View of the Nile River from Jinja, Uganda. Photo credit: Erica Moroney
Diana Chamrad, Ph.D.

Senior Technical Advisor, Vulnerable Children and Families, Mental Health

World Mental Health Day was recently observed on October 10. Since 1992, the day has been observed to call attention to mental health needs around the world. As a licensed clinical psychologist, I’ve worked in global health for more than 15 years, but this is the first World Mental Health Day that I am particularly optimistic about finding the mental in world health.

It has unfortunately taken a sweeping pandemic like COVID-19 to amplify the complex interrelationship between biological, psychological, and social conditions. It’s been a long time coming. Even before 2020, depression and anxiety disorders contributed heavily to the global health burden. Since the emergence of COVID-19, the situation has only worsened.

COVID-19 Increases Global Rates of Anxiety and Depression

A recent Lancet review article estimates an additional 53.2 million cases of major depressive disorder (a 28% increase) and 76.2 million cases of anxiety disorders (a 26% increase) globally are attributable to the COVID-19 epidemic. Women and youth are most affected. This is especially concerning given that there has been no reduction in the global prevalence of depression or anxiety since 1990 in spite of the availability of effective interventions for the disorders.

Since the start of the COVID-19 pandemic, it has been especially eye-opening to see its impact on the mental health of a particularly vulnerable group – health care providers. In the parts of the world where URC works, even in the best of times, health workers face immense challenges – such as unsafe working conditions, staff shortages, and lack of support for personal self-care – all of which have negative effects on their physical, mental, and emotional well-being.

World Health Organization (WHO) estimates a projected shortfall of 18 million health workers by 2030, mostly in low- and lower-middle income countries. Health care providers are of course concerned about their own health and the health of their children and families. Recent studies have found that half of all health care workers have experienced depression, anxiety, and post-traumatic stress during the COVID-19 pandemic. And those numbers are even higher in some places, such as conflict zones or areas with severe shortages of health workers.

Unfortunately, without systemic shifts in how we address mental health concerns, the prevention and treatment of mental health problems is unlikely to improve. A priority should be to promote the physical and mental health and well-being of health care workers to ensure their ability to provide quality care that results in positive outcomes for their patients and themselves.

Learning from Experience – Providing Psychosocial Support During Zika

While the scale and impact of the COVID-19 pandemic may be unprecedented in modern times, the global community is well versed in challenges related to disease outbreaks based on our experience with recent outbreaks of Zika and Ebola. Evidence on mental health concerns and interventions slowly began to emerge during both the Zika epidemic and Ebola outbreaks.

When I first started working with ministries of health to develop psychosocial support guidance for caregivers in Jamaica, Antigua and Barbuda, Dominica, St. Kitts and Nevis, and St. Vincent and the Grenadines under the URC USAID ASSIST Project, literature searches yielded only a small number of studies. This memory stands in stark difference to today’s reality. In 2021, there is an abundance of studies available on effective interventions. 

In the Caribbean, the USAID ASSIST Project was focused on improving providers’ skills to screen children under two years old for developmental delays, possibly due to the mother’s exposure to the Zika virus. Alongside that activity, the ministries of health wanted an evidence-based approach to provide for the overall well-being of the women and their families coping with the effects of the Zika epidemic. USAID ASSIST provided psychosocial support training to 3,993 health care providers in 12 countries to improve their skills at:

  • Developing trusting relationships with patients and their families;
  • Conveying accurate information effectively and with respect; and
  • Offering support to patients and families in developing and maintaining internal strengths and resources to foster patient resiliency.  

What I especially liked about the trainings was that a gender component was incorporated into the materials and that the guidance also engaged women’s partners, children, parents, and any other people involved in supporting women.

During the trainings, a particularly well-received session was on provider self-care. The training provided health workers with tools for taking stock of their self-care skills, identifying stress and burnout risk factors, and implementing risk reduction strategies to address these challenges. Providers were taught self-care techniques like mindfulness, progressive relaxation, and cognitive reframing, to be used in improving their own well-being in addition to being used as a tool for providing psychosocial support to patients. Managers also identified ways they could help reduce stress in their employees, such as rotating high- and low-stress work functions or supporting a group exercise period at the clinic. We conducted a survey of attendees at the end of the project, and awareness of the problem and permission to talk about it in the open seemed to be important first steps for most providers.

Making Mental Health a Global Priority

There are indications that the interest in mental health will go beyond the COVID-19 response. In September, a three-day technical consultation hosted by USAID, WHO, and UNPF on “Giving Voice to the Silent Burden: Maternal Mental Health,” brought together global and country level experts to discuss multisectoral collaborations to ensure that pregnant and postpartum women receive respectful and nurturing care. And in October, the Wilson Center’s Maternal Health Initiative collaborated with UNFPA to host a discussion on perinatal mental health, highlighting the fact that an estimated 20% of women will experience a perinatal mental health condition, but only 50-75% of these women will receive treatment. Advances in prevention and treatment for mothers would not only impact their well-being but the physical and mental health of their children as well.

It’s essential for all of us who are committed to a holistic view of well-being – that goes beyond identifying health as a solely physical state – to engage in conversations about the imperative of addressing mental health. The mental health of providers and patients can no longer be left out of the definition – and pursuit – of health for all. With the attention mental health is finally gaining, there’s reason for optimism.