According to a recent OECD report the COVID-19 pandemic has brought about a sharp increase in mental ill-health problems, particularly among the young, unemployed and those facing financial insecurity. This comes as no surprise to Mental Health Europe Director, Claudia Marinetti, who explains that - even before the COVID crisis - mental ill-health was responsible for an economic cost equivalent to more than 4.2 percent of GDP.
“That’s an average across Europe. In some countries it was even up to five percent,” she says, adding, “We’re talking about - prior to the crisis - one in six people in the European Union being affected by mental health problems: that’s more than 84 million people”. Across the 27-member bloc, the economic impact was estimated at more than €600bn, which Marinetti says, “you can imagine has only gotten worse during the pandemic”.
“I think there is really a need to change the discourse around mental health, and MHE are working with the WHO to make this switch, through the so-called “Parity of esteem” principle where we value mental health equally to physical health”
Unsurprisingly, around 30 percent of that €600bn is linked to direct costs associated with treatment with a further 30 percent down to social costs such as employment benefits. “What is interesting is that the largest proportion, around 40 percent, are indirect costs; basically, people that are not capable of being active at work or in society. When you think about that, it’s quite surprising there’s not been a lot more political talk around mental health”.
Mental Health Europe (MHE) was founded more than 35 years ago and has a diverse membership, spanning individuals and organisations in 33 countries across Europe. Mental health problems, are, says Marinetti the fastest growing health burden in Europe. “You have a lot of expenses in terms of in-patient costs; a quarter of all drug costs in Europe are linked to mental health”. Unsurprisingly, the COVID-19 crisis saw a spike in people seeking psychosocial support. However, as Marinetti explains, the mental health impact of the pandemic is not so simple to assess: “Frankly, given the the stigma attached to mental-ill health, the numbers are likely to be much higher. People are not disclosing why they’re not at work and are reluctant to say that they’re feeling unwell because of mental health problems”.
Public attitudes to mental health, and the stigma and discrimination that still surrounds people with mental health problems, are a significant problem. This is particularly the case in the workplace, where just mentioning the word ‘therapy’ runs the risk of being labelled crazy, or unstable. “One of the key problems is that when someone mentions ‘mental health’, people immediately assume something negative”, says Marinetti, adding “It’s something that people feel they need to shy away from”. And it’s true, we instinctively talk about ‘health’, as a positive.
Yet when we talk about ‘mental health’ our thoughts immediately think of mental ‘ill’ health. “So, I think there is really a need to change the discourse around mental health, and MHE are working with the WHO to make this switch, through the so-called “Parity of esteem” principle where we value mental health to the same level as physical health.
A key issue, and one that the COVID-19 crisis has to a certain extent put into sharp relief relates to how mental health is perceived. Currently, there are currently two distinctive frameworks; the biomedical model frames mental-ill health as an illness caused by biomedical factors and genetic disposition, while the psychosocial model frame mental-ill health as a human experience, such as the distress caused by socio-economic issues or challenging or traumatic life events, such as the current pandemic.
“I think we really should stop using medicalised language for mental health. When you pathologise mental health problems, you reinforce the stigma that ‘it’s something which is in your head’. But what the COVID-19 crisis has done in terms of mental health is to question whether the problem is really in your head, or is it a reaction to what’s happening around you that’s having an impact on your mental health?”
Pathologising mental health Marinetti suggests reinforces the biomedical approach to mental health which in turn relies strongly on medication. “As I said earlier, around a quarter of drug spending is on mental health treatments”.
If someone’s mental ill health is at risk because of unemployment, is it really mental-ill health that should be addressed, or should it be the causes behind the risk of unemployment?”
And returning to the impact the pandemic has had on mental health, she’s hesitant to say that COVID-19 is the direct cause of the increased mental-ill health pandemic. “Frankly, it’s stress and anxiety caused by working conditions, the lack of adequate social protection, loss of loved ones or risk of employment, but they have always been there. Yes, the pandemic has exacerbated them, but I think a lot of the mental distress is a normal reaction and that it should be taken care of but not pathologised. If someone’s mental ill health is at risk because of unemployment, is it really mental-ill health that should be addressed, or should it be the causes behind the risk of unemployment?”
Last month Marinetti was front and centre at the launch of a new MHE Strategy aimed at tackling inequalities, discrimination and securing equal access to services. At the ‘Bridging Policy Making and Human Experience’ strategic plan launch she argued that, “For over 35 years MHE has led the mental health movement across Europe, taking a human rights, recovery-based approach. Now more than ever, we feel the need to reinforce a psychosocial and recovery approach to counterbalance the overreliance on a medical model of mental health, which is at risk of being further exacerbated by the current pandemic”.