Managing Mental Health Amid COVID-19 Crisis and Beyond

After recording more than 250,000 cases of COVID-19, Pakistan has been able to achieve a declining trend in the number of cases due to prudent approach of the government. However, the evolving and unpredictable situation has induced anxiety, fear, depression and psychological stress not only due to health concerns and social isolation, but also the potential impact on livelihoods and financial security. This situation has highlighted the urgent need for promoting mental health in the country to protect the overall well-being of people. Under the focus area of enabling improved patient care, the PKR 1 billion Hussain Dawood Pledge has partnered with The British Asian Trust and IRD Pakistan to promote mental health support among frontline workers and the general population directly affected by COVID-19 crisis.

Despite the passage of Mental Health Ordinance (MHO) of 2001, there has been limited progress towards improved management and service provision towards mental health in Pakistan. According to the most recent data provided by World Health Organization, 24 million of the country’s population is facing mental health problems and 10,000 individuals have only 0.19 psychiatrist availability. Therefore, at a time when COVID-19 is likely to aggravate the mental health crisis, it is critical to mitigate its impact by adapting behaviours and lifestyle, removing the stigma around mental health and including psychological interventions as part of the healthcare system, especially over the long run.
Adapting Behaviours and lifestyle
All indications suggest that the COVID-19 is here to stay. Therefore, people need to adapt their behaviours to this new normal and develop greater self-awareness to cope with the psychological pressures. On the health side, the behaviours that need to be reinforced include regular hand washing and maintaining a healthy diet, and physical activity. These improved health and hygiene precautions can help alleviate mental health concerns and reduce the chances of contracting the virus. Mental health can also be improved by practicing mindfulness, personal growth and building resilience. The social isolation time can be utilized effectively to practice introspection and developing new skills that can potentially ensure greater employability in the job market based on the emerging trends. 
Removing Stigma, Increasing Access to Mental Health Services
The social stigma around accepting and discussing mental health problems is one of the key reasons why Pakistan is facing a mental health crisis today. There is lack of mental health awareness and limited access to treatment options in the country. To improve the mental health situation in Pakistan, especially amid the COVID-19 pandemic, it is critical to enhance the outreach of mental health services and change community attitudes towards mental health in Pakistan.
According to the UN policy brief on mental health, the governments should support “community action that strengthens social cohesion, solidarity and healthy coping, reduces loneliness and promotes psychosocial well-being.” Further, as COVID-19 restricts movements and access to physical healthcare facilities, innovations to mental healthcare should be encouraged to promote remote and technology-based support services for mental health needs. It is also important that psychiatrists and mental health practitioners provide empirically-evidence based perspectives on misinformation and normalize communities about the mental health issues.
As part of the strategic partnership with The Dawood Foundation, The British Asian Trust will develop outreach services to provide mental health support and referral for frontline workers, patients screened and tested for COVID-19 through the Indus Health Network and other partner hospitals, and the public in general as well. The program will be executed in collaboration with IRD Pakistan, a health delivery and research organization that has devised specific mental health interventions catered to healthcare providers and population affected by COVID-19. 
Mental Health Reforms and Long-Term Psychological Interventions   
Back in 2013, 194 countries including Pakistan had adopted the comprehensive mental health action plan (2013-2020) proposed by WHO. Yet, mental health has remained on the backburner and concerted efforts are required to mainstream mental health in the country.
Even though the Mental Health Ordinance (MHO) of 2001 exists at the federal level, we need to have a national mental health policy on priority. There is a dire need to set a clear roadmap and goals to overcome the mental health challenges and support this agenda by implementing effective legislation. In line with the WHO action plan, mental healthcare should be integrated into primary care and non-specialised health settings rather than mental hospitals and tertiary care facilities. At the same time, development of information systems and research should be undertaken in partnership with non-governmental organizations, community and private sector players in the health industry to promote evidence-based mental health interventions. In view of the low number of mental health professionals in Pakistan, there is also a need to invest in building human resource capacity for delivery of quality mental health and social care. 
It is imperative that we not only prioritize physical health but also take adequate steps to cater to the growing mental health concerns as we continue to fight COVID-19. Considering the current low status of mental health in Pakistan, concerted efforts are needed to introduce major changes in the healthcare sector to promote the accessibility and awareness about mental health services. Otherwise, the overall well-being of the population is likely to remain compromised and put the healthcare sector under immense pressure over the long run.

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