Mental Health and Substance Abuse
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27 March 2020- The Mental Health and Substance Use Unit hosted a virtual seminar for PAHO and Ministry of Health mental health focal points in Latin America on mental health and psychosocial support (MHPSS) for health professionals involved in the COVID-19 response. The webinar was coordinated by Drs. Carmen Martinez and Andrea Bruni, the mental health advisors for Central America and South America, respectively. Presenters included Dr. Bruni; Miguel Ángel Castejón Bellmunt of Fundación Manantial, a mental health foundation based in Spain; and Dr. Luz María Salazar, consultant at PAHO/WHO Colombia.
Health professionals, including doctors, nurses, technicians, social workers, among others are at the front line of the COVID-19 outbreak response, exposing them to numerous hazards and stressors that can tax their mental health and wellbeing. Such hazards include pathogen exposure, long working hours, psychological distress, fatigue, occupational burnout, stigma, and physical and psychological violence.
Dr. Bruni provided recommendations for health teams responding to the COVID-19 outbreaks. He highlighted the importance of self-care, such as the need to rest, exercise, maintain a healthy diet, and avoid the use of tobacco, alcohol, and drugs for stress relief. Other key strategies include maintaining communication with loved ones, seeking out support from colleagues, and trying to recall and put into practice strategies that have worked on other occasions to manage stress. Dr. Bruni then presented the main principles of action of Psychological First Aid (PFA), a resource used to provide support to people in distress.
In his presentation, Dr. Castejón Bellmunt emphasized that health professionals require priority care in the context of the COVID-19 outbreak and response. This care can come from three different areas: the work organization; the professionals themselves; and the method of working. Organizations can ensure the necessary protection measures by the authorities (masks, gloves, etc.), allow and facilitate teleworking, make support and health services available for persons with disabilities, and make functions and tasks more flexible and to enhance versatility and exchange. Health professionals themselves can recognize themselves as vulnerable in this context, give themselves permission to rest, and focus on the present while avoiding negative anticipation. As a whole, it is recommended that health professionals face the COVID-19 situation collectively by trying to feel part of the community they are supporting and connecting with the mission that they are developing.
Dr. Luz María Salazar shared a presentation on Colombia’s mental health response to the COVID-19 pandemic, with a focus on health professionals. Key actions that have been taken include webinars and training workshops for health personnel on topics such as managing stress and preventing burnout, and a psychological support line available through virtual media.
A recording of the webinar can be found at (available only in Spanish): https://paho.webex.com/paho/lsr.php?RCID=2d232b5f5438092f130ebbfa845c6653
On 23 March, the WHO launched the document Considerations During the COVID 19 Outbreak. The document has been subsequently translated into Spanish, Portuguese and French. On 26 March PAHO hosted 2 webinars – in English and in Spanish – to explain the key concepts and actions contained within the document. People with disabilities may be at greater risk of contracting COVID 19 due to inaccessible public health messaging, barriers to preventative measures and difficulties in enacting physical distancing. Further, people with disabilities may be at risk of worse health outcomes if they contract COVID-19 depending on underlying health conditions and due to barriers and exclusion within health services.
It is vital that people with disabilities are fully included within the planning and implementation of COVID-19 initiatives. PAHO has begun to collaborate with organizations of persons with disabilities including The Latin American Network of Non-Governmental Organizations of Persons with Disabilities and their Families (RIADIS) to ensure that the voice of the disability community is heard and included. RIADIS has supported PAHO to develop some of the PAHO’s Spanish public health videos in international sign language.
5 practical approaches for ensuring people with disabilities are being included in the COVID response are:
- Coordinate actions with Disabled People’s Organisations and disability leaders.
- Engage sign language interpreters, closed captioning providers and other disability expert providers for inclusive public health messaging.
- Ensure facilities are accessible, staff are trained and policies do not discriminate against people with disability.
- Ensure COVID-19 testing and protective equipment for people with disability, household members and caregivers.
- Where possible, collect data on people with disability within surveillance
Dublin, Ireland, 9-12 March, 2020 The global alcohol policy conference is the largest gathering of research and advocates working on alcohol policy. The conference was sponsored by WHO, the Global Alcohol Policy Alliance (GAPA), Institute on Alcohol Studies, Forut and Movendi International. Due to the COVID-19 pandemic, of the 412 registered participants, about 340 participated from 47 countries. A few speakers sent videos or connected online. The conference was opened by the Minister of Health of Ireland, announcing sweeping changes in their alcohol national policy, based on the "best buys" recommended by WHO. A central topic of the conference was the interference of the alcohol industry in all aspects of alcohol policy, at local, national, regional and global levels.
