Move for Mental Health: Let’s

Invest
Opinion Editorial by WHO Representative to Maldives, Dr Arvind Mathur, on the occasion
of World Mental Health Day 2020

Globally, 10th October marks World Mental Health day each year and
this year it comes at a time when our daily lives have changed
remarkably as a result of the COVID-19 pandemic.

The spread of COVID-19 and its accompanying safety measures have

understandably disrupted people’s routines and daily lives, leading to
stress and anxiety. The struggle to return to a new normal itself can be
overwhelming. Our frontline health-care workers across the country
continue to provide care in hard-hitting circumstances, still serving the
nation despite the fear of bringing COVID-19 home to their own
families. Our students and teachers are adjusting to study and teach
classes through virtual means, while missing their fellow classmates
and colleagues, and sharing the uneasiness about their own futures.

Our local and migrant workforce whose livelihoods and steady income
have been threatened throughout the pandemic and many may fall into
poverty. People with mental health conditions have been experiencing
even greater social isolation than ever before. And all this cannot even
equate to managing the grief of losing a loved one to COVID-19,
sometimes without being able to get any closure, or without being even
able to say their last goodbye. The economic consequences of the
pandemic can be seen and felt, as major companies and smaller local
businesses have let their staff go, to save their businesses or some
may have shut down completely.

In Maldives, there have been increased reports of COVID-19 related psychological distress. It
is expected that the necessity for mental health and psychosocial support will substantially
increase in the coming months and years. Therefore, investment in mental health
programmes at the national and international levels, is now crucial more than it has ever
been. Accordingly, the slogan of this year’s World Mental Health Day campaign is ‘increased
investment in mental health’.
Around the world, close to one billion people have a mental disorder and anyone, anywhere,
can be affected. A term often heard but misinterpreted; ‘Depression’ remains still one of the
leading causes of illness and disability among adolescents and adults worldwide. Suicide is
claiming the lives of close to 800 000 people every year (meaning; 1 person every 40
seconds) and is the second leading cause of death for young people aged 15-29 years. This
is a particularly alarming number, as Maldives itself is home to a large youth population; with
majority falling into the same age criteria.

In low- and middle-income countries, more than 75% of people with mental health conditions
receive no treatment for their condition at all. The serious gaps that still exist in mental health
care are a result of chronic under-investment over many decades in mental health promotion,
prevention and care. But there is positive news associated with Mental Health too even
though several people might not realize that the most common mental health conditions such
as depression and anxiety, can be in fact, treated with talking therapies, medication, or a
combination of two.

In recent times, The Republic of Maldives has been making great strides in Mental Health and
Mental Health services. In 2019, His Excellency President of the Maldives inaugurated the
Centre for Mental Health at Indira Gandhi Memorial Hospital. With a multi-disciplinary team,
the center offers emergency care as well as outpatient and inpatient services including
diagnostics, treatment, rehabilitation and occupational therapy which are now also covered
under the local health insurance scheme Aasandha. The center also conducts outreach
programmes in the atolls and seek to raise awareness among the public to evoke behavioral
change towards mental health issues.

Urgent action is required to protect the learning of

all South Asian children
School closures in South Asia are threatening the futures of millions of
children — and the most marginalized are paying the heaviest price.
Governments must prioritize the safe reopening of schools and seize
the opportunity to build education back better.

School closures

Safe reopening

Threatening the future THEMES basic needs

Students/children under threat

Difficult to survive

Safety network

When classrooms closed in South Asia, 434 million children's lives

changed. School is more than just a building. It’s a crucial part of a
child’s life. For many, school provides access to food, health services
and support networks not available at home. For vulnerable children,
it’s also a refuge from abuse, neglect or dysfunctional parenting. When
schools closed, many children were torn from the warmth of their
friends and teachers and left to battle trauma and anxiety without
support. During lockdowns, calls to child helplines rocketed. For children
without access to internet or phones, isolation was compounded.

