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The Impact of COVID-19 on Mental, Neurological and Substance Use Services in the Americas

Dr. Claudina Cayetano

Mental Health Regional Advisor

PAHO/WHO Washington DC

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Available Regional data show that the COVID-19 pandemic is having profoundly adverse impacts on mental health at the population level, coupled with the severe disruption of mental health services.

A failure to prioritize mental health before the pandemic has hindered appropriate responses to the current high mental health needs!

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The pandemic has had and continues to have a detrimental impact on the lives of many in the Americas.

As of 13 Oct 2022, the Region reported over 179 million confirmed cases (28% of cases worldwide) and over 2.8 million deaths (44% of deaths worldwide).

The Region of the Americas continue to report the highest numbers of deaths due to COVID-19 and several sub-region have reported increase in mental health conditions in adolescents (i.e., anxiety {27%} & depression {15%}).

Since its onset, the COVID-19 pandemic has posed numerous health, as well as economic, social, and human capital challenges resulting in upheaval of major facets of society.

Impact of the Pandemic

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Mental health prior to the COVID-19 pandemic

The global situation:

1 in 4 people worldwide will experience a mental health condition in their lifetime ⁴,
More than three million people will die as a result of harmful alcohol use each year⁵, and nearly one million will lose their lives to suicide.

The Americas situation:

Depressive disorders are the largest single cause of disability in the Americas,
Nearly 100,000 people die by suicide e/year, with GUY and SUR among the 10 countries with the highest suicide rates in the world.
Treatment gap reaching 82_·2% for substance use disorders.
Reduced access to mental health services
MH spending averaging 2% of total health budget with an average of 61% of the allocation disbursed to psychiatric hospitals,
Shortage of mental health human resources, ranging from less 1 X 100,000 population in low-income countries to over 50 per 100,000 population in high-income countries.

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Global Pulse Survey

Objectives:

Provide rapid snapshot of changes and challenges in service delivery/utilization during to the pandemic.
Inform countries to support policy and planning dialogue on critical bottlenecks and guide mitigation and recovery towards quality essential health services.
Produce globally comparable findings on extent of disruptions across health system throughout the pandemic

Three survey rounds:

(May-Sept 2020) – responses reflected (Feb-Aug 2020)
(Jan – Mar 2021) – responses reflected previous 3 months (Oct 2020 – Feb 2021)
(Nov-Dec 2021) – responses previous 6 months (May-Nov 2021)
Ministries of health appointed a focal point to complete the survey

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Survey Thematic Areas and Questions

Mental health and psychosocial support

MHPSS response in national COVID-19 response plans
Multisectoral MHPSS coordination platforms for COVID-19

Mental, neurological and substance use services during the COVID-19 pandemic

MNS in essential health services for COVID-19
Government policies for access to essential services for MNS
COVID-19 disruptions to MNS services/interventions
Causes of disruptions
Approaches to overcome disruptions

Surveillance and research concerning MNS disorders during the COVID-19 pandemic

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Participating Countries�

29 of 35 (83%) PAHO Member States that received survey responded.

Member States: Antigua and Barbuda, Argentina, Bahamas, Barbados, Belize, Bolivia, Brazil, Canada, Chile, Colombia, Cuba, Dominican Republic, Ecuador, Grenada, Guyana, Honduras, Jamaica, Mexico, Nicaragua, Panama, Paraguay, Peru, St. Kitts and Nevis, St. Lucia, Suriname, Trinidad and Tobago, United States of America, Uruguay, and Venezuela.

PAHO territories: Aruba, Bermuda, British Virgin Islands, Cayman Islands, and Curacao.

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Mental Health Services

The COVID-19 pandemic led to significant disruptions in mental health services
According to a 2020 WHO rapid assessment of service delivery for MNS

75% of MNS-related services were reported as being completely or partially disrupted.
MNS outpatient and community-based services, were particularly disrupted.

At a time when they were most in need of mental health services, vulnerable groups, such as women needing antenatal and postnatal interventions, children and adolescents with mental health conditions or disabilities, and people with substance use disorders, faced severe service disruption.

