The world is still firmly in the grips of the coronavirus pandemic, but already we’re looking to its lingering aftereffects.

Instances of reported drug overdoses and alcoholism have increased in the United States during the last few months. Searches for the word “stress” have increased since lockdown in India. Frontline medical staff are seeing traumatic cases of illness that are causing them to speak out about the risks of coronavirus, while millions are trapped at home, shorn of human interaction.

We’re also in the midst of a global recession, with workers being laid off by the thousands every day. Finances are stretched, and government support around the world is happening, but likely to be limited.

“Use all your innovative thinking and act here and now"

Speaking at the NACCHO annual conference, that brings together people from across public health disciplines, in a panel organised by Apolitical, public health experts warned of the imminent crisis looming around the corner.

In a poll of attendees at a panel on the close mental health crisis, 39% said they were most worried about anxiety and depression relating to the pandemic, with a further 30% concerned about the effects of social isolation on people – particularly the elderly. A further 13% feared unemployment and economic turmoil would increase mental health problems.

More than half of respondents said their organisation’s efforts “aren’t getting near enough to meeting the need” from the population.

What’s needed is a shift in perception of who might need mental health support. “We need to see mental health issues and substance abuse issues as a dimension,” said Shekhar Saxena of the Havard T. H. Chan School of Public Health, who also worked at the World Health Organisation for 20 years as the director of the department for mental health and substance abuse.

“We can be anywhere on a spectrum,” he added. “We need to take the whole perspective into account, so we’re helping serve the public health needs of everybody, not just those who are diagnosed or diagnosable.”

That’s something Steve Platt, emeritus professor of health policy research at the University of Edinburgh agreed with. “Evidence from previous health emergencies like SARA, Ebola and MERS shows you get increased psychological distress in the population, substance abuse and disconnectedness,” he said. Financial strain, an increase in domestic violence, decreased access to services and the exacerbation of existing inequalities all compound that.

“What’s interesting about this awful set of consequences is many if not all are risk factors for suicidal behaviour,” he said. “They impact mental health and in turn impact suicide risk.”

To try and stem the issue before it becomes too great, both Saxena and Platt advised governments big and small instigate policies that encourage the population to consider more openly their mental health and to talk about it.

“The problem around the world is the parameters are very small – mental health care is not adequate for a lot of the population, but also we don’t have enough self-care or community care,” said Saxena. “The objective is to expand the least expensive self-care and informal community care, and keep the specialist care for people who really need it.”

Some local and national governments are already doing that. As an advisor to the Scottish government, which has devolved authority over health policy from the UK government, Platt has helped establish SeeMeScotland.org, a government-backed initiative run by two charities that aim to reduce the stigma of mental health. “You need to think about increasing mental health literacy across the population,” said Platt.

39% said they were most worried about anxiety and depression relating to the pandemic

Similar initiatives in local government in Hertfordshire, England, Oregon and Colorado, as well as a national campaign in New Zealand called ‘All Right?’ try to foster connection and normalise honest discussions about mental health.

The challenge for public servants is that finances were already stretched pre-crisis, and the economic torpor that’s coming down the road makes it even more difficult to carve out a budget. Additionally, overstretched staff are being asked to do more with less at a time of crisis.

The experts agreed that it’s important to keep your own mental health on an even keel before even considering trying to enact nation- or state-wide policies. But if you can, the message from Saxena was clear. “Use all your innovative thinking and act here and now.” Otherwise, it may be too late. – Chris Stokel-Walker

(Photo credit: Johan Mouchet/Unsplash)