PAHO HIGH-LEVEL COMMISSION ON MENTAL HEALTH AND COVID-19

May 6, 2022 - Washington, DC

H.E. Epsy Campbell Barr, Vice President of the Republic of Costa Rica and Chair of the Commission
Dr. Carissa F. Etienne, Director, Pan American Health Organization
The Honourable Terrence Deyalsingh, Minister of Health, Trinidad and Tobago
The Honourable Lida Mercedes Sosa Arguello, Vice Minister of Governance and Health Monitoring, Paraguay
Dr. Jarbas Barbosa, Assistant Director, Pan American Health Organization
Distinguished Commissioners, Ladies and Gentlemen

We have often cited during the past two years, the impact of the Covid-19 pandemic on the lives and economic wellbeing of people in our region. In a region where we have seen a death toll of over 2 million two hundred thousand people, which represents about 46% of deaths globally, this has understandably been the significant focus of attention.

The untimely arrival of the pandemic and its prolonged effects have had comprehensive impacts on the people of our Region, particularly in the lives of those who are in vulnerable situations. This global emergency revealed long-standing structural challenges that have always been present in our societies: inequity, violence and gender violence, exclusion, discrimination, and gaps in access to rights for many citizens of the Americas.

One of these structural challenges that perhaps has not been so visible but certainly palpable, is the growing toll that the pandemic has taken and continues to take on mental health in the Americas.

From early in the pandemic, we began hearing and reading about the stress and anxiety caused by the uncertainty in the progression of the pandemic, the loss of loved ones, having to learn how to deal with isolation and a new way of life.

As collective experiences with the rippling effects of Covid-19 were broadcast in real time, we witnessed the anguish of health care workers, as they struggled to cope in the most unfathomable of demands and circumstances.

And as the pandemic drew on, families had to adapt to situations of economic upheaval in some cases, in others to new dynamics of working and living as mobility restrictions, physical distancing and telework and virtual learning became the norm. In early 2021, there were still approximately 114 million children and youths in the Americas that had not returned to in-person schooling and would not do so until a year later.

We have learned of the effects that this ongoing situation has had on women who have had to leave the work force, and those who have been victim to the surge in gender-based violence.

According to the World Health Organization , it is estimated that the COVID-19 pandemic led to a 27.6% increase in cases of major depressive disorders and a 25.6% increase in cases of anxiety disorders worldwide in 2020. Furthermore, the greatest increases were found in places highly affected by Covid-19, as well as low and middle-income countries.

Considering the high incidence of COVID cases and death in our region, as well as preexisting inequalities, the work of this PAHO High Level Commission on Mental Health and Covid-19 is timely, relevant and indeed urgent.

Addressing the connection between mental health and Covid-19 in this High-Level Commission, is a necessary step towards deepening discussions and solutions aimed at improving mental health in the Americas.

From the OAS standpoint, we welcome this as an opportunity to broaden dialogue and set forth a multisectoral path for action. The Inter-American system recognizes health as a fundamental human right and in this regard, universal access to mental health is intrinsic to the general advancement and wellbeing of our communities. Therefore, a comprehensive Covid-19 recovery action plan must include prioritizing mental health with a human rights perspective, and taking into account the particular situation of women.

Prior to the Covid-19 outbreak, many countries in our region were already struggling to meet mental health demands arising because of historical under-resourcing of mental health care systems. And although the Declaration of Caracas represented a paradigm shift to a preventive and human rights focus on dealing with mental health, in many countries of the Americas where mental health care models have not evolved, the scarce resources available are still often allocated to psychiatric hospitals . Access to care and treatment availability remains limited.

In 2018, studies showed that the median treatment gap for various mental health conditions in the Americas was approximately 71%, increasing to over 80% for different countries and when analyzing specific groups such as for example indigenous populations . So, the reality prior to the pandemic was that the mental health situation was very precarious.

As the pandemic brought about aggravated effects on mental health, there were disruptions in existing mental health services particularly affecting out-patient treatments and certain groups in vulnerable situation including among others, children, adolescents, and people with continuing substance use disorders. With closure of schools and access to in-person facilities, we will likely learn that the treatment gap has widened during the pandemic.

And today, two years and some months after the first Covid-19 cases hit the Americas, we know that we are still at a distance from understanding the full impact that the pandemic will have on mental health. But we are also aware of the financial burdens and other health care demands that have required immediate attention from governments, such as vaccine availability and medical facility infrastructure. It is therefore a necessary task to also bring forward the issue of mental health in all its complexity.

I mention the complexity because I understand that this effort presents certain challenges of its own. We know for example that there is still a great stigma connected to mental health in the region, and that requires appropriate attention. Rooted societal norms, reduced access to education about mental health, cause a lack of understanding resulting in stigmatization of mental health conditions in many areas of our region. This stigmatization constitutes not only an obstacle in the construction of public policy , but it also adversely affects the generation of appropriate conditions for access to mental health services.

The challenge that stigmatization poses is amplified when considering the differentiated impact of the pandemic in general for persons in vulnerable situations and those affected by discrimination. Persons with disabilities, older persons and individuals with pre-existing medical conditions, women, children, and adolescents, LGBTI persons, and disenfranchised communities face greater risks to suffering from mental health in the current setting. And yet these are the people who are most likely to lack full access to human rights such as health, and who we need to think about when ensuring that universal mental health care becomes a reality.

It is therefore very relevant that we consider in addressing the various aspects that will be set forth to this High-Level Commission, that this is an opportunity to bring forth a cultural change with respect to mental health in our region and with special attention to women. This cultural shift can lead us away from stigmatization and towards more inclusive and open conversations to educate and generate a collective commitment to building back better mental health systems.

I especially wish to thank Dr. Carissa Etienne, for promoting this initiative and bestowing upon me the honor and responsibility of serving as co-chair together with H.E. Ms. Epsy Campbell Barr, a distinguished leader and voice for the rights of all people in the Americas. I reiterate both my personal commitment and that of the OAS to the work that we are undertaking.

I trust that the conversations and work that we initiate today will be fruitful. The exemplary group of experts that have accepted this call to action, is a promising first step, and I am certain that the results will be of immeasurable value to our region and our communities.

Thank you.