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COVID-19 disrupting critical mental health services

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A social worker (left) and a psychologist (second from left) give colouring and exercise books to children in eastern Ukraine, during a home visit to meet with the family. © UNICEF/Pavel Zmey

The global pandemic has disrupted critical mental health services in 93 per cent of the countries it surveyed, underscoring the devastating impact of COVID-19 and highlighting an urgent need to scale up funding, the UN World Health Organization (WHO) has said. 

Announcing the findings on Monday, the UN health agency also said that the pandemic has increased the need for the vital services. 

COVID-19 has interrupted essential mental health services around the world just when they’re needed most,” said Tedros Adhanom Ghebreyesus, WHO Director-General, calling on world leaders to “move fast and decisively to invest more in life-saving mental health programmes – during the pandemic and beyond.” 

“Good mental health is absolutely fundamental to overall health and well-being,” he added. 

Bereavement, isolation, loss of income and fear are triggering mental health conditions or exacerbating existing ones. Many people may be facing increased levels of alcohol and drug use, insomnia, and anxiety, according to WHO. 

COVID-19 itself can lead to neurological and mental complications, such as delirium, agitation, and stroke. People with pre-existing mental, neurological or substance use disorders are also more vulnerable to SARS-CoV-2 infection – they may stand a higher risk of severe outcomes and even death. 

Survey findings 

The survey – conducted between June and August 2020, covering 130 countries – evaluated how the provision of mental, neurological and substance use services changed due to COVID-19, the types of services disrupted, and how the countries are adapting. 

It showed that while many countries (70 per cent) adopted telemedicine or teletherapy to overcome disruptions to in-person services, there were significant disparities among them. More than 80 per cent of high-income countries reported deploying such measures to bridge gaps, compared with less than 50 per cent of low-income countries, said WHO. 

Findings also showed that counselling and psychotherapy were disrupted in 67 per cent of the countries, 65 per cent reported impact on critical harm reduction services, and 45 per cent on treatment for opioid dependence.  

More than a third (35 per cent) reported disruptions to emergency interventions, including those for people experiencing prolonged seizures, severe substance use withdrawal syndromes, and delirium, often a sign of a serious underlying medical condition. Three in ten countries also reported disrupted access for medications for mental, neurological and substance use disorders.  

The results were released ahead of the UN health agency’s Big Event for Mental Health – a global online advocacy event on 10 October, which will highlight the need for increased investments in mental health in the wake of COVID-19. 

Ensure resources for essential services  

Recalling its guidance on maintaining essential services – including mental health services – during COVID-19, WHO urged countries to allocate resources to mental health as an integral component of their response and recovery plans.  

According to the survey results, while 89 per cent of countries reported that mental health and psychosocial support is part of their national COVID-19 response plans, only 17 per cent among them reported having full additional funding to cover these activities. 

“This all highlights the need for more money for mental health,” said WHO, noting that as the pandemic continues, even greater demand will be placed on national and international mental health programmes that have suffered from years of chronic underfunding.  

Prior to the pandemic, countries were spending less than 2 per cent of their national health budgets on mental health, and struggling to meet their populations’ needs, the UN agency added, calling for greater resources for the sector, including from international partners as mental health receives less than 1 per cent of international aid earmarked for health. 

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Time to address mental health issues in the workplace

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With an estimated 12 billion workdays lost annually due to depression and anxiety, costing the global economy nearly $1 trillion, more action is needed to tackle mental health issues at work, the World Health Organization (WHO) and the International Labour Organization (ILO) said on Wednesday. The UN agencies have launched two publications which aim to prevent negative work situations and cultures while also offering mental health protection and support for employees.  

Performance and productivity affected 

“It’s time to focus on the detrimental effect work can have on our mental health,” said Tedros Adhanom Ghebreyesus, Director-General at WHO, which has issued global guidelines on the issue. 

“The well-being of the individual is reason enough to act, but poor mental health can also have a debilitating impact on a person’s performance and productivity.” 

The WHO guidelines contain actions to tackle risks to mental health at work such as heavy workloads, negative behaviours, and other factors that can create distress. 

For the first time, the UN health agency recommends manager training, to build their capacity to prevent stressful work environments and respond to workers’ needs. 

A workplace taboo 

WHO’s World Mental Health Report, published in June, revealed that of one billion people estimated to be living with a mental disorder in 2019, 15 per cent of working-age adults experienced a mental disorder.  

