Strong and resilient health systems are crucial for properly responding to health emergencies. For Dr. Rabih El Chammay, investing in strengthening mental health systems proved to be key for Lebanon’s mental health response to COVID-19.

Medical personnel in the Rafik Hariri public hospital in Beirut on April 7, 2020. (Photo by Joseph Eid / AFP)

COVID-19 pandemic has been the ultimate test for humanity, for the priorities we have set as societies and for the way we value our health and our health systems. Countries were not equally affected, nor were they able to equally respond. Many factors ranging from the country’s infrastructure, to the availability of qualified healthcare staff, to the responsiveness of the health system and ultimately to the political choices taken by its leadership were core to how “successful” or not the response was.

But one might ask, how can we measure success? Is it how strong the economy still is? Speed and responsiveness of government policies to the pandemic? Resilience and capacity of the health system? Reduced number of fatalities? Strength of the social protection network? Number of jobs saved? How supported and cared for the population felt?

 

Meeting mental health needs related to COVID-19

Different countries resorted to different strategies in responding to COVID-19. Lebanon was initially quick to respond and developed a National COVID-19 Health Strategic Preparedness and Response Plan that so far proved to be effective in curbing and containing the spread.

As part of this response, a National Mental Health and Psychosocial Support Response Action Plan was developed at the Ministry of Public Health. This mental health response plan had four main goals:

  • promote mental health and mitigate COVID-19 related stressors, including stigma and discrimination against persons affected and health workers;
  • provide mental health support to the persons in quarantine;
  • support the mental health of health workers;
  • and ensure continuity of care for persons using mental health services.

Lebanon also used the momentum created by the response to strengthen the mental health system in place, creating synergies where possible, following the World Health Organization model of “Building Back Better”.

 

 

Many factors have enabled Lebanon to be responsive in term of mental health response to COVID-19. But I believe that one of the most important was having a National Mental Health Programme as a central governing body for mental health at the level of the Ministry. The existence of such a programme was crucial to ensure that mental health is not forgotten in the national response to COVID-19. For example, having solid coordination with UN agencies, NGOs allowed for the development of an intersectoral Mental Health and Psychological Support response action plan for COVID-19; having an existing collaboration with health facilities, including hospitals, allowed for quick uptake for tools such as the nursing checklist, patient leaflet and training of nursing.

 

Making well-resourced health systems a priority

COVID-19 made more tangible the need to have well-resourced health systems that are sufficiently resilient to cope with shocks such as pandemics. Although many public health experts have been advocating for years to invest in health systems, they were rarely heard. Investing in system strengthening and more specifically in transitional institutional support was, as maybe to a certain extent still is, rarely seen in the donors’ landscape whether in the development or the humanitarian sector as a strategic priority. Yet, if we zoom in on the mental health response to COVID-19 in Lebanon, it would be evident that the institutional support provided was one of the most important factors that enabled Lebanon to effectively respond to the mental health needs related to COVID-19.

What might be surprising to many is that the National Mental Health Programme does not receive any funding from the Ministry of Public Health. It was established in partnership with WHO, UNICEF and International Medical Corps in 2014, and has been relying on support from UNICEF for the first two years then on project-based funding. It now receives support from the French Agency for Development and from Bernard van Leer Foundation. The downsizing or suspension of the National Mental Health Programme would have drastically impacted Lebanon’s capacity to respond to COVID-19 in term of mental health.

Historically, development and humanitarian funding were, and are to a large extent, two very separate mechanisms. Only recently, there has been initiatives to seriously bridge this gap through initiatives such as the Development-Humanitarian nexus. It is becoming obvious, that separating the two, can only lead to more inefficiencies, lost opportunities and duplications. By now it is evident that proper preparedness and strong systems are core to effectively respond to any type of crisis and that crises can be opportunities to strengthen or reform health systems.

 

Investing in mental health for sustainable development

At the core of any long-term vision for any development or humanitarian agenda that aspire to get closer to achieving the Sustainable Development Goals (SDGs), mental health should have center stage. COVID-19 has only made that more salient as discussed in the UN Policy Brief: COVID-19 and the Need for Action on Mental Health.

As a matter of fact, investing in mental health is directly linked to Sustainable Development Goal number 3 (Health and Wellbeing) and contributes indirectly to all Sustainable Development Goals through affecting the person’s capacity to learn (Education), to have a job (Sustainable and Inclusive Economic Growth), to be an active member of society (Reducing Inequalities).

Going back to the question “How can one measure success?” Different people, institutions, sectors, have different definitions for that. However, I believe that the Sustainable Development Goals provide a good framework with clear indicators for governments to measure their success. I believe that if all the persons living in a given country report having good mental health it would be the best measure of success as it means no one is left behind, that human rights are protected, social protection is provided, support to parents is available, education and dignified work is possible, diversity is respected and access to quality mental health preventive and care services is widely present. And for that a strong and resilient mental health system is a must.

 

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