This article is part of a series in which OECD experts and thought leaders — from around the world and all parts of society — address the COVID-19 crisis, discussing and developing solutions now and for the future.
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Uncertainty about the future, job and financial security and social isolation have contributed to a very sharp increase in rates of anxiety and depression across OECD countries since the onset of the COVID-19 crisis.
Source: OECD (2021), Tackling the mental health impact of the COVID-19 crisis through an integrated whole-of-society response, OECD Coronavirus Policy Brief. To the extent possible, 2020 prevalence estimates were taken from March-April 2020. The survey instruments used to measure depression/anxiety differ between countries, and therefore are not directly comparable, and some surveys may have small sample sizes or not use nationally representative samples.
Mental health was already an urgent policy issue before COVID-19, but the pandemic has now put the issue under an intense public spotlight. Pre-COVID, it was estimated that one in two people in OECD countries experienced a mental health condition in their lifetime; one in five have a mental health condition at any given time. The total economic cost of mental health problems was estimated to be as high as 4% of gross domestic product before COVID-19—in the United States alone, this would be more than USD 800 billion.
Yet, despite some progress, openly talking about and addressing mental health problems remains shrouded in stigma. Mental health care is also, not unrelatedly, acutely underfunded, and many people struggle to get the help they need. A simultaneous uptick in financial insecurity, physical isolation and general uncertainty has resulted in a “perfect storm” of risk factors. The COVID-19 pandemic has triggered a mental health pandemic that will likely outlive the virus itself—with potentially devastating results. The discussion at the OECD’s Forum Event Addressing the hidden pandemic: The impact of COVID on mental health was instructive and at times poignant, providing an inside look into the challenges that many must confront and, crucially, the range of policy responses that governments are exploring.
Several themes stood out. First, the negative impact of mental ill health is pervasive, but it is especially pronounced among the young. Second, the pandemic has upended established working patterns. It is again younger workers—those at the beginning of their careers and only just starting to develop their skills and social capital—who have suffered an outsized negative impact. Third, healthcare professionals who have been on the front lines of the pandemic have often had to operate under immense physical and mental strain.
“It was intolerable…”
Mental ill health is one of the chronic diseases of the young...its impact can be severe and long-lasting—sometimes with fatal consequences.
– Husseini Manji
We have now known for over 14 months that the impact of COVID-19 on our physical health is very severe, but we have only just begun understanding how dire its impact could be on our mental health, too. COVID-19 leaves many of us feeling lonely, anxious, overwhelmed and depressed, but it is also expected to have very serious, long-lasting impacts on the mental health of those who have contracted the disease, with lingering symptoms including brain fog and intense fatigue. According to Husseini Manji, Global Head of Science for Minds at Johnson & Johnson, there is a strong correlation between neurological outcomes like stroke and dementia and the severity of the infection.
“Mental ill health is one of the chronic diseases of the young”, said Manji. “Its impact can be severe and long-lasting—sometimes with fatal consequences: it is the second leading cause of death among 15 to 19 year olds in the United States”. He also noted its greater impact on minority groups in the United States, pointing to greater stigma and less access to healthcare: this has resulted in higher suicide rates among these groups.
Eurochild, a Brussels-based organisation that supports children, looked at the effects of lockdown in the autumn of 2020. From its survey of 10,000 children aged between 11 and 17, it found that one in ten had symptoms of depression or anxiety, and one in five reported feeling sad or unhappy most of the time. Girls, older children and minority groups were especially vulnerable. Uncertainty about the future, a disrupted school routine and economic hardship were all proximate causes.
“Some children were having difficulty sleeping and even those with no history of behavioural problems showed signs of stress, sometimes including aggression”, said Mieke Schuurman, Senior Policy Adviser at Eurochild. Schools are a place as much for social interaction and support as they are for formal education and must be kept open as much as possible, she believes. In addition, we should give children a voice in decisions that affect them directly and, crucially, to address with them the stigma around mental health.
The effects of isolation and lack of support for employees working online have a huge negative impact on mental well-being.
– Nina Hedegaard Nielsen
While the pandemic has been a boon for the robustness of our technological infrastructure, allowing many businesses and workers to continue their operations, it has also highlighted its shortcomings. A 2020 Danish survey of the experiences of remote working found 67% of workers miss social interaction.
“The effects of isolation and lack of support and feedback for employees working online have a huge negative impact on workers’ mental well-being”, explained Nina Hedegaard Nielsen, Senior Policy Adviser for Occupational Health and Safety at the Danish Trade Union Confederation. Working online has often meant working longer hours, more time in virtual meetings, fewer breaks and a blurring of the boundaries between work and private spheres.
