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HEALTH

Q&A: Post COVID-19 Pandemic Let’s Stop the Next Wave of Medicalisation over Mental Health

By Samira SadequeReprint | |

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The wall at a Community Mental Health Movement in Brazil. Credit: Mario Osava/IPS

UNITED NATIONS, Jun 26 2020 (IPS) - The current pandemic is not only heightening mental health concerns, but might also put many at risk of becoming institutionalised or being neglected by the system.

This is according to Dainius Pūras, the United Nations special rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health.

Pūras recently voiced his concerns about the “historical neglect of dignified mental health care,” that has been even more heightened under the pandemic.

“Before the pandemic, I critically addressed the current status quo of global mental health, and now with this pandemic my position is: even more I would recommend to rethink how we invest in mental health,” Pūras, a medical doctor with notable expertise in mental health and children’s health, told IPS.

He added that there are two principles used when addressing mental health: a human rights and evidence-based approach. Currently, under the pandemic, the latter has come under attack with a massive amount of misinformation and false news spreading, which he says can affect mental health of people and their communities.

Excerpts of the interview with Pūras follow. Some of the answers have been paraphrased for clarity.

Inter Press Service (IPS): In what ways has the pandemic affected mental health of people?

Dainius Pūras (DP): During a pandemic, there are risks that if a person has a mental health condition, he or she might be hospitalised by force. Also, because of the virus, there might be suspicions that this person may spread the virus, which poses an additional risk factor for discriminating against people with mental health concerns.

There should be more research done but there are many insights and preliminary observations that this pandemic will probably have a serious impact on the mental health of individuals and societies.

There are several reasons for this: the spread of the virus and requirements for distancing and isolation, plus economic and social [effects] and employment also increase different forms of violence for example domestic violence. All these will fuel mental distress, anxiety, fear, all these feelings of uncertainty about the future

I should highlight — another serious risk factor is that we witness massive amounts of fake news, disinformation, conspiracy theories around the virus, the origin of the virus and around statistics. This is not good for mental health.

When children are not going to school, they’re missing out on very important aspects of socialisation. For many children, it’s their only way to get a meal — physical and mental health are interrelated in these ways.

IPS: What is one of the current challenges of addressing mental health issues, especially under the pandemic?

DP: I don’t support the narrative that this pandemic fuels mental distress, fear, anxiety, and the narrative that more mental illnesses will come. It’s not about producing more mental illness — it makes people anxious and scared but that’s a part of normal life, I do not want to medicalise that.

We need to work against pathologisation and medicalisation. Because if we say millions of people are now more anxious than before, does it mean we will go on globally with medicalisation? Does it mean we will suggest psychological medication to all these people including children and adults?

I’m not against medication but when I analyse global situations, for sure this has gone too far. Feelings have been medicalised. I am warning that with this pandemic there would be a next wave of medicalisation. That when people are anxious and not happy, there might be an attempt to “medicalise them even more than before”. We have to be creative and to think of some innovative forms of support and cure, not necessarily medicalise.

IPS: What are the risks involved for those with mental health at this time?

DP: More and more people are diagnosed. But then because of this diagnosis they’re discriminated against. And also because of that, in many parts of the world, many suffer from institutionalisation: sometimes that can be lifelong.

Sometimes that’s because of a lack of services in the community and [as a result] they live in institutions but now we know these institutions are hotspots for the virus. As for many countries, the closed spaces, such as prisons or psychiatric institutions are now making it worse given how dangerous it can be for residents and staff because the virus can spread.

IPS: Are there certain communities more vulnerable to facing mental health risks in this pandemic?

DP: Many people who were already left behind will suffer disproportionately… So, in many parts of the world, LGBT people are discriminated against, people with disabilities other than psycho-social ones we discussed, and those with physical disability, indigenous people, migrants and refugees in difficult situations, and also the prison population — these people are at more risk.

IPS: The issue of mental health appears to have multiple layers of barriers: financial means and social stigma. How do you navigate both financial concern as well as social stigma of this issue?

DP: My approach is that we always have to keep in mind the principles and then we will not be lost when it’s concrete. We should follow non-discrimination, empowerment, accountability and other principles.

The problem is all these global mental health [responses] are based on discriminatory approaches; for example, if a person is diagnosed with a mental health condition or illness they could be discriminated against by mental health law in their country.

Next week, I will be presenting many arguments to the Office of the High Commissioner of Human Rights (OHCHR) about the need for a shift in paradigm instead of making small changes. A shift is needed. There is too much: the biomedical model is overused; its okay but when it’s overused, it’s harmful.

IPS: What’re your hopes going forward?

DP: With this pandemic what I’m emphasising in my statement; now we should be finally convinced that we need to move ahead with reducing the number of these [mental health] institutions, with a final goal of abandoning this legacy.