Making a Difference on Mental Health during the COVID-19 Pandemic: How Can Advisors Help?
To help weather the coronavirus (COVID-19) pandemic and its public health consequences, the philanthropic sector has mobilized in excess of US$20 billion to support diagnostics, vaccines, as well as long-term health challenges such as mental illness. Many donors are now asking how they can direct their support most effectively, and it’s up to their advisors to come up with ideas.
Mental illness represents a leading cause of disability worldwide, and consistently ranks among the five leading non-communicable diseases, along with cardiovascular diseases, cancer, chronic respiratory diseases, and diabetes. Beyond causing a great deal of suffering to those experiencing mental health problems, these conditions also affect families and friends. Furthermore, lost productivity, service costs and premature mortality are linked to mental health problems and cost society billions of dollars annually. With its complex psychosocial stressors such as loneliness, stigma and bereavement, the COVID-19 pandemic has amplified the existing mental health crisis.
COVID-19’s Impacts on Mental Health
At this point in time, it is too early to estimate the full impact of COVID-19 on the mental health of society. The COVID-19 pandemic has brought about many changes to our daily lives including social distancing, masking and lockdown, further complicating what is traditionally a multi-faceted field, where different specialists hold a wide range of views on mental health.
One unintended consequence of lockdown has been a slew of mental health disorders ranging from anxiety and substance abuse to suicidal behaviour. Lockdown has also dramatically compounded domestic abuse among vulnerable groups such as women and children. Frontline healthcare workers exposed to COVID-19 report a high level of burnout syndrome, problem drinking, and post-traumatic stress disorder. Stress-related disorders stemming from economic and job insecurity are also on the rise. Similarly, self-isolation and uncertainty surrounding their future are fuelling emotional distress among children and young adults. The growing trend of Internet addiction and e-gambling represents another collateral challenge of the pandemic. And the disruption of mental health services due to the pandemic is bound to exacerbate mental illness.
The list of problems is long, diverse, and shifting. For a philanthropist seeking to define their intervention strategy and the advisors assisting them, it is therefore worthwhile spending some time reflecting and gathering information on where exactly to focus one’s philanthropic engagement.
Define the Field of Work
To direct philanthropic funding effectively, one must first define the field of work. Focus options include building the public’s mental health literacy. Mental health is a field that is still in need of demystification and awareness building. Funding mental health literacy initiatives and campaigns can help build the public’s knowledge and reduce stigma. For example, the “Time to Change” anti-stigma campaign, formed by the UK mental health charities Mind and Time to Rethink Mental Illness, has revealed a dramatic improvement of mental health related knowledge and attitudes among the public. This is powerful, because evidence suggests that maintaining a normal life in the community can help a person with mental illness get better and return to a productive life, and building mental health literacy in the community will increase its acceptance of people suffering from mental illness.
Building out the research talent pool focusing on youth mental health is another lever. From a social impact perspective, given that many mental health disorders emerge in late childhood and early adolescence, supporting researchers working on these critical periods of neurodevelopment offers a window of opportunity for positive change in mental health and prevention intervention. Against this background, Fundación Alicia Koplowitz in Spain offers advanced research grants in the area of child and adolescent psychiatry. The foundation also provides the opportunity for talented clinical psychologists and psychiatrists to pursue training and research fellowships focusing on child and adolescence psychiatry, clinical psychology, neuroscience and neuropediatric at leading research universities.
Philanthropists can also help to close the treatment gap for mental disorders through novel forms of implementation. Where treatments exist, access to them remains a challenge in many places. Supporting implementation science initiatives is a way to respond to the current treatment gap for mental disorders in resource-limited settings. For example, task shifting is a means of sharing clinical care responsibilities between psychiatrists and community mental health workers in a novel way. An example of a successful task-shifting intervention for common mental disorders (including anxiety and depression) is the Friendship Bench. Developed in Zimbabwe by Dr Dixon Chibanda, this brief psychological intervention is delivered through lay health workers, community members who have received some training to carry out health-care services. The Friendship Bench approach has been rolled out in Kenya, Tanzania and Malawi, in addition to western nations including Canada and the USA. In resource-constrained settings, task shifting represents a proven, cost-effective implementation strategy for expanding health care in settings with shortages of qualified health personnel.