The workplace amplifies wider societal issues that negatively affect mental health, including discrimination and inequality, the agency said.

Bullying and psychological violence, also known as “mobbing,” is a key complaint of workplace harassment that has a negative impact on mental health. However, discussing or disclosing mental health remains a taboo in work settings globally. 

The guidelines also recommend better ways to accommodate the needs of workers with mental health conditions and proposes interventions that support their return to work. 

Increasing opportunities 

They also outline measures to ease entry into the jobs market, for those workers with severe mental health conditions. 

Importantly, the guidelines call for interventions for the protection of health, humanitarian, and emergency workers. 

A separate policy brief with ILO explains the WHO guidelines in terms of practical strategies for governments, employers and workers, and their organizations, in both the public and private sectors.  

The objective is to support the prevention of mental health risks, protect and promote mental health at work, and support those with mental health conditions, so they can participate and thrive at work.  

“As people spend a large proportion of their lives in work – a safe and healthy working environment is critical,” said, Guy Ryder, the ILO Director-General. 

“We need to invest to build a culture of prevention around mental health at work, reshape the work environment to stop stigma and social exclusion, and ensure employees with mental health conditions feel protected and supported.” 

ILO’s Convention on occupational safety and health, and a related recommendation, provide legal frameworks to safeguard workers.  

Lack of national programmes 

However, only 35 per cent of countries reported having national programmes for work-related mental health promotion and prevention. 

The COVID-19 pandemic triggered a 25 per cent increase in general anxiety and depression worldwide, according to a WHO study published in March. 

The crisis exposed how unprepared governments were for its impact on mental health, as well as a chronic global shortage of mental health resources.  

In 2020, governments worldwide spent an average of just two per cent of health budgets on mental health, with lower-middle income countries allocating less than one per cent. 

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A good night’s sleep is a tonic to remember

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BY ANTHONY KING

Everyone suffers restless nights from time to time. Chewing over failures or worries at the end of the day undermines rest, especially deep sleep. ‘A ruffled mind makes a restless pillow,’ wrote author Charlotte Brontë.  

A good night’s sleep serves as a tonic. What’s more, it is long recognised that shuteye gives learning and memory a boost. More recently, scientists revealed that the early phase of deep slow-wave sleep is especially important.

‘When you learn something in the evening, that information becomes reactivated during sleep,’ said Dr Bjoern Rasch, who took part in the Horizon-funded MemoSleep project and is a professor at the University of Fribourg.

The Swiss researcher added that ‘Ruminations and negative thoughts increase our awakenings during sleep, make us wake earlier than we want and make us sleep less deeply.’ 

Reactivated thoughts

But there is good news too. Positive thoughts can also be reactivated in brain circuits and, in the process, improve sleep, according to Dr Rasch. He organized an experiment around the whole idea.  

His test was a small boon to students in his university who received 50 Swiss francs (EUR 52) for every night they spent snoozing in a comfortable four-bed sleeping laboratory.

The students were connected to an electroencephalogram that monitored their brain waves. They also had their muscles monitored to record when they fell into slumber and what sleep-state they were in.

Some relaxation strategies allow people to fall asleep faster, but don’t change the quality of sleep afterwards, according to Dr Rasch. He played hypnotic tapes with imagery such as a fish swimming in deep water, and with words suggestive of safety and relaxation, for the students.

‘The subjects spent more time in the deeper slow-wave sleep stage after listening to the hypnotic tape,’ said Dr Rasch. ‘We would explain this by an increased reactivation of relaxing and reassuring thoughts during sleep, heard previously during the hypnosis tape.’

In future studies, Dr Rasch hopes to help patients who suffer from insomnia. 

‘It could not only help them fall asleep but could actually make their sleep more restful,’ he said. Furthermore, this could aid people with psychological illnesses, such as post-traumatic stress disorder, who sleep poorly.

Seahorses and learning

The seahorse-shaped part of the brain called the hippocampus (from the Greek word for seahorse) is especially important for learning and memory. Scientists often use rodents to investigate their hippocampus in learning and sleep.

Rats, for example, are masters at remembering paths through mazes to find foods. The hippocampus is key to this recall.  

Dr Juan Ramirez-Villegas uses rodents to probe how mammalian brains store memories – work that could eventually contribute to fighting human illnesses such as Alzheimer’s. 

