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Child mental health crisis ‘magnified’ by COVID

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A seven-year-old child looks out the window in Istanbul, Turkey, during the COVID-19 emergency. Closure of schools, disruption of health services and suspension of nutrition programmes, due to the coronavirus pandemic, have affected hundreds of millions of children globally. Photo: UNICEF

Half of the world’s children experience violence on and offline in some form every year, with “devastating and life-long consequences” for their mental health, the UN chief warned a symposium on the issue on Thursday.

In a video address to an event organized within the on-going High-Level Political Forum (HLPF), on mental health and wellbeing, he said that mental health services have long suffered from neglect and underinvestment, with “too few children” accessing the services they need.

Services cut

“The COVID-19 pandemic has magnified the problem. Millions of children are out of school, increasing their vulnerability to violence and mental stress, while services have been cut or moved online.

“As we consider investing in a strong recovery, support for children’s mental wellbeing must be a priority”, said Secretary-General António Guterres.

“I also urge governments to take a preventive approach by addressing the determinants of mental well-being through robust social protection for children and families”, he added, saying that mental health and psychosocial support, together with community-based approaches to care, are “integral to universal health coverage. They cannot be its forgotten part.”

Child’s view paramount

He also urged authorities everywhere to take the views and lived-experiences of children themselves, exposed to increasing on and offline threats, into account when formulating policies and protection strategies.

“Children play an important role in supporting each other’s mental wellbeing. They must be empowered as part of the solution. Let’s work together for sustainable, people-centered, resilient societies, where all children live free from violence and with the highest standards of mental health”, he concluded.

Children contribute

The meeting co-organized with the Permanent Mission of Belgium to the United Nations, and the Group of Friends on mental health and wellbeing, featured a video with contributions from children from 19 countries who took action to support one another.

UN Special Representative on Violence Against Children, Maalla M’jid, highlighted the devastating impact of violence on the mental health of children: “Exposure to violence and other adverse childhood experiences can evoke toxic responses to stress that cause both immediate and long-term physiological and psychological damage.

“In addition to the human cost, the economic cost of mental illness is significant”, she added.

Opportunity for change

The recovery phase of the pandemic, provides an opportunity for countries to invest in this field, she said, emphasizing that “we cannot go back to normal. Because what was ‘normal’ before the pandemic was not good enough, with countries spending on average only 2% of their health budgets on mental health.

“In addition to more investment, we need to change our approach to mental health. Building on the lessons of the pandemic, mental health and child protection services must be recognized as life-saving and essential.

“They must be incorporated into both emergency preparedness and longer-term planning and children must also shape the design, delivery and evaluation of responses”, she added.

The meeting contributed to raising awareness of the impact of violence on the mental health of children, both before and during the COVID-19 pandemic.

Examples were shared of effective approaches to supporting children’s mental health from different regions and in different settings; to identify what steps are needed to embed mental health best practices; put child protection and social protection services into action to build back better after the pandemic, while also supporting the Decade of Action to deliver the SDGs by 2030.

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Health & Wellness

COVID-19 deaths at lowest level in nearly a year

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A thermometer gun is used to take a boy's temperature in Sri Lanka. © UNICEF/Chameera Laknath

Although COVID-19 deaths continue to decline, vaccine inequity persists, the head of the World Health Organization (WHO) said on Wednesday, again calling for greater support for developing countries.

Agency chief Tedros Adhanom Ghebreyesus reported that the death toll from the disease is now at its lowest level in almost a year. 

“But it’s still an unacceptably high level – almost 50,000 deaths a week, and the real number is certainly higher,” he said, speaking during the regular WHO briefing from Geneva. 

“Deaths are declining in every region except Europe, where several countries are facing fresh waves of cases and deaths.  And of course, deaths are highest in the countries and populations with the least access to vaccines.” 

Tedros appealed for global cooperation. “Countries that continue to roll out boosters now are effectively preventing other countries from vaccinating their most at-risk populations,” he said. 

Missing the mark 

As of Wednesday, there were more than 238 million COVID-19 cases worldwide, and more than 4.8 million deaths. 

WHO had previously pushed governments to vaccinate 10 per cent of their populations by the end of September, a target which 56 nations missed, most of them in Africa. 

