ISANO: Focus on community mental health during physical crisis

Monday October 12 2020

Covid-19 is a wakeup call to remind the world that there is no health without mental health. PHOTO | FILE


COVID-19 has changed our lives -- from going out to dinner with friends to isolating at home, from busy work-days with colleagues to social distancing and mask-wearing.

For the majority of us, there will be no exposure to COVID-19 at all. For some of us, COVID-19 will cause miserable symptoms that subside in a few weeks, and for others, COVID-19 will be severe and even result in death.

These physical manifestations of the pandemic are significant but this crisis has also negatively affected the psychosocial wellbeing of people -- both those who had COVID-19 and those who did not. Mental health during this crisis has been increasingly discussed but remains grossly underfunded and unaddressed.

Instead, focus has been on the virus, and the symptoms that cause visible injury and illness. According to WHO mental disorders may be less visible, but they significantly affect life chances, family relationships, physical health, job security and a person's general wellbeing.

Opportunities exist to develop solutions at the intersection of mental and physical health and to better address the needs of whole persons and families during crises.

While the ramifications of COVID-19 have compromised health worldwide, the most disadvantaged in society - socially, economically and geographically - are also the most acutely vulnerable to transmission and the adverse effects of the disease.


Communities have been dealing with the loss of  loved ones, the pressure of lockdowns, job insecurity, new working conditions, hunger, uncertainty and the undeniable fear of contracting the virus.

And mental health is no exception. Those living in overcrowded places will find it difficult to comply with social distancing strategies and will face fines for disobeying policies -- all of which ultimately impact both their physical and mental health.

Community members now face a triple burden-- (1) that of the current pandemic on health, (2) the prexisting racism, classism and other forms of discrimination they endure, and (3) the risk of loss of livelihood during lockdown measures that have compromised daily income.

Leaders and decision-makers have a responsibility to urgently craft policy solutions that not only tackle health but also dismantle the social inequities that have fueled COVID-19 across the globe

Populations that have been pushed to the margins of society, including refugees and migrants, victims of gender based violence, people with pre-existing mental disorders, and those who live in extreme poverty, continue to be neglected during this pandemic as supportive services are either unaffordable or inaccessible to those most in need.

Evidence shows that many people in low and middle income countries who need mental health treatment do not have access to  mental health care, due to a  lack of trained  mental health caregivers, and undeveloped mental wellbeing support services.

The African continent, as an example, has 1·4 mental health workers per 100 000 people, in comparison to the global average of 9·0 per 100 000 people.

To deal with scarcity of mental health professional,  a “task sharing” model where community members not traditionally considered mental healthcare professionals such as teachers, nurses, general practitioners and Community Health Workers (CHWs) could be trained to identify people with mental illness, and perform adequate referrals for proper management of the condition.

Task sharing has already been utilized with positive results in some areas in Uganda, Ethiopia, and South Africa, as a  significant step towards addressing unmet mental health needs.

A variety of creative, community-based mental health services can be mobilized during COVID-19. In Rwanda, for example, mental health services are integrated into primary healthcare and decentralized to the most grassroots level of the health system (health centers and CHWs).

CHWs function at the frontline to identify people living with mental disorders, and to link them to appropriate care. In health centers, nurses provide counseling and medication. Rwanda’s approach to mental health existed prior to the pandemic and has been an effective launching pad for additional services during COVID-19.

In a recent interview, the director of the Community Mental Health and Rehabilitation unit at the Rwanda Biomedical Center, Claire Nancy Misago, described current COVID-19 efforts, stating, “We [are creating] awareness programs [about] how to cope with stress. The program will primarily focus on the community, and frontline staff, especially health workers.”

As the pandemic wears on, meeting the increasing demand for mental health services using traditional methods seems something hard to attain. In this era of digitalization, tech-based solutions such as Wysa, an AI-based emotionally intelligent mobile chatbot app may be useful to help with early detection of stress symptoms.

Recognizing the limitations of smart phone based tech solutions, digital technologies which utilize feature mobile phones, with limited internet such as Interactive Voice Response (IVR) could be particularly leveraged for  mass communication  to disseminate information on mental health,  and to collect community feedback throughout the pandemic.

Past experiences using this technology have highlighted  positive results. In Bolivia, for instance patients who received IVR calls on depression self-care showed an alleviation in depressive symptoms. In Bangladesh, the same technology has been used with success to provide information on Covid-19 in refugees camps.

Mental health problems are shaped by a number of factors;  social, economical, cultural and environmental operating at different phases of a human life. 

To effectively promote mental health, it is crucial to address inequities that drive ill mental health through community centered interventions, community based capacity building, and building community trust in mental health services.

None knows when the pandemic will end. As it is likely that the pandemic will have long lasting impacts on mental health to all people, and negative impacts to the most vulnerable populations in the society, we need to prioritize building resilient mental health care systems that promote health and well being for all people.

Covid-19 is a wakeup call to remind the world that there is no health without mental health!

Sandra Isano is a Rwandan Public Health Researcher, Lecturer, Mental health advocate and Coordinator for Community Based Education in the Department of Community Health, and Social Medicine at the University of Global Health Equity.  Email -  [email protected]