Statement on the future of mental health, rights and recovery in the European Region

Dr. Hans Henri P. Kluge, WHO Regional Director for Europe

October 2020, Mental Health Europe high-level seminar

2020 will be a year that we remember as one that shook the world and brought many countries to their knees. An unimaginable number of lives and livelihoods have been lost to COVID-19. Families and communities have been forced apart, businesses bankrupted and people deprived of opportunities that a year ago were taken for granted.

However, we have a way forward to create important change. As WHO Regional Director for Europe, I am prioritizing efforts on mental health in three main ways:

1. Addressing the stigma and misinformation that exacerbate suffering
2. Bringing mental health care to the community
3. Reforming policy and increasing investment.

To understand where we need to go, we must first understand where we have been

… and that means examining the toll the pandemic has taken on the mental health and well-being of individuals.

From anxieties around virus transmission and the psychological impact of quarantine and self-isolation to the effects of unemployment, financial worries and social exclusion – the mental health impact will be long term and far reaching. And, it is very clear that although impacted differently, no demographic or age group has been spared.

Elderly populations faced increased exposure to isolation, loneliness and social exclusion so they could protect themselves physically. Other adults had to navigate daily uncertainty around employment, income and how to meet the needs of their families. Health workers carried an enormous mental health burden in the workplace, often without adequate support.

Although children and adolescents can contract and transmit COVID-19, they have largely been spared from the direct health effects of the virus, with most cases of COVID-19 in these age groups being mild or asymptomatic. Despite this, they continue to be negatively impacted by mitigation measures that may inadvertently do more harm than good, such as school closures.

Overall the harmful effects of the pandemic have not been distributed equally. The poor and vulnerable have been hit most severely and often with the least access to the essential services they so fundamentally deserve.

Services were disrupted as demand increased

During the acute phase of the pandemic, lockdown measures were implemented across the Region and resources were reallocated to deal with the virus. As with primary health care and treatment of noncommunicable diseases, mental health services were dramatically disrupted.

Now that we are recovering and reassessing the health priorities, we must determine how to appropriately address the increased psychosocial needs of the population at a time when services have been so heavily disrupted.

COVID-19 has revealed that when necessary, we can make enormous policy and societal shifts for the benefit of our populations. Health, including mental health, must become central to efforts to recover in the wake of the pandemic.

With a growing acknowledgement of the importance of mental health, we need to adequately respond

Even before the challenging events of 2020, I had identified mental health as a core need and priority in the European Region. Working as a doctor for Médecins Sans Frontières in several complex contexts I saw first-hand the impact that inadequate services and deep stigma have on mental health. This became a catalyst for my work in strengthening health systems for WHO.

During my campaign for Regional Director, I travelled across the Region meeting with ministries of health. Each visit brought the issue to the fore. There was a growing concern about the public health challenge of mental health, the impact of stigma and increasing inequalities.

In response, I made mental health a key priority in the vision for health of the WHO European Region, the European Programme of Work 2020–2025 – “United Action for Better Health”. This strategic workplan was unanimously endorsed by our Member States with strong input from non-state actors at the Regional Committee session held last month, during which there was substantial support for the mental health agenda.

This agenda is being operationalized through a Mental Health Coalition. The coalition will exist under the auspices of Sustainable Development Goal Advocate, Her Majesty Queen Mathilde of the Belgians. It will bring together Member States, innovators and advocates, but most importantly includes service users and providers.

The coalition has three main goals:

1. Addressing stigma and discrimination
2. Bringing mental health care to the community
3. Reforming policy and investment structures

Addressing stigma

It is unacceptable that individuals with mental health conditions – and their families – are subject to stigma, discrimination and victimization. The Coalition will build on efforts to eliminate stigma and discrimination by engaging communities and increasing mental health literacy, including concerted efforts with health workforces across the Region.

Bringing mental health care to the community

The opportunity to integrate health and well-being into all sectors means that new ways of working are progressing with speed. In Belgium for instance, we met July, a woman whose care was revolutionized and much improved when mobile teams were deployed to provide home services. We have a growing evidence base that multisectoral networks providing varied assistance at the community level can be a vital lifeline for individuals dealing with mental health challenges.

The pandemic has demonstrated the true potential of digital mental health solutions. This new frontier can help us better meet the needs of patients with pre-existing conditions and those with newly presenting mental health challenges.

Our mental health and social care workers are integral to these efforts. No real reforms in mental health care are possible without truly recognizing the value of this workforce and prioritizing their needs.

Reforming policy and investment

In the wake of the pandemic, we can better understand the scale of the mental health toll and prioritize efforts to address its impact. There is a new sensitivity to, and awareness of, the importance of good mental health, and the need to invest in care that is informed by the strongest evidence.

This renewed awareness provides a unique opportunity for greater investment in providing these services at the community level and in initiatives that fight stigma and inform communities.

I am confident that by coming together through “United Action for Better Health” we can truly make a difference. I invite Mental Health Europe, Member States, the European Commission, Members of the European Parliament and other partners represented here today to contribute to our efforts to advocate for mental health as part of the broader health and well-being agenda.

As we come to terms with the impact that COVID-19 has had on our lives, there is great scope to better meet the varied health needs of our communities. The joint trauma of the pandemic provides us with an opportunity to reshape the way we care for each other and create a shared environment of health and well-being.