Tedros said even more countries are at risk of missing the 40 per cent target to be achieved by the end of the year.  Three countries – Burundi, Eritrea and the Democratic People’s Republic of Korea – have yet to start vaccinations. 

 “About half of the remaining countries are constrained by supply. They have a vaccination programme underway, but don’t have enough supply to accelerate enough to reach the target,” he said. 

Tedros urged countries and companies that control global vaccine supply to prioritize distribution to the COVAX solidarity initiative and the African Vaccine Acquisition Trust (AVAT). 

Meanwhile, WHO and partners are working with other countries, such as those affected by fragility or conflict, to strengthen technical and logistical capacity for vaccine rollout. 

“With aggressive and ambitious action, most of these countries can still reach the 40% target by the end of this year, or be on a clear pathway to reaching it.” 

Crisis in Tigray 

Tedros also addressed the escalating crisis in northern Ethiopia, where a nearly year-long war in the Tigray region has left up to seven million people in urgent need for food and other assistance. 

The conflict has spilled over into neighbouring Afar and Amhara, further increasing needs and complicating response efforts. Aid is not reaching the area “at anywhere close to the levels needed”, he said, and communications, electricity, other basis services remain cut off. 

WHO and partners are calling for unfettered access to the affected regions, as the lives of millions of people are at stake, Tedros told journalists. 

“People with chronic illnesses are dying due to lack of both food and medicine. Nearly 200,000 children have gone without critical vaccinations,” he said   

“When people do not have enough food, they are more susceptible to deadly diseases, as well as the threat of starvation, and that’s what we’re now seeing in Tigray.”

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Global health community prescribes climate action for COVID recovery

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Street scene in India. © UNICEF/Vinay Panjwani

Ambitious national climate commitments are crucial for States to sustain a healthy, green recovery from the COVID-19 pandemic, according to a new UN health agency report launched on Monday in the lead-up to the COP26 climate change conference in Glasgow, Scotland.

Based on a growing body of research confirming numerous and inseparable links between climate and health, the World Health Organization’s (WHO) COP26 Special Report on Climate Change and Health spells out that transformational action in every sector, from energy, transport and nature to food systems and finance is needed to protect people.

The COVID-19 pandemic has shone a light on the intimate and delicate links between humans, animals and our environment”, said WHO chief Tedros Adhanom Ghebreyesus. “The same unsustainable choices that are killing our planet are killing people”.

An urgent call

WHO’s report was launched at the same time as an open letter, signed by over two thirds of the global health workforce – 300 organizations representing at least 45 million doctors and health professionals worldwide – calling for national leaders and COP26 country delegations to step up climate action. 

“Wherever we deliver care, in our hospitals, clinics and communities around the world, we are already responding to the health harms caused by climate change”, the letter from the health professionals reads.

“We call on the leaders of every country and their representatives at COP26 to avert the impending health catastrophe by limiting global warming to 1.5°C, and to make human health and equity central to all climate change mitigation and adaptation actions”.

Fossil fuels ‘killing us’

Both the report and open letter come as unprecedented extreme weather events and other climate impacts are taking a rising toll on everyone.

Heatwaves, storms and floods have taken thousands of lives and disrupted millions of others while also threatening healthcare systems and facilities when they are needed most, according to WHO.

Changes in weather and climate are threatening food security and driving up food-, water- and vector-borne diseases, such as malaria, while climate impacts are also negatively affecting mental health.  

“The burning of fossil fuels is killing us. Climate change is the single biggest health threat facing humanity”, states the WHO report. And while no one is safe from the health impacts of climate change, “they are disproportionately felt by the most vulnerable and disadvantaged”.

Climate actions far outweigh costs

Meanwhile, air pollution, primarily the result of burning fossil fuels, which also drives climate change, causes 13 deaths per minute worldwide, according to WHO. 

The report states clearly that the public health benefits from implementing ambitious climate actions far outweigh the costs. 

“It has never been clearer that the climate crisis is one of the most urgent health emergencies we all face”, said Maria Neira, WHO Director of Environment, Climate Change and Health.

