Beyond access to psychotropic medicines: treatment coverage amid COVID-19
Authors: Lola Kola
Journal: The Lancet Psychiatry (2021)

Over the past several months of the COVID-19 pandemic, the global health community has been repeatedly reminded that people with diagnosable mental disorders are but a fraction of the population undergoing mental distress. The pandemic continues to shape discourses in global health reforms. We are confronted with the challenges of devising ways of explicitly incorporating mental wellbeing objectives into population-level activities and intersectoral programmes, for these programmes to align with an expanded definition of mental health and wellbeing as an essential part of development. In the updated Comprehensive Mental Health Action Plan 2021–2030, WHO provides global direction for service coverage, in its emphasis on "promotion, prevention, treatment, rehabilitation, care and recovery" efforts through comprehensive and multisectoral approaches from the health and social sectors.1WHOComprehensive Mental Health Action Plan 2013-2030.https://www.who.int/publications/i/item/9789240031029Date: Sept 21, 2021Date accessed: October 15, 2021Google Scholar In The Lancet Psychiatry, Ruth Brauer and colleagues used psychotropic medications as a proxy indicator for service coverage in their analysis of pharmaceutical sales data from 65 countries over a period of 12 years.2Brauer R Alfageh B Blais JE et al.Psychotropic medicine consumption in 65 countries and regions, 2008–19: a longitudinal study.Lancet Psychiatry. 2021; 8: 1071-1082Summary Full Text Full Text PDF PubMed Scopus (51) Google Scholar They identified disparities in access across countries and an increasing trend in consumption rates over the study period (from 28·54 defined daily dose per 1000 inhabitants per day in 2008 to 34·77 defined daily dose per 1000 inhabitants per day in 2019). Their robust data on various psychotropic medications provide a basis for similar comparisons at future periods. Psychotropic medications play a central part in managing a wide range of mental health conditions, and a scarcity of these medications could cause suffering in people with serious mental illness. Notwithstanding the strength of their data and the importance of this study, I would use a wider lens to discuss some of their implications and conclusions within patients' and population mental health needs, amid the current pandemic. The authors concluded with the need for increased efforts in making psychotropic medications available in countries with low consumption for improved access to patients. However, is access to medication enough for patients with mental disorders? Despite the importance of medication in improving the symptoms of mental disorders, other factors within and outside the health-care system interact to determine patient care and health outcomes. In the context of the current pandemic, prolonged isolation, difficulties with coping with stress, and uncertainties about income and housing support are some problems outside the health sectors that have exacerbated pre-existing psychiatric disabilities in people with mental disorders.3Javed A Afzal M COVID-19 and the management of chronic mental illnesses.J Psychosoc Rehabil Ment Health. 2020; 7: 207-208Crossref Scopus (2) Google Scholar These real-life problems that patients face cannot be medicalised in the long term but can instead be addressed with necessary social interventions and practical coping strategies to improve resilience and functioning in everyday life. Existing individual vulnerabilities and high mortality in people with mental disorders are often worsened by lack of supportive health policies and responsive services at the national level to promote physical health needs, as exemplified by the lack of prioritisation of this population for the COVID-19 vaccines in several countries.4The Lancet PsychiatryA matter of priority: COVID-19 vaccination and mental health.Lancet Psychiatry. 2021; 8: 551Summary Full Text Full Text PDF PubMed Scopus (11) Google Scholar Political commitment to mental health partnerships within the health-care sectors is essential to address discrimination and disparities in health care5Jenkins R Supporting governments to adopt mental health policies.World Psychiatry. 2003; 2: 14PubMed Google Scholar to reduce patients' physical disabilities and improve health outcomes. Brauer and colleagues recommended that governments in countries with low consumption "focus on training health-care workers who can prescribe cost-effective psychotropic medicines" to close the gap between needs and available resources. Nonetheless, can the training of health workers be used to address the current burden of mental disorders? The everyday large or small challenges of the COVID-19 pandemic have continued to affect otherwise healthy people's mood, behaviour, or both, particularly given unequal distribution in risk factors to mental ill-health. Several aspects of wellbeing as correlates of mental health in the general population have been reportedly affected by the pandemic,6Dawel A Shou Y Smithson M et al.The effect of COVID-19 on mental health and well-being in a representative sample of Australian adults.Front Psychiatry. 2020; 111026Crossref Scopus (208) Google Scholar and the long-term psychological sequelae of the pandemic remain unclear. Globally, there are indications of inadequate government investment and responses to mental health recovery efforts even in high-income countries, where the number of mental health professionals is 40% higher than in low-income countries.7WHOWHO report highlights global shortfall in investment in mental health.https://www.who.int/news/item/08-10-2021-who-report-highlights-global-shortfall-in-investment-in-mental-healthDate: Oct 8, 2021Date accessed: October 15, 2021Google Scholar The authors rightly recognised the relevance of social partners such as community and religious leaders in mental health promotion and prevention efforts. As countries ease their lockdown rules, schools' wellbeing programmes, workplace organisational policies, community programmes for older people, suicide prevention strategies, and promotion of mental health help-seeking at population levels are examples of programmes outside the traditional health-care settings with the utmost relevance to population mental health and wellbeing. Other possible community partners to widen the mental health workforce and the number of persons eligible for mental health care in the communities include peers, lay community health workers, counsellors, local non-governmental organisation, and local influencers. Digital platforms remain potentially effective channels to reach widespread audiences with health promotion and prevention information8Rauschenberg C Schick A Hirjak D et al.Evidence synthesis of digital interventions to mitigate the negative impact of the COVID-19 pandemic on public mental health: rapid meta-review.J Med Internet Res. 2021; 23e23365Crossref PubMed Scopus (111) Google Scholar to build hope, foster relations, and boost resilience, and to promote social interactions and belongingness for improved population wellbeing. Mental health is "more than just the absence of mental disorders or disabilities".9WHOMental Health: strengthening our response.https://www.who.int/news-room/fact-sheets/detail/mental-health-strengthening-our-responseDate: 2018Date accessed: October 28, 2021Google Scholar A biomedical focus on treatment coverage narrows the population eligible for mental health treatment and the much-needed community workforce to increase mental health service coverage. I declare no competing interests. Psychotropic medicine consumption in 65 countries and regions, 2008–19: a longitudinal studyThe consumption of psychotropic medicines has increased over a 12-year period, and although the absolute growth rate was highest in high-income countries, the relative growth is highest in middle-income countries and especially upper-middle-income countries. Disparities in psychotropic medicine consumption of countries can only partly be explained by geographical location and income. Greater efforts are needed to increase the availability of psychotropic medicines in countries with very low consumption, which is probably due to financial or cultural reasons as well as scarcity of trained health-care professionals to prescribe psychotropic medicines. Full-Text PDF