack of devices, selling of phones to meet other needs, or low technological literacy [27].…”

“…Access to certain populations can become difficult in contexts in which women share their phone or own a phone that is controlled by male family members [27]. Also, relying on technology to maintain contact can be difficult because of unstable internet access or network coverage, lack of devices, selling of phones to meet other needs, or low technological literacy [27]. Therefore, we propose including questions in MHPSS intervention recruitment processes that address accessibility to cellular devices, stable internet networks, and phone ownership.…”

Feasibility, acceptability and preliminary effectiveness of a community-based group psychosocial support model for conflict survivors in Colombia: An assessment of in-person and remote intervention modalities during the COVID-19 pandemic

“…The decision to give participants the opportunity to choose their modality was made based on the results of a pilot study (Rattner et al, 2023 ) in which the primary lesson learned was that participants wished to decide for themselves whether to participate in MHPSS services in-person or remotely. Participants and staff shared that determining whether to participate in-person or remotely is a highly personal decision with important implications for accessibility, particularly in an emergency context (Armijos et al, 2023 ). The research team determined that randomly assigning participants to modality would compromise equitable access to services and therefore that allowing participants to make this choice was a more ethical option amid the COVID-19 and national protest emergencies.…”

“…In the context of the COVID-19 pandemic, additional innovative methods have been employed to increase access to services (Moreno et al, 2020 ; Armijos et al, 2023 ). Remote service delivery through tele-mental health and/or digital tools is a key strategy to enhance the uptake of services during circumstances that impede in-person participation, including pandemics, conditions of community violence and when travel is otherwise difficult (e.g., in some rural areas) (Fu et al, 2020 ; IFRC, 2020 ) and was used widely during the COVID-19 pandemic (Witteveen et al, 2022 ).…”

Brief Coping Scale TCS-9: Optimising the Assessment of Coping Strategies. The case of Health Care Workers.

“…Therefore, as hospitals continue to adapt to better serve their communities and strive for health equity, the mental health of their employees must remain a top priority. 5 By engaging in active assessment and treatment of healthcare workers' coping strategies, hospitals can safeguard the health of their workforce and, in turn, the quality of care provided to patients.…”