Concerned that the crisis could lead to a global spike in suicides and drug abuse, UN Secretary-General António Guterres has urged the international community to do much more to protect people facing mounting mental pressures.

Launching the UN policy brief, ‘COVID-19 and the need for action on mental health’, Guterres highlighted how those most at risk today were “frontline healthcare workers, older people, adolescents and young people, those with pre-existing mental health conditions, and those caught up in conflict and crisis”.

According to the UN guidelines, depression and anxiety before the COVID-19 pandemic cost the global economy more than $ 1 trillion per year. Depression affects 264 million people in the world, while around half of all mental health conditions start by age 14, with suicide the second leading cause of death in young people aged 15 to 29.

Alcohol, substance abuse and suicide

In Canada, one report indicated that 20 per cent of the population aged 15-49 have been drinking more alcohol during the pandemic.

“During the COVID-19 emergency, people are afraid of infection, dying and losing family members”, the UN recommendations explain. “At the same time, vast numbers of people have lost or are at risk of losing their livelihoods, have been socially isolated and separated from loved ones, and, in some countries, have experienced stay-at-home orders implemented in drastic ways.”

Women and children are at greater physical and mental risk as they have experienced increased domestic violence and abuse, the UN paper affirms. At the same time, misinformation about the virus and prevention measures, coupled with deep uncertainty about the future, are additional major sources of distress.

Dévora Kestel, director of the Department of Mental Health and Substance Use at the World Health Organization, echoed the message.

She pointed to past economic crises that have “increased the number of people with mental health issues, leading to higher rates of suicide, for example, due to their mental health condition or substance abuse”.

And national data from around the world appear to confirm the increased mental vulnerability of populations, with Kestel citing surveys “showing an increase of prevalence of distress of 35 per cent of the population surveyed in China, 60 per cent in Iran, and 45 per cent in the US”.

Much higher levels of depression and anxiety than normal were also recorded in Ethiopia’s Amhara Regional State last month, the WHO official continued, pointing to the estimated a 33-per-cent prevalence rate of symptoms – a three-fold increase compared with pre-pandemic levels.

General symptoms caused by COVID-19 include headaches, impaired sense of smell and taste, agitation, delirium and stroke, according to the UN paper. Underlying neurological conditions also increase the risk of hospitalisation for COVID-19, it notes, while stress, social isolation and violence in the family are likely to affect brain health and development in young children and adolescents. Social isolation, reduced physical activity and reduced intellectual stimulation increase the risk of cognitive decline and dementia in older adults, the paper adds.

Frontline workers at risk

Data also confirms that medical professionals and other key workers have experienced significant mental health problems linked to the crisis and the day-to-day stresses they are experiencing on the frontline.

“There were some surveys that were done in Canada where 47 per cent of healthcare workers reported (the) need for psychological support – 47 per cent – so almost half of them,” said Kestel. “In China, we have different figures for depression: 50 per cent, anxiety 45 per cent, insomnia 34 per cent.”

One study surveyed healthcare workers in hospitals equipped with fever clinics or wards for patients with COVID-19 in Wuhan and other regions in China. The results, published in the Journal of the American Medical Association Network Open, found participants reported experiencing psychological burden – especially nurses, women, those in Wuhan, and frontline healthcare workers directly engaged in the diagnosis, treatment and care of coronavirus patients.

In another study, not yet peer-reviewed, researchers from the University of Rome surveyed 1379 healthcare providers during Italy’s epidemic at the end of March. Nearly half of those questioned reported symptoms of post-traumatic stress disorder.

The UN paper argues for an institutional overhaul with mental health services moving out of long-term facilities and into the community. 

“In all emergencies, not only in COVID, there is a risk of human rights violations in long-term facilities”, said Dr Fahmy Hanna, technical officer of the Department of Mental Health and Substance Use at WHO. “There is a risk also of neglect in emergency situations in these facilities and there is a risk, also, in situations of disease outbreaks and of pandemic, of exposure of staff and residents to infections.”

Half of Britons experiencing heightened anxiety

In the UK, the Royal College of Psychiatrists (RCPsych) has warned that mental health services are not only dealing with a rise in urgent and emergency cases but are also preparing for a ‘tsunami’ of mental illness still to come. The Office of National Statistics has found that almost half of the population of Great Britain (49.6 per cent) has reported high levels of anxiety. 

Coinciding with Mental Health Awareness Week, a survey by the Royal College of more than 1300 mental health doctors in the UK reveals that 43 per cent of psychiatrists have seen an increase in their urgent and emergency caseload while 45 per cent have seen a reduction in their most routine appointments. 

The pandemic has made it much harder for services to offer routine appointments despite rapid adoption of new ways of working, such as remote consultations and social distancing. There are also concerns that many patients are staying away from mental health services until they reach a crisis point. 

Professor Wendy Burn, president of the Royal College of Psychiatrists, said: “We’re already seeing the devastating impact of COVID-19 on mental health with more people in crisis. But we’re just as worried about the people who need help now but aren’t getting it. Our fear is that the lockdown is storing up problems, which could then lead to a tsunami of referrals. Mental health services will be at risk of being overwhelmed unless we see continued investment.” 

The survey results suggest that the biggest drop-offs in routine care have been in mental health services for older adults, for children and young people, and in general hospitals. This is raising concerns that self-isolation and shielding, school closures and fear of hospitals are impacting on the numbers of patients accessing treatment for mental health. The biggest rises in urgent and emergency cases have been for psychiatrists working with adults and those working in general hospitals. 

Dr Amanda Thompsell, chair of the Faculty of Old Age Psychiatry, said: “We’re worried about the impact of shielding and self-isolation, anxiety about the virus, and the difficulty some older people find in using technology to video-call a doctor. Older people are often reluctant to seek help and their need for mental health support is likely to be greater than ever.” 

Dr Jim Bolton, chair of the Faculty of Liaison Psychiatry, added: “Following a quieter than normal period, we’re now seeing more vulnerable patients presenting in crisis. Many of these patients have suicidal thoughts or have harmed themselves. The pandemic is having a serious negative impact on people with mental illness and we’re worried things could get worse.” 

The survey ran from 1-6 May and attracted responses from 1369 RCPsych members.