A recent global UNICEF study into remote learning found that at least 2 in 5 children in South
Asia did not have the tools to access remote learning at home. So when schools closed —
seven months ago — at least 147 million children stopped learning. However, in Nepal, a
recent study found that just 25% of children had used distance learning platforms to continue
learning during school closures.

Decades of progress in access to quality education, especially for girls and the most
marginalized, now hangs in the balance. The most disadvantaged children have fallen the
furthest behind. This includes hundreds of millions of the poorest, the displaced, girls without
access to internet and phones, and those from remote localities and linguistic minorities.
Children with disabilities have been particularly affected. The impact on their long-term futures
could be drastic, if such children are not prioritized in efforts to re-open schools. Many may
drop out of education entirely.

As the pandemic pushes more people into poverty, closed classrooms leave children exposed
to forced marriage and child labour. Girls are disproportionately affected. South Asia already
has the highest rates of child marriage in the world. The rate had been in decline, but
emerging anecdotal evidence indicates child marriage is now becoming more frequent.

This is an education emergency. The longer children are out of school the less likely they are
to ever return. Yet, trends in the region suggest that the pandemic could become a protracted
crisis. Children’s education could be disrupted for many more months and the impact felt for
years. This is why, reopening schools must be considered an utmost priority, as soon as
adequate safety can be assured.

The current evidence shows that children are not the main driver of the pandemic and have
an extremely low risk of becoming severely unwell from the infection, although they can pass
the virus on to each other and adults. Schools can substantially reduce infection risks by
providing frequent opportunities for children to wash their hands with soap and water and
ensuring physical distancing through shift systems or use of open spaces. All children do not
need to suffer from school closure because COVID-19 is a high risk in some areas.
Containment measures need to be applied locally when outbreaks occur, rather than through
national shutdowns. To ensure this community support and flexible decision making at local
levels is key.

UNICEF's Regional Director for South Asia (ROSA), Jean Gough. PHOTO/UNICEF
We commend those governments that have prioritized reopening schools. In July, some
schools in Bhutan and Sri Lanka were among the first to reopen, and then close, in response
to localized COVID-19 transmission. But in recent weeks, older children in Bhutan returned to
their desks once more. Children in Sri Lanka returned too, but then schools closed once more.
Hopefully they will re-open again soon. Between July and October, all children returned to
school in Afghanistan and Pakistan, while phased re-openings also began in, the
Maldives. Governments in India and Nepal have recently empowered states and local
authorities to decide when to reopen schools. This is all significant progress.’

Where schools cannot re-open safely, remote learning must be improved and expanded to
reach all children — especially the most marginalized and those with disabilities. We must
also be mindful that remote learning is less appropriate for the youngest children. As countries
have reopened schools, these children have often been the least prioritized, despite their
need for face to face interaction to help them develop foundational skills and address their
socio-emotional needs.

Governments, UNICEF and other agencies across the region are collaborating on surveys to
understand the effectiveness and accessibility of remote learning. These will help countries
prepare for higher quality remote learning options, which reach all children, if schools need to
close again in future. Remote learning should embrace the full spectrum of options.
Television, radio and SMS should be explored alongside printed materials — to ensure we
reach the huge numbers of children without access to electricity, the internet or devices.

The opportunities are as great as the challenges. Since this crisis started, parents, caregivers
and educators have found innovative and admirable ways to keep children learning. In just a
few months significant changes to teaching have been witnessed in pockets throughout the
region. This creativity is testament to how much learning can be enhanced in future if we re-
imagine how education is delivered.

To prioritize learning, we must make schools safe to reopen. Currently 50% of schools in the
region do not have access to soap and water. We must increase investment in the services
that keep children safe and healthy — hand-washing, hygiene, school meals, health and
immunization. A healthy child is likely to learn more and an educated child is likely to lead a
healthier life.

We have a once-in-a-generation opportunity to strengthen the flexibility and quality of our

education systems. Governments must act — by protecting education budgets, increasing
investment, and collaborating with partners, including the private sector, to innovate and
adapt as the context evolves.

