The impact of COVID-19 on mental, neurological and substance use services: results of a rapid assessment

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Executive summary

The World Health Organization (WHO) has identified mental health as an integral component of the COVID-19 response. Its rapid assessment of service delivery for mental, neurological and substance use (MNS) disorders during the COVID-19 pandemic, on which this report is based, is the first attempt to measure the impact of the pandemic on such services at a global level. The data were collected through a web-based survey completed by mental health focal points at ministries of health between June and August 2020. The questionnaire covered the existence and funding of mental health and psychosocial support (MHPSS) plans, the presence and composition of MHPSS coordination platforms, the degree of continuation and causes of disruption of different MNS services, the approaches used to overcome these disruptions, and surveillance mechanisms and research on MNS data.

In total, 130 (67%) WHO Member States, across all WHO regions, submitted answers to the survey. Data were disaggregated by region, income group and stage of transmission of COVID-19.

The vast majority, 116 or 89% of responding countries, reported that MHPSS response is part of their national COVID-19 response plans. However, only 17% of these countries have ensured full additional funding for MHPSS covering all activities.

Two-thirds (65%) of responding countries have a multisectoral MHPSS coordination platform for COVID-19 response, and more than 65% of these countries include the ministries of health, social/family affairs and education and also nongovernmental organizations as part of these platforms.

Almost half (51%) of responding countries reported that ensuring the continuity of all MNS services was included in the list of essential health services in their national COVID-19 response plan, while 40% of countries reported the inclusion of some MNS services in the list of essential health services in their national response plan.

To understand government policies on access to a range of MNS services, the status of closure of existing services was checked across different categories and settings. A total of 10 types of services for MNS disorders were included, such as inpatient and outpatient services at mental hospitals; outpatient services, inpatient psychiatric and neurological units as well as treatment of substance use disorders at general hospitals; and services for MNS disorders at primary health care, residential, home and day care services at community level. No country reported a full closure of all services; but in only 7% of responding countries were all services fully open, with 93% of countries reported disruptions in one or more of their services for MNS disorders.

There were differences in the types of service affected by closure, with outpatient services in mental and general hospitals as well as community-based services predominantly more affected. For example, community-based services were more impacted compared with inpatient facilities, with full or partial closure in more than 40% of countries and home care and day care services reaching levels of full or partial closure in 60–70% of countries.

Countries were also asked to report on disruption (complete or partial) of delivery of specific MNS interventions. For the purpose of the survey, complete disruption was defined as more than 50% of users not served as usual, and partial disruption as between 5% and 50% of users not served as usual.
One-third (33%) of responding countries reported complete or partial disruption across at least 75% of specific MNS-related interventions/services. This level of disruption was the highest within countries in the community transmission stage of COVID-19 (44%).

An important finding is that some life-saving emergency and essential MNS services were reported as being disrupted; 35% of countries reported some disruption of management of emergency MNS manifestations (including status epilepticus, delirium and severe substance withdrawal syndromes) and 30% reported disruption in supply of medications for people with MNS disorders.

Prevention and promotion mental health services and programmes were most severely affected. Around three-quarters of school mental health or workplace mental health services were wholly or partially disrupted. Approximately only 30% of mental health services for children and adolescents or for older adults were available with no disruption, and fewer than 40% of antenatal or postnatal mental health services were not disrupted. Almost 60% of all psychotherapy and counselling services were reported as partially disrupted. Overdose prevention and management programmes and critical harm reduction services were disrupted in more than 50% of countries.

The main causes of disruption were identified as a decrease in outpatient volume due to patients not presenting, travel restrictions hindering access to health facilities for patients and a decrease in inpatient volume due to cancellation of elective care.

Community-based services and mental health prevention and promotion programmes, already limited in availability, are reported to be disrupted at a time when society needs them the most due to the adverse mental health impacts COVID-19.

Countries have responded to the disruption of MNS services in multiple ways. Some 70% of countries have responded by using telemedicine/teletherapy to replace in-person consultations (this included use of any remote contact, such as telephone or video conferencing). Other measures that were reported include helplines for MHPSS (68%) and specific measures for infection prevention and control in mental health services (65%). Training in basic psychosocial skills for health care providers working in COVID-19 treatment centres was the most common approach in low-income countries (60%). Generally speaking, however, interventions such as task sharing through building the capacity of general health workers seem to be underutilized in many countries (38%).

Slightly more than half of responding countries (53%) were reported to be collecting data on MNS disorders or manifestations in people with COVID-19, and two-thirds (66%) of countries reported ongoing or planned studies related to the impact of COVID-19 on mental health. A gap was identified in the areas of substance use and neurology research related to the pandemic.

This report provides key insights into the extent of disruption of MNS services and measures being adopted in response. Certain limitations should be kept in mind when examining the results of this rapid assessment; these include the limitations associated with self-reported data, particularly concerning judgements often being made by a single focal point.

The survey highlights the need to strengthen the monitoring of changes in service availability, delivery and utilization at country level, and to establish informed decision making on required adaptations and strategies for MNS services during the pandemic. WHO has published Maintaining essential health services: operational guidance for the COVID-19 context (1) which should be considered when making specific adaptations and considerations for safe delivery and restoration of MNS services, including emergency acute care and outpatient care guidance.