Another point of entry is funding work to tackle particular problems with large knock-on effects for the affected communities such as gambling addiction among ethnic minorities and high-risk groups. Gambling addiction represents a public mental health concern, but when linked to criminal behaviour, physical illness and suicide in minority ethnic groups, such as Aboriginal people, its impacts can become dramatic. The Victoria Responsible Gambling Foundation is a non-profit organisation in Australia focused on addressing the challenge of gambling harm in the Victorian community. It has launched a number of pioneering community-led projects focused on preventing and reducing gambling harm among young Aboriginal and Torres Strait Islanders people. One such project launched in 2018 is directed towards supporting pre-adolescents who are regularly exposed to online gambling games with betting advertisements, as a means to better understand the addictive nature of gaming and its links to gambling.
A powerful way to contribute is strategically funding pipeline projects, including those that focus on research related to the neurobiological underpinnings of mental illness. Research is capital-intensive and philanthropists are rarely in a position to replace public research funding. Philanthropic funding can nevertheless play a valuable catalytic role to help pioneer and establish new, groundbreaking scientific research and innovation. For example, the Alamaya Foundation in Switzerland provides financial support for neurobiological research targeting schizophrenia. The overarching goal of early diagnosis is to help lead to earlier treatment, as well as enabling preventative measures in the developmental trajectory of the illness.
Philanthropists can moreover offer valuable help to improve contextual conditions by funding work to tackle the social determinants of mental health. Adequate prevention and early response measures regarding adverse experiences during childhood hold the potential to modify the trajectory of low-income families, particularly those from minority ethnic backgrounds, who often do not have access to such services. While outside the domain of mental health in a narrow sense, backing projects targeting the social determinants of mental health can be powerful. Philanthropy has a long record in funding civil society efforts to address social inequalities, and can help improve mental healthcare access. For example, the Lankelly Chase Foundation aims to create an environment in the UK that “effectively responds to the interlocking nature of severe disadvantages, such as homelessness, drug misuse, violence and abuse, extreme poverty and mental ill health.”
Next to many other valuable opportunities to lend support, a critical part of the way forward will be improving access and personalization of treatment while bringing down the cost curve. This means backing digital mental health care. One way to boost access and reduce the cost of diagnosis and treatment is leveraging the power of information and communication technologies and tools. Digital mental health has been associated with a number of benefits, including overcoming access barriers such as stigma (given that support services can be accessed anonymously) and improving online self-help. For example, Inuka, a social enterprise start-up with operations in Kenya and the Netherlands, seeks to make wellbeing accessible to everyone, and has launched two mental health apps that provide remote support via chat-based coaching. The Inuka Wellbeing app is geared towards employee mental health, while Inuka Hero aims to connect people living with common mental disorders in low-resource settings to trained coaches (Heroes). The support provided by the coaches is based on the Friendship Bench intervention, mentioned earlier. Depending on organisational structures, the entities behind digital mental health propositions may qualify as recipients of grant-based support or impact investments, or a combination of both.
Apply First Principles and Rise to the Occasion
Philanthropists often feel emotionally attracted to a specific aspect of the problem. This is where advisors come in. They can help add evidence-based analysis to the equation, looking at what a donor can realistically achieve, with how much money and over what time horizon. Applying the first principles of effective philanthropy is what unlocks social impact, and good advice can make a difference.
As a global community, we are in an unprecedented moment of change. As we seek to re-establish society’s vitality after the emergency, philanthropists can make powerful contributions to the emerging post-COVID social contract, and help address the short and long-term mental health effects of the pandemic. Fortunately, the prioritisation of mental health has started to improve in recent years, opening up a new window of opportunity. The United Nations Sustainable Development Goals (SDGs) includes two targets (3.4 and 3.5) focused on mental health and substance abuse, and mental health is causally linked to SDG 8, calling for achieving sustainable economic growth through productive employment and decent work for all.
Advisors have a responsibility too: The quality of philanthropic advice in this field will be measured in part by its ability to help unlock transformational change in mental healthcare at all strata of society in the years ahead. Resources such as the donor brief on mental health can hopefully serve as a useful resource for those funding and advising on current and future mental health solutions.
About the authors
Maximilian Martin, Ph.D., serves as Global Head of Philanthropy at Lombard Odier Group, secretary general of the Fondation Lombard Odier, a trustee of the Fondation Philanthropia and the Womanity Foundation. He is also the founder of Impact Economy and a visiting lecturer at the University of St. Gallen.
Byron Bitanihirwe, Ph.D., is a Neuroscientist with an interest in global mental health—particularly sustainable initiatives that can provide support to people with mental health needs in low- and middle-income countries.
The opinions expressed in this article are those of the authors, and do not necessarily reflect the views of the organizations whom they serve in an executive or board of directors’ capacity.