What we do next could transform the future for millions of children. Or, it could tip our
education emergency into a learning catastrophe.
WHO Representative to Maldives Dr Arvind Mathur called to invest in provision of mental
health services, on the occasion of World Mental Health Day 2020. PHOTO/WHO
MALDIVES
WHO is privileged to extend technical assistance to the Government of Maldives in
development and continuing support in implementing the Mental Health Policy 2015-2025 and
the National Mental Health Strategic Plan 2016-2021 which outlines a robust governance
structure for mental health with financing requirement for implementation of strategies and
proposes to develop a network of community-based mental health services which are
integrated to the general health services. The focus is on preventing mental disorders and
promoting mental health in collaboration with other stakeholder sectors, and advocate for
better mental health and human rights of people with mental disorders at all levels of society
and enshrine this in legislation, policies and plans. With promising policy and program
decisions by the Ministry of Health, one hopes for accelerated actions in bridging the financial
and implementation gaps.

WHO advocacy for provision of Psycho-social support (PSS) benefited the people who were
quarantined and isolated at an early stage of outbreak. Building on the experience and
recognizing Mental Health and Psycho-social support (PSS) as emerging priority need in
evolving outbreak; we advocated for focused service delivery. This was translated into setup
and establishment of mental and psychological support cluster with the Health/National
Emergencies Operation Center- an example of multi-player collaboration with more than 30
partners, establishment of psycho-social support hotlines operated by civil society
organization with outreach services. The training needs were identified and WHO supports the
development of guidelines and training package on Mental Health and PSS during
emergency. Also, from the onset of the pandemic, WHO continued to collaborate and partner
with Ministry of Health and Ministry of Gender, Family and Social Services not only in
provision of PSS to vulnerable population but also for provision of essential care items at a
time of need, which proved to be greatly linked to their physical but importantly their mental
wellbeing.

The experiences during COVID-19 also highlighted the importance of simple steps that one
can take by oneself to cope with stress. We must recognize that it is normal to feel sad,
stressed, confused or even angry during a crisis. Talking to someone you trust through virtual
means, maintaining a healthy diet, getting adequate rest, and staying active through regular
exercise can do wonders to our physical and mental wellbeing. We must ensure avoiding
tobacco consumption and illicit substances to deal with the stress, as this can only make it
worse. In a time of a global pandemic and equally with an ‘infodemic’; it is essential to only
gather facts and information from credible sources such as WHO and Health Protection
Agency, and to limit exposing yourself to news or social media posts that you perceive as
upsetting. It is important to seek help especially if you feel overwhelmed, consult a local
health worker or counselor.

Despite all, stigma, discrimination and human rights abuse of people with mental health
conditions remain widespread still. It is now more crucial than ever to support one another, at
both personal and community level, to protect and nurture each other’s mental health and
wellbeing. As support, WHO has partnered with the Government of Maldives in our joint
Solidarity Ekugai Emmen Campaign (‘All Together Campaign’), as an extension of WHO
Director General’s global call for Solidarity during COVID-19.

Let me make an economic case as I urge leaders, partners and stakeholders for investment in
mental health as for every US$ 1 invested in scaled-up treatment for depression and anxiety,
there is a return of US$ 5. For every US$ 1 invested in evidence-based treatment for drug
dependence, there is a return of up to US$ 7 in reduced crime and criminal justice costs.
Primary health care workers can be trained to identify and manage mental health conditions.
Regular health checks of people with severe mental disorders can prevent premature death.
The quality of life of people living with conditions such as autism and dementia can be greatly
improved when their caregivers receive appropriate training. These are all doable, impactful
actions that benefits not only the health of our nation, but the economic stature as well.

On World Mental Health Day, I reiterate WHO’s support to the Government and people of
Maldives to Move for Mental Health. The fact is, there is ‘No Health’ without ‘Mental Health’.
The COVID-19 pandemic is not only a global health and socio-economic crisis, but a mental
health crisis which serves as a reminder that investment towards Mental Health services is
central, essential and mutually inclusive part of Universal Health Coverage.

We must ensure Mental Health services for all, to achieve Health for All.