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World Mental Health Day October 10, 2020

EFPA asks for significant investment in capacity–building for psychological services.

Funding for mental health has often been the first to be cut during times of austerity

Mental health funding has been a significant concern for some time. Parity of esteem work (WHO, Mental Health Europe, Global Alliance of Mental Illness Advocacy Networks-Europe, GAMIAN-Europe and others) to ensure that mental health is seen as important as physical health has been variably successful, and perceptions have changed or are changing across the globe. However, this has not come with an increase in funding. Many countries are well developed in their thinking about how to deliver psychological interventions, and it is becoming more common to see psychologists contributing to policy, but countries have largely been unable to implement fit for purpose large scale systems. Whilst access has been improved to mental health services ⁽¹⁾, funding for mental health has historically often been the first to be cut during times of austerity (^{2) (3) (4)}.

During the pandemic mental health issues are on the rise and psychological support is ever more key.

As we progress through different phases of the Covid-19 pandemic, mental health issues are on the rise and psychological support is ever more key. A number of issues are contributing to this increase including social isolation, job and financial losses, housing insecurity, loss of coping mechanisms, consequences of working in a front-line job. Internationally, requests for crisis mental health support has increased but routine appointments decreased ⁽⁵⁾ – this provides significant challenges for psychologists to manage workload short and longer term and deal with urgent needs; especially where health care facilities have been converted to covid-19 response units.

Where funding is available, some psychologists are working remotely, but this way of working excludes large parts of societies – those who are digitally excluded. This means that the most vulnerable people in society – those who don’t have or can’t operate the necessary equipment (computer, phone) and/or can’t afford data or call costs are less likely to receive the support they need. For countries to move forward with offering alternative ways of delivering psychological interventions, hidden costs such as impacts on the digitally excluded and training needs for psychologists must be considered.

Whilst international resources are currently appropriately being diverted into Covid-19 responses; medium- and long-term financial planning urgently needs to take account of supporting the mental health of nations alongside other imperatives such as supporting economic recovery and providing vaccinations. This support needs to go further then classical clinical interventions or access to online – interventions.

For example, the use of SMS text messaging (Text4Hope)^(6), an evidence-based program, with prior research supporting good outcomes and high user satisfaction as a convenient, cost-effective, and accessible population-level has been proposed as a mental health intervention for closing the treatment gap.

Psychological services at the community level

We also need to think about delivering psychological services at the community level. Initial efforts have been made on responding to the development, implementation, and evaluation of mental health interventions such as the Conceptual Model of the Emotional Epidemic Curve which combines Mental health preparedness and action framework (MHPAF)⁽⁷⁾ along with The WHO-Global Influenza Preparedness Plan (WHO-GIPP)⁽⁸⁾ or the Optimal Mix of Services: WHO Pyramid Framework.⁽⁹⁾

Without a concurrent, increased focus on mental health, the current increase in mental health issues ⁽⁵⁾ will translate to long term significant mental and physical health issues for individuals and populations.

REFERENCES

⁽¹⁾ Clark et al https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(17)32133-5/fulltext

⁽²⁾ Kings Fund 2015 https://www.kingsfund.org.uk/sites/default/files/field/field_publication_file/mental-health-under-pressure-nov15_0.pdf

⁽³⁾Kerasidou, A., & Kingori, P. (2019). Austerity measures and the transforming role of A&E professionals in a weakening welfare system. PloS one, 14(2), e0212314.

⁽⁴⁾Stuckler, D., Reeves, A., Loopstra, R., Karanikolos, M., & McKee, M. (2017). Austerity and health: the impact in the UK and Europe. European journal of public health, 27(suppl_4), 18-21.

⁽⁵⁾Moreno, C., Wykes, T., Galderisi, S., Nordentoft, M., Crossley, N., Jones, N., … & Chen, E. Y. (2020). How mental health care should change as a consequence of the COVID-19 pandemic. The Lancet Psychiatry

https://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(20)30307-2/fulltext

⁽⁶⁾Agyapong, V. I. O., Hrabok, M., Vuong, W., Gusnowski, A., Shalaby, R., Mrklas, K., … & Cao, B. (2020). COVID-19: Closing the Psychological Treatment Gap during the Pandemic, a Protocol for Implementation and Evaluation of Text4Hope (a Supportive Text Message Program). JMIR Research Protocols.

https://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(20)30307-2/fulltext

Health and Social Care Act 2012, c.7. https://www.legislation.gov.uk/ukpga/2012/7/contents

⁽⁷ Ransing, R., Adiukwu, F., Pereira-Sanchez, V., Ramalho, R., Orsolini, L., Teixeira, A. S.,& Larnaout, A. (2020). Mental health interventions during the COVID-19 pandemic: a conceptual framework by early career psychiatrists. Asian journal of psychiatry, 51.

⁽⁸) The WHO-Global Influenza Preparedness Plan (WHO-GIPP⁾

⁽⁹⁾ Optimal Mix of Services: WHO Pyramid Framework.

With many thanks to the EFPA SC Psychology and Health, EFPA Board Promotion & Prevention and EFPA Executive Council.