What is the MASC Project?
Prior to the Covid-19 pandemic, mental health care was only being delivered to a small minority of people in the world who have mental illness, a challenge called the ‘treatment gap’. For people with severe depression, for example, only 22%, 11% and 4% of those in high-, medium- and low-income countries, respectively, receive minimally effective treatment. It is anticipated that the needs for mental health care will increase during and after the pandemic, while mental health services may be degraded, which together can: (i) risk an increase in the mental health treatment gap; (ii) compromise the UN ‘Right to Health’, and (iii) be a fundamental set back in relation to the UN Sustainable Development Goals aim to ‘Leave No-one Behind’.
This project is framed within the concept of the ‘mental health treatment gap’, defined as the difference between the number of people who receive care and those who need care for mental disorders. In LMICs, over 80% of the population with severe mental disorders are left without treatment (1) and only 16.5 (2) of the people with depression have access to minimally adequate care. As a result, symptoms persist and lead to health deterioration, ostracism, and people with a long-term disability become socially isolated and stop being economically productive. In LMICs, disorders like these account for 7.4% of the global burden of disease (3, 4), but due to limited supply and demand in treatment only 0.5% of countries’ health budgets go towards mental health. Community mental health is scarce and specialists are in short supply and mostly hospital-based (6).
The UN 2030 Agenda for Sustainable Development recognised the importance of mental health within its Goals, Targets and Indicators (5). For example, task shifting has been recommended by the World Health Organization (WHO) as a way to strengthen non-specialist workforce and improve access to health care, including mental health care (2). This requires well trained primary health care staff (PHC), able to identify and treat mental health disorders (8). In reality however, PHC staff from LMICs lack the necessary skills, show the same level of stigma towards people with mental illness as the general public (9) and can be hesitant to receive mental health training (10). These attitudinal supply-side barriers visible in PHC centres are coupled with the negative attitudes among the local community which prevent people with mental health disorders from seeking help (demand- side barriers) (11-15). This is why if the global burden of disease (4, 16), premature mortality (5, 6), and stigma and discrimination (7) are to be reduced, a global effort is required. The MASC project contributes to redress the treatment gap by gathering information on whether the Covid-19 pandemic has adversely reduced or deteriorated the provision of services for people with mental health problems.
The impact of the global Covid-19 pandemic on mental health
It is anticipated that the needs for mental health care will increase during and after the pandemic (8, 9), while the provision of mental health services may be degraded, which together can have the following adverse consequences for mental health services and for people with experience of mental ill health:
(1) risk an increase in the mental health treatment gap;
(2) compromise the UN ‘Right to Health’,
(3) be a fundamental set back in relation to the UN Sustainable Development Goals aim to ‘Leave No-one Behind’.
Aims and objectives of the project
In this context, the project aim is to answer the question: What are the implications for global mental health services of the Covid-19 pandemic in sentinel low- and middle-income countries (LMICs)?
The project objectives are:
(1) identify what the consequences of the COVID-19 pandemic are for mental health services in LMICs; (2) record their frequency and severity;
(3) provide baseline data for a grant application on a prospective study of these issues;
(4) identify examples of good practice and disseminate this information.
The project was developed on partnership with the following countries and institutions:
• Chile, Programa Salud Mental, Escuela de Salud Pública, University of Chile, Santiago
• Ethiopia, Addis Ababa University
• Georgia, Ilia State University
• Nigeria, University of Ibadan
• South Africa, University of Cape Town, Department of Psychiatry and Mental Health
• Ukraine, Institute of Psychiatry of Taras Shevchenko National University of Kyiv
• Netherlands, Federation: Global Initiative on Psychiatry
• USA, Columbia University, Psychiatric Epidemiology Training Program
• UK, King’s College London
Papers, outputs and reports will be published soon. For more information on the project, please contact Prof Charlotte Hanlon, at King's College London.
References:
1. Wang PS, Aguilar-Gaxiola S, Alonso J, Angermeyer MC, Borges G, Bromet EJ, et al. Use of mental health services for anxiety, mood, and substance disorders in 17 countries in the WHO world mental health surveys. The Lancet. 2007;370(9590):841-50.
2. Thornicroft G, Chatterji S, Evans-Lacko S, Gruber M, Sampson N, Aguilar-Gaxiola S, et al. Undertreatment of people with major depressive disorder in 21 countries. The British Journal of Psychiatry. 2017;210(2):119-24.
3. Saxena S, Thornicroft G, Knapp M, Whiteford H. Resources for mental health: scarcity, inequity, and inefficiency. The Lancet. 2007;370(9590):878-89.
4. Whiteford HA, Degenhardt L, Rehm J, Baxter AJ, Ferrari AJ, Erskine HE, et al. Global burden of disease attributable to mental and substance use disorders: findings from the Global Burden of Disease Study 2010. The Lancet. 2013;382(9904):1575-86.
5. Thornicroft G, Votruba N. Does the United Nations care about mental health? The Lancet Psychiatry. 2016;3(7):599-600.
6. Organization WH. Comprehensive mental health action plan 2013–2020. Geneva: World Health Organization. Geneva: World Health ORganization; 2013.
7. Organization WH. Task shifting: rational redistribution of tasks among health workforce teams: global recommendations and guidelines. Geneva; 2007.
8. Hanlon C, Fekadu A, Jordans M, Kigozi F, Petersen I, Shidhaye R, et al. District mental healthcare plans for five low-and middle- income countries: commonalities, variations and evidence gaps. The British Journal of Psychiatry. 2016;208(s56):s47-s54.
9. Henderson C, Noblett J, Parke H, Clement S, Caffrey A, Gale-Grant O, et al. Mental health-related stigma in health care and mental health-care settings. The Lancet Psychiatry. 2014;1(6):467-82.
10. Abdulmalik J, Kola L, Fadahunsi W, Adebayo K, Yasamy MT, Musa E, et al. Country contextualization of the mental health gap action programme intervention guide: a case study from Nigeria. PLoS Medicine. 2013;10(8):e1001501.
11. Clement S, Schauman O, Graham T, Maggioni F, Evans-Lacko S, Bezborodovs N, et al. What is the impact of mental health- related stigma on help-seeking? A systematic review of quantitative and qualitative studies. Psychological Medicine. 2015;45(1):11-27. 12. Koschorke M, Padmavati R, Kumar S, Cohen A, Weiss HA, Chatterjee S, et al. Experiences of stigma and discrimination of