COVID-19 and global mental health
Authors: Zeus Aranda, Fátima Gabriela Rodríguez-Cuevas
Journal: The Lancet Psychiatry (2021)

In The Lancet Psychiatry, Lola Kola and colleagues1Kola L Kohrt BA Hanlon C et al.COVID-19 mental health impact and responses in low-income and middle-income countries: reimagining global mental health.Lancet Psychiatry. 2021; 8: 535-550Summary Full Text Full Text PDF PubMed Scopus (379) Google Scholar suggested three dimensions that could change the way global mental health is framed to achieve equitable mental health coverage worldwide: context, stakeholders, and sectors. Here we share one of our interventions as an example of how these dimensions should be addressed. Our organisation, Partners in Health Mexico (Compañeros En Salud), has been working for 10 years in the rural Sierra and Fraylesca regions of Chiapas, Mexico. Chiapas has severe socioeconomic adversity, with 77% of the population living in poverty.2Consejo Nacional de Evaluacion de la Politica de Desarrollo SocialInforme de pobreza y evaluación Chiapas 2020.https://www.coneval.org.mx/coordinacion/entidades/Documents/Informes_de_pobreza_y_evaluacion_2020_Documentos/Informe_Chiapas_2020.pdfDate: 2020Date accessed: March 22, 2021Google Scholar The regions supported by Compañeros En Salud are also afflicted by a high burden of mental illness, with an estimated prevalence of depression of 7·9%,3Elliott ML Aguerrebere M Elliott PF Depression in rural communities and primary care clinics in Chiapas, Mexico.J Epidemiol Glob Health. 2019; 9: 103-106PubMed Google Scholar which is exacerbated by a shortage of health-care professionals, with less than one psychiatrist per 100 000 inhabitants.4Heinze G Chapa GC Carmona-Huerta J Los especialistas en psiquiatría en México: año 2016.Salud Ment. 2016; 39: 69-76Crossref Scopus (21) Google Scholar Given the scarcity of mental health personnel in Chiapas, in 2014, Compañeros En Salud decided to introduce a mental health programme. In June, 2019, the programme piloted a version of the Problem Management Plus intervention, which has been scaled up during the COVID-19 pandemic. This low-intensity psychological intervention was designed by WHO as a therapy to be provided by non-specialists, targeting adults impaired by distress and common mental disorders in communities exposed to adversity.5WHOProblem Management Plus (PM+): individual psychological help for adults impaired by distress in communities exposed to adversity. World Health Organization, Geneva2018Google Scholar We hereby describe how this intervention addresses the three dimensions suggested by Kola and colleagues. With regard to context, the communities served by Compañeros En Salud experience funding shortages for health-care professionals and infrastructure. However, these communities have deep ties to the land and to each other that have been strengthened over several decades. The organisation identified this as a resource for improving community access to mental health care. In terms of stakeholders, we implemented the Problem Management Plus intervention through a local workforce of female community mental health workers. 80% of the workforce had experienced mental health issues at some point in their lives. Therefore, by providing mental health care through community mental health workers, we help empower women in the community, ensure that the care provided is socioculturally appropriate, and promote that patients benefit from providers' lived experiences. As for sectors, we offer integrated mental health care to our patients. Through collaboration with the Compañeros En Salud referrals programme, we provide accompaniment, food, and transportation to patients who require access to specialised mental health services in the state. We also cooperate with other programmes and Ministry of Health services so that patients have access to other health services and those with greater socioeconomic vulnerability have access to social support packages. During the COVID-19 pandemic, this project has helped provide mental health care to remote rural areas during regular lockdowns that prevented people from accessing care outside their communities. Community mental health workers have acquired a major role in ensuring community wellbeing during these hard times, combining their tasks as mental health providers with the distribution of occupational psychosocial toolkits among community households during physical distancing. This model provides an example of how local leadership-based interventions appear as a compelling approach to relieve underserved communities from the burden of mental illness which has been exacerbated by the pandemic. We declare no competing interests. COVID-19 mental health impact and responses in low-income and middle-income countries: reimagining global mental healthMost of the global population live in low-income and middle-income countries (LMICs), which have historically received a small fraction of global resources for mental health. The COVID-19 pandemic has spread rapidly in many of these countries. This Review examines the mental health implications of the COVID-19 pandemic in LMICs in four parts. First, we review the emerging literature on the impact of the pandemic on mental health, which shows high rates of psychological distress and early warning signs of an increase in mental health disorders. Full-Text PDF COVID-19 and global mental healthIn The Lancet Psychiatry, my colleagues and I describe the mental health services and supports mobilised in the initial months of the COVID-19 pandemic in low-income and middle-income countries (LMICs).1 In our Review, we describe how humanitarian organisations with expertise in mental health began issuing guidelines in February, 2020, to manage the pandemic's effects on mental health, and many LMICs integrated this guidance into national response plans for mental health. The Review documents widespread innovation in LMICs to increase mental illness detection and maintain treatment during lockdowns. Full-Text PDF COVID-19 and global mental healthWe are inspired by the optimistic tone of the comprehensive Review by Lola Kola and colleagues1 of mental health initiatives in low-income and middle-income countries (LMICs) during the COVID-19 pandemic. However, reading the paper from the point of view of Latin America and the Caribbean (LAC), we are not as optimistic as the authors, for three reasons. LAC has been deeply affected by the pandemic,2 even more than other LMICs; the region has structural inequities and a high prevalence of informal work;3 some countries in LAC already faced challenges to the implementation of mental health care reform before the pandemic. Full-Text PDF COVID-19 and global mental health – Authors' replyWe appreciate the insightful responses to our position paper on global mental health and COVID-19. We note the consensus that the COVID-19 pandemic is an opportunity to strengthen mental health care globally, and particularly that the emergence of a global pandemic has highlighted the value of learning from countries with experience in regularly responding to such outbreaks and other emergencies. The examples given of lessons in mental health and psychosocial support that can be applied in the USA are very well observed. Full-Text PDF COVID-19 and global mental healthWe welcome the review in The Lancet Psychiatry by Lola Kola and colleagues1 on COVID-19 and mental health in low-income and middle-income countries (LMICs). Our view is that this could have gone further to call on universities in high-income countries (HICs), and academics working within them, to make changes to improve equity with universities and academics in LMICs. Given that universities in HICs hold disproportionate power and funding, we propose that a fundamental shift is needed. Imbalances in power and privileges are seen right across global health, with one study finding that 80% of leaders of global organisations active in health were citizens of HICs, 90% were educated in HICs, and 70% were men. Full-Text PDF