Mental health inequities and the pandemic: a communication emergency

We are in the midst of a mental health crisis.

In fact, there is no doubt that everyone has been emotionally affected by the ongoing pandemic. The mental health cost of COVID-19 may well go beyond the already devastating burden of depression, loneliness, and exhaustion, and the increased toll of substance misuse among many groups. The prolonged nature of the pandemic as well as its ‘social ramifications from social distancing, financial impacts, and physical health concerns are creating a toll on social functioning’ [1]. Mental health experts are sounding the alarm and are concerned about the long-term impact of these unusual times, especially considering that the pandemic ‘has many characteristics of trauma or traumatic stress that are toxic to mental health’ [2].

In these difficult times, many social stressors contribute to mental health inequities among populations that have been experiencing vulnerability, disadvantage, and/or marginalization. Social stressors, such as financial instability, social discrimination, lack of access to essential services, disability, housing or food insecurity, and/or caregiving status, increase both vulnerability to feeling stressed as well as the risk for mental health conditions and psychological distress [2–5]. As other authors suggest, ‘mental health symptoms as a result of the pandemic may decrease over time, but some people are likely to experience long-lasting or more severe mental health impacts, especially those with fewer resources and more life stressors’ [1]. Undoubtedly, these groups unfortunately may include communities of colour, refugees and immigrants, people living in poverty or with a disability, the LGBTQI+ community, women, older adults, and families with young kids. In other words, a lot of people!

As the pandemic affects all, using a ‘health equity’ framework in our communication efforts has never been as important as in tackling the ongoing mental health crisis. With its emphasis on social and political determinants of health and bottleneck analyses, a health-equity driven approach may help achieve much needed change for all, and also provide arguments to prioritize those who are most in need.

Specifically, it’s important that our evidence-based communication efforts ‘see’ beyond our collective attempt to reassure each other and our loved ones, just because of the role society may have bestowed upon many groups or individuals. Think of the many conversations you may have had with colleagues, peers, or friends who claim to be ‘just fine,’ which, unfortunately, does not reflect what mental health statistics show in many communities in these difficult times. Making people feel comfortable sharing how they feel is a key aspect of a health equity-driven approach to communication, one that is linked to mutual trust, empathy, genuine concern, and unbiased community dialogue.

Many issues continue unaddressed in our society and have been further exacerbated by the pandemic since I last covered the role of communication in mental health [6] or specifically focused on the impact of COVID-19 on children and families [7]. The pandemic has revealed the many inequities too many groups experience. Yet, we still think of mental health as separate from physical health, instead of regarding mental health as the foundation of health and wellbeing. Stigma is still pervasively associated with mental health conditions, which unfortunately may limit our collective investment in addressing mental health issues and strengthening social and mental health services for all. Across the globe, too many social support systems have been proven weak (at their best) in addressing existing and emerging community needs during COVID-19. In some cases, access to social support systems, including day care centres, support groups and/or community activities (e.g., singing or arts groups) such as, for example, for people living with dementia and their unpaid caregivers, has been significantly affected by COVID-19 [8]. In the absence of strong social support systems, social isolation and emotional distress have increased for both essential workers and the millions of people living alone [9].

Therefore, it’s equally important that we analyze the kinds of barriers each and every one in our communities may face to building resilience against the mental health impact of the pandemic. Analyzing and addressing barriers to improved health and social outcomes is also a key mantra of a health equity-driven approach to intervention and research design. For example, do people have access to quality childcare or mental health services that may help them balance life and work, or social programmes that aim to decrease discrimination? Do they have someone to talk to? What are some of the other impacts of COVID-19 that may prevent people from taking care of their mental wellbeing and building resilience? How do we measure ‘resilience’ in specific groups and populations? What are some of the policies, and related communication or advocacy strategies, we need to implement in order to increase resilience? What is the role of communication in increasing social support? How can we encourage community resilience on mental health issues and help create strong resources and support systems? How do we give voice to the unheard, and engage local communities? What are some promising practices? These (and many others) are key questions for our communication and global health community to address the mental health impact of COVID-19 and minimize its long-term consequences.

In light of the above questions, global health policies and healthcare practices must be comprehensive, cross-sectoral, and effectively address the many barriers people face in building mental health resilience. They should transcend individual behaviours and healthcare systems [3], and truly address the many political and social determinants of mental health. They should be grounded in a renewed emphasis on the much established ‘body-mind connection’ and a strong commitment to regard mental health as the foundation of good health and prosperity.

Finally, for new policies and practices to be in place, we need strong narrative change processes, cross-sectoral investment, and adequate political commitment at the local and global levels. These are all areas and processes the field of communication can greatly shape. Ultimately, this is a communication emergency as the future of many generations depends on our ability to address it.

In this issue

As always, we are pleased to feature articles from a variety of country settings and on multiple topics. In addition to this editorial, the Front Matter section includes a new piece in our Patient Voices series. We invite our readers to publicize this new section of the Journal and solicit submissions, so that together we can help give voice to patients on key health communication issues. The articles in this issue cover a variety of topics, including public anxiety and distrust during COVID-19, a youth e-cigarette prevention campaign, the substituting relationship between presumed media influence and interpersonal health communication, and behavioural and environmental factors influencing infant and young children feeding. We are grateful to our authors, reviewers, and editorial board members for their continuous efforts. Most importantly, we hope the articles in this issue will be helpful to your work and professional development. Stay well!