As part of the Horizon-funded DREAM project, he discovered that another part of the brain – the brainstem – plays a crucial role along with the hippocampus and becomes active beforehand.

‘It seems like the brainstem is setting up some scenery so that the hippocampus can reactivate memories across different stages of sleep,’ said Dr Ramirez-Villegas, who is a postdoctoral fellow at the Institute of Science and Technology Austria. 

He has attached electrodes to record activity in the brains of rats as they navigate a maze and afterwards as they sleep. Sleeping allows the brain to replay daytime events and etch them as long-term memories. 

‘It is very striking that the cells fire in the same order during sleep that they did during learning, but they are more compressed in time during sleep,’ said Dr Ramirez-Villegas.

How we remember

The discovery was surprising because it suggests that the brainstem has an overlooked function in stimulating and changing memory formation. This seems to be true for rodents as much as for primates and, as a result, is likely to be a basic mechanism of the brains of mammals, including people. 

The research, while crucial to understanding the basic operation of the brain, could have clinical benefits too. ‘We are untangling the basic principles of memory processes, but we can also use these to ameliorate the effects of memory-related illnesses,’ said Dr Ramirez-Villegas.

The research in this article was funded via the EU’s European Research Council and the Marie Skłodowska-Curie Actions (MSCA). This article was originally published in Horizon, the EU Research and Innovation Magazine. 

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Noncommunicable diseases now ‘top killers globally’

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From heart disease to cancer and diabetes, noncommunicable diseases (NCDs) now outnumber infectious diseases as the “top killers globally,” the UN health agency said in a new report, released on Wednesday, with one person under 70 dying every two seconds from an NCD.

The report and new data portal, was launched on the sidelines of the 77th session of the General Assembly, at an event co-organized by the World Health Organization (WHO) together with Bloomberg Philanthropies.

Report assets

NCDs constitute one of the greatest health and development challenges of this century, according to WHO.

Chief among them are cardiovascular diseases, such as heart disease and stroke; cancer; and diabetes and chronic respiratory diseases – as well as mental health illnesses.

Together they account for nearly three-quarters of deaths in the world, taking 41 million lives every year. 

The report, Invisible numbers: The true extent of noncommunicable diseases and what to do about them, highlights NCDs statistics to illustrate the true scale of the threats and risk factors they pose. 

It also shows cost-effective and globally applicable interventions that can lower those numbers and save lives and money.

“This report is a reminder of the true scale of the threat posed by NCDs and their risk factors,” said WHO chief Adhanom Ghebreyesus.

Country-specific portal

Sharing the latest country-specific data, risk factors and policy implementation for 194 countries, the NCD data portal brings the numbers in the report to life. 

Moreover, it allows data exploration on cardiovascular diseases, cancer, diabetes and chronic respiratory diseases along with their main drivers and risk factors, which include tobacco, unhealthy diet, harmful use of alcohol and lack of physical activity. 

The portal spotlights patterns and trends throughout countries and allows comparison across nations and/or within geographical regions.

Important timing

To date, only a handful of countries are on track to meet the 2030 Sustainable Development Goal (SDG) target of reducing early deaths from NCDs by a third.  

And yet, NCDs are at the heart of sustainable development and their prevention and treatment is a prime opportunity for investment that would have myriad impacts on economic growth, far outweighing the money spent.

“It is a misconception” that they are “diseases of high-income countries”, said Bente Mikkelsen, WHO’s Director of Noncommunicable Diseased, adding that a full 85 per cent of all premature deaths happen in low and middle-income countries.

At a critical juncture for public health, WHO said that the new information offers a chance to address the issue and recommends spending more on prevention.

Investing $18 billion a year across all low and middle-income countries could generate net economic benefits of $2.7 trillion by 2030.

At the event, the WHO chief called on global leaders to take urgent action on NCDs and renewed the two-year appointment of Michael R. Bloomberg as WHO Global Ambassador for Noncommunicable Diseases and Injuries – his  third reappointment since 2016.

“As we continue to respond to this pandemic and prepare for the next, we have seen the critical importance of addressing a major risk factor in COVID-19 hospitalizations and deaths – noncommunicable diseases,” said Mr. Bloomberg.

He maintained that they can often be prevented with investment in “proven, cost-effective interventions” and looked forward to continuing to make “life-saving investments in NCD and injury prevention” alongside WHO.

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