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MHPSS Inclusion in List of Essential Health Services �

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Funding for MHPSS in COVID-19 Response Plans

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Disruptions Across Services/ programs

Management of MNS emergency manifestations
Counselling for MNS disorders
Prescriptions for MNS disorder medicines
Services for children and adolescents with mental health conditions/disabilities
Services for older adults with mental health conditions/disabilities
School mental health programs
Suicide prevention programs
Overdose prevention and management programs
Critical harm reduction services

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Reasons for Service Disruptions �

Closures or postponing of services (60% of countries)
Insufficient staff to provide services
Lack of MH health care human resources (44% of countries)
Clinical staff deployed to provide covid-19 clinical management
Inpatient services beds not available
Closure of outpatient, consultation clinics
Travel restrictions hindering access to the health facilities
Decreased care seeking (48% of countries)

Particularly for first level of care services!

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The mental health impact of the pandemic

Depression and anxiety ranging from 20% - 60% in the general population, increased drug use.

People recovering from COVID-19 are experiencing high rates of mental health problems.

In people with no previous psychiatric history, a diagnosis of COVID-19 was associated with increased incidence of a first psychiatric diagnosis in the following 14 to 90 days,

Health and frontline workers who face increased physical risks, high work demands, where at an increased risk of psychiatric episode.

Children and adolescents have faced the loss of loved ones, heightened adversity in their home environments, including an increased risk of domestic violence.

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Way Forward

Scaling up emergency MHPSS:

Good mental health is not only essential for physical health and overall wellbeing, but also a fundamental human right.
Mental health support, including but not limited to, frontline and healthcare workers, children and adolescents, women, people with pre-existing mental health conditions, racial and ethnic minorities, and indigenous peoples.
Communication materials to promote psychosocial wellbeing.
Recruitment of additional health personnel & redistribution of tasks and optimization of roles.
Provision of home-based care and telemedicine.

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Transforming mental health systems for the future

The pandemic provides a window from which to advocate for long-term changes in mental health service delivery and care.
Building back better mental health systems and services will require integrating mental health into Universal Health Coverage (UHC); scaling up and reallocating funding for mental health; and a renewed commitment to community-based mental health care, grounded in human rights.
Thinking beyond COVID-19, countries should incorporate MHPSS into all existing and future national emergency and disaster response plans, including it as an integral part of all emergency phases (preparedness, response, and recovery).
Investing in long term recovery, access to medicines, digital health, workforce capacity

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Key areas to consider

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Conclusions�

Mental health has long been a neglected area of public health in the Region of the Americas.
Before the COVID-19 pandemic, low public expenditure contributed to under-resourced mental health systems and services that were unable to meet the high demand for care for mental health conditions.
The pandemic has significantly exacerbated the mental health crisis, increasing the need for mental health services and simultaneously disrupting services for MNS disorders.
There is an immediate need for countries in the Americas to scale up and improve mental health and psychosocial support services during the pandemic and to build back better mental health systems in anticipation of future emergencies, including climate change. �

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WHAT IS URGENTLY NEEDED

Developing and strengthening mental health as part of a broader whole-of-society approach – towards UHC
Leveraging innovative technologies, including Telehealth
Reaching people at high risk and those in vulnerable situations
Integrating MHPSS into ALL emergency preparedness, response and recovery activities in the Region
Allocating adequate funding for mental health services and care

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Thank You!��

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References�

Pan American Health Organization. Third round of National Survey on the Continuity of Essential Health Services during the COVID-19 Pandemic: Nov-Dec 2021 [Internet]. Washington DC: Pan American Health Organization; 2021 [cited 2022 July]. Available from: https://iris.paho.org/bitstream/handle/10665.2/56128/PAHOHSSHSCOVID19220023_eng.pdf?sequence=1&isAllowed=y
Pan American Health Organization. The impact of COVID-19 on MNS in the Americas: Results of a Rapid Assessment. [Internet]. Washington DC: Pan American Health Organization; 2021 [cited 2022 July]. https://iris.paho.org/bitstream/handle/10665.2/54784/PAHONMHMHCOVID-19210018_eng.pdf?sequence=5&isAllowed=y
World Health Organization. Pulse survey on continuity of essential health services during the COVID-19 pandemic: interim report, 27 August 2020 [Internet]. World Health Organization; 2021 [cited 2022 July]. Available from: https://www.who.int/publications/i/item/WHO-2019-nCoV-EHS_continuity-survey-2020.1
World Health Organization. Mental Health and COVID-19: Early evidence of the pandemic’s impact [Internet]. World Health Organization; 2022 [cited 2022 July]. Available from: https://www.who.int/publications/i/item/WHO-2019-nCoV-Sci_Brief-Mental_health-2022.1
Strengthening mental health responses to COVID-19 in the Americas: A health policy analysis and recommendations - ScienceDirect