Psychosocial support during Covid-19
According to the World Health Organization (WHO), worldwide, nearly 1 billion people are suffering from some form of mental disorder and in every 40 seconds, one person is committing suicide. The situation is worsening gradually. Not only does this affect people's personal life, but it also eventually affects the global economy too. Just depression and anxiety, two of the more prominent mental health conditions, costs the world USD 1 trillion each year. According to the Bangladesh Mental Health Survey 2018-2019, the prevalence of any type of mental disorder among adults (age 18-60+ years) is 16.8 percent and children (age 7-17 years) is 13.6 percent. The percentage is higher among females than males (17.0 vs. 16.7) and urban adults than rural adults (18.7 percent vs. 16.2 percent). Interestingly, it is the opposite among children where the percentage is higher among boys than girls (14.6 vs. 12.7) and rural children than urban children (13.8 percent vs. 13.0 percent).
Despite having a new policy and strategic plan in place, evidence from Bangladesh shows that the mental health needs of the people have not been addressed adequately. The possible reasons for lagging in delivering mental health needs are that neither the policy nor the strategic plan has been implemented, lack of mental health related human resources, limited share in the health budget, and the absence of mental healthcare system up to the grass-root level. Moreover, stigma and discrimination related to mental health conditions refrain patients and their families from seeking such services.
With the increasing demand for mental health services and a huge gap in their availability, the Covid-19 pandemic might be the last straw that broke the camel's back. On the one side, mental health service is going through a major disruption due to the pandemic. On the other, the pandemic has increased the demand for mental health services. Firstly, people are experiencing social isolation, frustration, boredom, fear of infection, financial loss, loss of near and dear ones, inadequate supplies, inadequate as well as confusing information, and stigma. It's triggering negative psychological effects like stress, confusion, and anger; or aggravating existing situations like increased levels of alcohol and drug use, insomnia, and anxiety; or worsening pre-existing mental health conditions. Emerging research findings are claiming that the Covid-19 itself can lead to certain complications like delirium, agitation, and stroke, and on the contrary, people who have pre-existing mental health conditions have a higher risk of experiencing more severe outcomes. So, the need for mental health services at a mass scale is needed now more than ever.
In LMICs (low-to-middle-income countries) like Bangladesh where the health budget is less than 1 percent of its GDP and mental health is at the bottom of the priority list, the shift is very crucial yet challenging. Here, a low cost and scalable at mass with limited resource intervention would be necessary. A recently published research suggested that involving CHWs (community health workers) during the pandemic and beyond for delivering mental health services in the community could be a great strategy for LMICs. This study was led by Sabuj Kanti Mistry, a researcher from Bangladesh and his colleagues from Nepal and Australia, and has suggested some potential strategies to engage CHWs, such as provide psychosocial support either face-to-face or over the telephone to address anxiety, depression, and suicide, connect people with nearby mental health resources, fostering societal support, capacitating people in stress management skills, empowering self-efficacy of people, imparting health literacy, providing a listening ear and reflective empathy.
There is no doubt about the widespread stigma and discrimination related to mental health treatment that impacts the health-seeking practices for mental health problems. So, community-based psychosocial counselling through non-medical health workers like community health workers for common mental disorders can be the possible solution for a country like Bangladesh. The idea is not totally new as non-medical health workers have a history of providing support to the family members, assisting in the outreach activities, and ensuring adherence. A randomised control trial carried out in Nepal assessed the effectiveness of non-medical health worker-led psychosocial counselling in a rural setting and the intervention was found to be remarkably effective. Economic evaluations provided evidence that these kinds of interventions are not only cost-effective but also cost-saving. The paper also pointed out that CHW based psychosocial counselling can be a cost-effective alternative, especially in the pandemic situation. However, adequate training should be ensured for the CHWs so that they become well equipped before providing psychosocial support.
WHO has already felt the need and took a special initiative for mental health where they will scaling up interventions and services across "community-based settings" along with advancing mental health policy, advocacy, and human rights. "Guidance on community mental health services" has already been prepared to promote person-centred and rights-based approaches. National Mental Health Policy, Bangladesh, 2019 also emphasised on the community-based approach for mental healthcare.
If mental health issues are left unaddressed, Bangladesh may not be able to achieve some of the SDGs. Therefore, it is crucial to invest in prevention methods today. In a vastly resource-poor setting where there is a high demand for mental healthcare like Bangladesh, experimenting with an alternative option for delivering effective treatments to psychological problems by community health workers is highly recommended.
Nazia Islam is a Policy Analyst for Brac Advocacy for Social Change Programme. Email: [email protected]
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