Dr Maristela Monteiro, senior advisor on alcohol, presented in several sessions, on the activities carried out by PAHO since the launching of WHO SAFER technical package, as well as on regional barriers and opportunities to achieve a reduction in harmful use of alcohol. Dr Beatriz Champagne, from the Healthy Latin American Coalition on NCDs (CLAS), presented in several sessions, providing a perspective on what NGOs are doing in Latin America, as well as the gaps and challenges to advance civil society participation. As a result of her participation, CLAS is now a member organization of GAPA.
Dr Monteiro also had three posters: one with key findings from the upcoming regional report on alcohol and health; the SAFER initiative in the Americas, and on indicators for trials on screening and brief interventions from a Latin American perspective (results from a regional study sponsored by PAHO and the National Institute of Psychiatry, first author was Dr Marcela Tiburcio Sainz, who could not attend the conference).
COVID-19: addressing mental health needs and providing psychosocial support during the pandemic in the Region of the Americas: Plan of action 2020-
The mental health and psychosocial wellbeing of populations are profoundly affected by the COVID-19 pandemic. Fear, anxiety/worry, and uncertainty are common reactions in all of the affected countries. However, for some people, these reactions can be more prolonged, severe and disabling, leading to increases in mental disorders in the Region. Additionally, extreme stressors may induce, worsen or exacerbate pre-existing mental health conditions.
In response to this growing threat, PAHO’s Mental Health and Substance Use Unit has developed a Plan of Action to guide mental health and psychosocial support (MHPSS) actions in the context of the COVID-19 outbreak in the Americas, entitled “COVID-19: addressing mental health needs and providing psychosocial support during the pandemic in the Region of the Americas: Plan of action 2020.” The goal of the Regional plan, aligned with the WHO MHPSS plan, is to reduce suffering and improve the mental health and psychosocial wellbeing of people in the Region of the Americas affected by the global COVID-19 pandemic.
The structure of the plan follows the five pillars of the PAHO/WHO Regional COVID-19 Incident Management Strategic Plan, and below are the areas covered in each pillar:
- Communications (developing, adapting and disseminating communications materials related to MHPSS during COVID-19);
- Strengthening Health Systems (building MHPSS response capacity, supporting the mental health of healthcare workers, and protecting persons in institutions);
- Epidemic Intelligence (generating evidence on MHPSS and COVID-19 and supporting countries in rapid appraisal and monitoring);
- Public Health Measures (enabling digital/virtual MHPSS and strengthening cross-disciplinary coordination and integration); and
- Enabling Functions (staff wellbeing and information).
The Plan is a living document, intended to inform PAHO COVID-19 MHPSS technical activities as well as countries’ response to the developing mental health and psychosocial needs of their populations. The Plan incorporates key evidence-based recommendations for action. The COVID-19 MHPSS response plan encompasses short-, medium-, and longer-term actions, with the long-term aim of building back stronger mental health systems. Country contexts within the Region differ widely, and countries may choose to prioritize actions that are most relevant to their context, or use the Plan as guidance in developing more specific national action plans.
December 2019 saw the end of the 5-year Plan of Action on Disabilities and Rehabilitation. The plan, the first of its kind, has seen progress made in the Region to better address the health needs of persons with disabilities and to strengthen and extend rehabilitation services within the Americas. However, it is clear that there is much more to be done in this area and although some countries are beginning to establish good programmes in the health sector for people with disabilities and strengthen their rehabilitation services across all levels of health, others are not yet making strong progress.
According to Antony Duttine, PAHO’s Regional Advisor on Disability and Rehabilitation, “the need for rehabilitation services across the Americas is increasing since people are living longer, but doing so with more short and long term health conditions that impact on functioning and quality of life. Its important that the momentum that has begun through the Plan of Action continues to grow. At the same time, people with disabilities continue to face significant barriers to everyday health services due to inaccessibility, cost, inexperience of healthcare professionals and, at times, discrimination. We therefore need to dramatically increase the visibility of this as an issue of health inequality”.
The Final Report of the Plan of Action will be presented at the 58th Directing Council in September 2020. During the Directing council a report on Habilitation and Rehabilitation in the Americas is due to be officially launched, compiling potential need for rehabilitation and workforce data within the countries of the Americas.