Public mental health: required actions to address implementation failure in the context of COVID-19

Abstract

Mental disorders account for at least 18% of global disease burden, and the associated annual global costs are projected to be US$6 trillion by 2030. Evidence-based, cost-effective public mental health (PMH) interventions exist to prevent mental disorders from arising, prevent associated impacts of mental disorders (including through treatment), and promote mental wellbeing and resilience. However, only a small proportion of people with mental disorders receive minimally adequate treatment. Compared with treatment, there is even less coverage of interventions to prevent the associated impacts of mental disorders, prevent mental disorders from arising, or promote mental wellbeing and resilience. This implementation failure breaches the right to health, has increased during the COVID-19 pandemic, and results in preventable suffering, broad impacts, and associated economic costs. In this Health Policy paper, we outline specific actions to improve the coverage of PMH interventions, including PMH needs assessments, collaborative advocacy and leadership, PMH practice to inform policy and implementation, training and improvement of population literacy, settings-based and integrated approaches, use of digital technology, maximising existing resources, focus on high-return interventions, human rights approaches, legislation, and implementation research. Increased interest in PMH in populations and governments since the onset of the COVID-19 pandemic supports these actions. Improved implementation of PMH interventions can result in broad health, social, and economic impacts, even in the short-term, which support the achievement of a range of policy objectives, sustainable economic development, and recovery.

Intersections between COVID-19 and socio-economic mental health stressors in the lives of South African adolescent girls and young women

“…Using platforms such as schools and community-based services in the provision of basic mental health support programmes could help to increase access to mental health care, and in turn mainstream and promote mental health during periods of heightened adversity, buffering against pandemic related stressors, and bolstering cohesion and resilience at the community level, even in the absence of physical proximity [ 14 , 27 , 30 , 39 , 55 ]. Integrating mental health care support into school-based services may be a cost-effective opportunity for promoting mental wellbeing and resilience amongst adolescents and young people [ 57 ]. Addressing the mental health treatment and care gap in South Africa, particularly in rural and/or resource restricted communities, through building skills and capacity of lay mental health providers, and frontline workers including community health workers and teachers, and improving access to mental health literacy resources could help to promote resilience and increase access to necessary care and support [ 9 , 30 , 57 ].…”

“…Integrating mental health care support into school-based services may be a cost-effective opportunity for promoting mental wellbeing and resilience amongst adolescents and young people [ 57 ]. Addressing the mental health treatment and care gap in South Africa, particularly in rural and/or resource restricted communities, through building skills and capacity of lay mental health providers, and frontline workers including community health workers and teachers, and improving access to mental health literacy resources could help to promote resilience and increase access to necessary care and support [ 9 , 30 , 57 ].…”

“…Other recommendations include the provision of accessible and data free Mobile health applications, digital technologies, virtual support solutions and online platforms to deliver brief evidence-based psychological interventions for young people with symptoms of depression and anxiety, and provide psycho-social support through online/digital and telephonic counselling services, and through community safe spaces to reduce isolation and address gaps in psycho-social support [ 2 , 39 ]. Whilst digitally based interventions can be effective and support improved coverage of mental health support and care, potential harms of digital technology for adolescents and young people need to be considered, and efforts need to be made to ensure equity in access [ 57 ].…”

Public mental health: An opportunity to address implementation failure

“…Public mental health (PMH) involves a population approach to mental health in order to improve coverage, outcomes, and coordination of interventions to treat mental disorder, prevent associated impacts, prevent mental disorder from arising, and promote mental well-being and resilience (Campion et al ., 2022). [ 1 ] This supports efficient, equitable, and sustainable reduction of the burden of mental disorders and promotion of mental well-being of populations.…”

“…2018, Campion, 2019; Campion et al ., 2022). [ 1 9 14 ] However, treatment alleviates a relatively small proportion of disease burden of mental disorders (Andrews et al ., 2004)[ 15 ] which highlights the importance of prevention. Many PMH interventions also have economic evaluation demonstrating an economic return on investment even in the short term including in India (Chisholm et al .…”