By Paige Arthur
Whether COVID-19 has affected you personally, or whether you are just trying to survive through social distancing, the COVID-19 pandemic is universally fraying our nerves—from individual health and even death, to massive economic uncertainty, to the anxiety generated in daily interactions within anyone or anything that comes from outside the boundaries of our own homes.
The mental health consequences of COVID-19 have been recognized as a global issue by the WHO. In the UK, there is a reported rise in depression and anxiety since the beginning of confinement, and accompanying initiatives such as the royal family’s efforts to support the mental health of front-line workers. Political leaders have been open about it. In my home state of New York, Governor Andrew Cuomo has stressed the seriousness of the issue in his daily briefings, recently announcing a slate of mental health initiatives including a partnership with the mindfulness app Headspace.
This focus on mental health feels correct. We are in the midst of what will be a prolonged crisis, with little certainty about what the immediate future will bring, with every news headline more deflating than the last, and latching on to any small glimmer of hopeful news. At a recent international conference on mental health and psychosocial support in humanitarian emergencies, experts summarized the mental health effects of a pandemic—this rings very true right now: “Fear of the virus is associated with the experience of intense distress,” and “Social problems may emerge after a population is exposed to the virus and the disease control response: for example, breakdown of community support systems, social stigma and discrimination associated with the disease.”
As difficult as it is, though, for many of us, the most urgent crisis period of COVID-19 will pass in the short- to medium-term. We are lucky in that respect.
This is not something that can be said for the millions of people whose daily lives are shaped by state fragility and violence, and for whom trauma, prolonged insecurity and uncertainty, and the attendant social dislocation that comes from these. Their experience is more durable and less certain of an end being on the horizon.
Like those of us who are now experiencing the psychological challenge of dealing with COVID-19, these communities are largely characterized by their resilience, strength, and ability to support one another. There is no shortage of examples of solidarity that demonstrate the human will listen to our better angels.
In spite of this, though, the reality is that many individuals and communities really do need specific support in order to address traumatic events, rebuild broken trust, and prevent grievances from deepening. WHO has delivered staggering numbers on the issue: in emergency situations, almost all people will experience psychological distress. During a conflict, 1 person out of 5 will develop depression, anxiety, post-traumatic stress disorder, bipolar disorder, or schizophrenia; and after the conflict, 9 percent will develop a moderate or severe mental disorder.
Indeed, in recent years, the humanitarian sector led the charge in raising the visibility of mental health and psychosocial support (MHPSS for short) issues, as it works in crisis situations that go on for years and even decades.
In this moment where we must start to think about how to build back better, has the time come for the peacebuilding field to sit up and take notice of the great need for integrating MHPSS into its efforts to support societies as they rebuild after conflict?
It’s not a completely new issue for peacebuilding. Fields such as transitional justice have integrated measures that directly address human needs for recognition, reparation, and dignity as part of the process of rebuilding the social contract after conflict—connecting with concerns not just on mental health diagnoses but also on the socio-emotional effects of crisis and conflict on affected populations. Transitional justice has also specifically argued for attention to the mental health and psychosocial needs of victim groups as part of specialized reparations programs (often, where possible, through national health systems).
But the connection goes farther than the link with transitional justice alone. Psychosocial support has been a mainstay of peacebuilders’ efforts to address gender-based violence, for example, and it is has also been integrated into approaches to supply “one stop shops” to provide services to conflict-affected populations. It has also at times been integrated into demobilization and reintegration approaches. The World Bank has argued that integrating mental health and psychosocial approaches enhance the outcomes of development initiatives in fragile contexts. Therefore, there are many good examples of integration that can provide the basis for positive discussion.
MHPSS approaches can also have an important preventive effect. At the individual level, attention to the effects of past violence may help: evidence has shown that some psychosocial risk factors make individuals more prone to violence. For instance, a history of violent victimization, such as high levels of domestic violence against children, can create more violent adults, and desensitization to violence may increase the use of violence later on. In certain cases, domestic violence can even be an important motivation for young people to join armed groups. At the social level, inequalities are associated with an increased risk of mental disorders.
This said, integration of peacebuilding and MHPSS approaches remains anecdotal, ad hoc, and too far outside the norm. Looking to the future, in order to generate a more structural integration, there needs to be a paradigm shift. As the world responds to the COVID-19 pandemic, people everywhere are coming to have a more immediate understanding of how prolonged crisis can create challenges for both individuals’ mental health as well as maintaining the social fabric of communities. The post-COVID-19 world is one where the recognition of and the momentum for this shift may have finally come.
Photo: A joint decontamination operation between the United Nations Multidimensional Integrated Stabilization Mission in Mali (MINUSMA) and the Directorate General of Health and Civil Protection in Bamako, Mali during the COVID-19 outbreak (UN Photo/Harandane Dicko).