“Bringing down air pollution…would reduce the total number of global deaths from air pollution by 80 per cent while dramatically reducing the greenhouse gas emissions that fuel climate change”, she pointed out.

Dr. Neira added that a shift to more nutritious, plant-based diets “could reduce global emissions significantly, ensure more resilient food systems, and avoid up to 5.1 million diet-related deaths a year by 2050”.  

Call to action

Although achieving the Paris Agreement on climate change would improve air quality, diet and physical activity – saving millions of lives a year – most climate decision-making processes currently do not account for these health co-benefits and their economic valuation.  

Tedros underscored WHO’s call for all countries to “commit to decisive action at COP26 to limit global warming to 1.5°C – not just because it’s the right thing to do, but because it’s in our own interests”, and highlighted 10 priorities in the report to safeguard “the health of people and the planet that sustains us.”

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Health & Wellness

World misses most 2020 mental health targets

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At a time when the COVID-19 pandemic is highlighting a growing need for mental health support, there has been a worldwide failure to provide people with the services they need, a report by the World Health Organization (WHO) has concluded.

Released on Friday, the latest edition of the Mental Health Atlas ‘paints a disappointing picture, which shows that increased attention given to mental health in recent years has yet to result in a scale-up of quality mental services that are aligned with needs.

‘Extremely concerning’

“It is extremely concerning that…good intentions are not being met with investment,” Tedros Adhanom Ghebreyesus, Director-General of the WHO said.

“We must heed and act on this wake-up call and dramatically accelerate the scale-up of investment in mental health because there is no health without mental health.”

 “Investments in mental health data and in strengthening services are needed so countries can build back better post COVID-19,” Dr. Tarun Dua, WHO Unit Head, Department of Mental Health and Substance Use, said at the release of the report in Geneva.

The cost of low investment in community-based health services is too high, she added, stating that mental, neurological and substance abuse services were the most disrupted health services during the pandemic.

“COVID-19 has provided us with a new opportunity to reflect on services, their equitable distribution and prevention programmes, so it’s an opportunity to build back better…Lost productivity costs a trillion dollars a year, so we should be investing, as for every dollar invested the return is five dollars”, added Dr. Fahmy Hanna, from WHO’s Department of Mental Health and Substance Use.

2020 targets missed

According to the report, which includes data from 171 countries, none of the targets for effective leadership and governance for mental health, provision of mental health services in communities, mental health promotion and prevention, or targets for strengthening of information systems, were close to being achieved.

In 2020, just 51 per cent of WHO’s 194 Member States reported that their mental health policy or plan was in line with international and regional human rights instruments, way short of the 80 per cent target.

And only 52 per cent of countries met the target relating to mental health promotion and prevention programmes, also well below the 80 per cent target.

The only 2020 target met was a reduction in the rate of suicide by 10 per cent, but even then, only 35 countries said they had a stand-alone prevention strategy, policy or plan, the report stated.

Massive inequalities 

Although gaps exist globally, there has been steady progress seen in the adoption of policies, plans and laws, as well as improvements in capacity to report regularly across years on a set of core mental health indicators, the report found.

Despite this, the  percentage of government health budgets spent on mental health has scarcely changed during the last years, still hovering around two per cent.

The Mental Health Atlas 2020 also shows massive inequalities in the availability of mental health resources and their allocation between high- and low-income countries and across regions.

More encouraging was the increase in countries reporting mental health promotion and prevention programmes, from 41 per cent of Member States in 2014 to 52 per cent in 2020.

Decentralized care is slow

The decentralization of mental health care to community settings has long been recommended by WHO.

However the report found that more than 70 per cent of total government expenditure on mental health was allocated to mental hospitals in middle-income countries, compared with 35 per cent in high-income countries.

This indicates that centralized mental hospitals and institutional inpatient care still receive more funds than services provided in general hospitals and primary health-care centres in many countries, the report said.

New targets for 2030

The global targets reported on in the Mental Health Atlas are from WHO’s Comprehensive Mental Health Action Plan, which contained targets for 2020.

This plan has now been extended to 2030 and includes new targets for the inclusion of mental health and psychosocial support in emergency preparedness plans, the integration of mental health into primary health care, and research on mental health.

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