EHS-COVID (383) COVID-19 and mental health services (3)

7 June, 2021

The guidance on mental health is available on pages 37 and 38 of Maintaining essential health services: operational guidance for the COVID-19 context interim guidance

https://www.who.int/publications/i/item/WHO-2019-nCoV-essential-health-s...

Extracts are shown below in relation to our five discussion questions.

A new version of the Guidance is planned. We would like to invite your thoughts on the existing guidance and how this can be improved.

Q1. What has been the impact of COVID-19 on the MENTAL health of people in your country?

Q2. What has been the impact of COVID-19 on the MENTAL health of health workers in your country/facility?

Q3. How has COVID-19 affected the delivery of essential MENTAL health services in your health facility or country?

Q4. What has been the impact of health service disruptions on the MENTAL health and wellbeing of people in your health facility or country?

Q5. What have you, your health facility or country done to maintain essential MENTAL health services?

Q1. The WHO Guidance has this to say on the impact of COVID-19 on mental health:

'Mental health conditions include a range of mental, neurological and substance use (MNS) disorders and their associated psychosocial, cognitive and intellectual disabilities. The direct and indirect consequences of the pandemic impact these conditions in many different ways. Major stressors are a potent risk factor for the development, exacerbation and relapse of a range of MNS disorders and unhealthy patterns of behaviour, including the use of alcohol and psychoactive drugs and excessive gaming or gambling. Among people with substance use disorders, disruption of the supply of alcohol and drugs during the pandemic can result in severe withdrawal states. COVID-19 itself is associated with neurological manifestations, such as delirium, encephalopathy, agitation, stroke and meningoencephalitis. Social isolation, reduced physical activity and reduced cognitive stimulation may increase the risks of cognitive decline and dementia, and people with dementia have higher susceptibility to COVID-19 and higher rates of death associated with the disease.'

Q4. The WHO guidance notes:

'The disruption of care for MNS disorders can be life-threatening, such as in the cases of interruptions to treatment for epilepsy, unaddressed suicide risk, disrupted harm reduction services, and unmanaged opioid overdose and

severe alcohol withdrawal syndromes. It may also lead to increased contact with the criminal justice system or expose people to intolerable suffering (such as in severe depression, acute psychosis, opioid withdrawal or severe

dementia), and can have an impact on child development in the case of antenatal or postnatal MNS disorders. WHO recommends that mental health services be enhanced and strengthened in the pandemic context. Providing safe care for MNS disorders in prisons and detention centres is a priority, given the high rates of MNS disorders in incarcerated populations and the high risk of infection in confinement.'

Best wishes, Neil

Neil Pakenham-Walsh, HIFA Coordinator, neil@hifa.org www.hifa.org