This is a recipe for lower levels of satisfaction with work and higher risks of mental illness—in particular for younger workers, who are less familiar with their colleagues and organisation and are trying to build their networks. Compared to the 67% of all Danish respondents who said they missed social interactions at work in the survey cited above, for 18-to-34 year olds the figure is 77%. Much more needs to be done to support younger and new workers, including better training on psychosocial risks for managers.
The hardest thing was not even the scale of the deaths, but the manner in which they die: COVID separates individuals from one another at a time they most need family and close friends.
– Rachel Clarke
Among workers, those in healthcare have been among the most affected by the impact of COVID-19 on their mental health. Many found themselves working under conditions of intense pressure during the past year. Coupled with insufficient supplies of equipment at the beginning of the pandemic and the need to console patients unable to see their loved ones in the final moments of their lives, around half of all frontline workers have met the clinical criteria for anxiety and depression, according to Rachel Clarke, a palliative care doctor and author. One in five meet the criteria for post-traumatic stress disorder (PTSD).
“The hardest thing was not even the scale of the deaths, but the manner in which they die: COVID separates individuals from one another at a time they most need family and close friends”, said Clarke. “We were left trying to make up for absent family members over and over again, sitting with dying people, reading messages from family and friends—but always wearing full PPE. Patients did not see a human face the whole time. It was intolerable”.
Clarke’s efforts to use social media to highlight the seriousness of COVID-19, and therefore to support public health measures such as lockdown, were in some cases met with online abuse, including death threats.
Read more on the Forum Network: "Breathtaking: Inside the NHS in a time of pandemic", by Rachel Clarke, Author & Palliative care doctor, NHS
“Strengthening the muscle of the mind…”
The mental health challenges the COVID-19 crisis has raised—the pervasiveness of mental ill health, especially amongst the young; the cost of mental ill health to the global economy; the downsides of remote working; the lack of capacity of our healthcare systems; and the lack of integration with education systems and employers—are all problems policy makers must confront.
However, the rapid shift to digital has presented opportunities to experiment with new ways to deliver preventative care and treatments. Jolawn Victor, Chief International Officer at Headspace, pointed to the democratisation of meditation and mindfulness during the pandemic, underlining the rapid growth of tech-driven solutions to stress and anxiety (including that of Headspace).
“A positive takeaway from the pandemic has been the de-stigmatisation of mental health”, she said, which has allowed more people to explore ways to “strengthen the muscle of the mind”. It has become more affordable and accessible, including for those with mobility challenges. “I hope that taking care of our brains will become as routine as brushing our teeth”, she added.
Concrete measures beyond applause
This latest OECD Forum gathering highlighted the vital importance to continue to address the everyday challenges many have been facing for over a year now.
Participants were asked what percentage of total health expenditure was, in their view, dedicated to mental health in OECD countries today. The actual level of investment ranges between 2% to 14%, according to OECD data. Interestingly, while most participants gave an accurate assessment of that level today, they wished more investment to be made after getting the full grasp of this critical issue.
The pandemic has drawn attention to the essential work of care professionals that play a critical role in our societies and economies. As societies, we must ask ourselves whether we place sufficient value on the extraordinary dedication of care workers too often underpaid and underappreciated. A new OECD project, “Beyond Applause”, seeks to ensure care workers and our societies as a whole are better prepared for future health threats as well as changing patterns of disease linked to ageing societies.
The OECD measures how people feel about their lives. Forty-five percent of households reported that their work and/or income had been disrupted during the pandemic. These findings from the Risk That Matter survey, conducted in autumn 2020 across 25 OECD countries, raise major concerns about financial security and overall well-being. Among households that lost a job during the pandemic, nearly 60% had trouble paying their bills and worried they did not have the right skills and the right knowledge to work in secure, well-paid jobs in the future.
The OECD is therefore working on developing labour and social protection policies that support the most vulnerable. A new Youth Action plan will be dedicated to helping young people access jobs and learning opportunities. We are taking a fresh look at education policies with the aim of supporting students during the health crisis. And we are working to enhance our digital policies to help drive the recovery and prevent the COVID-19 crisis from widening inequalities.
- OECD (2021) Tackling the mental health impact of the COVID-19 crisis through an integrated whole-of-society response
- OECD (2021) Risks that Matter 2020 – the long reach of covid-19
- OECD (2019) OECD Mental Health Performance Framework
- OECD (2019) Health at a Glance
- OECD (2018) Health at a Glance Europe 2018 - Promoting mental health in Europe: Why and how?
- OECD (2018) Children & Young People’s Mental Health in the Digital Age - Shaping the Future
- OECD (2015) OECD Council Recommendation on Integrated Mental Health, Skills and Work Policy
- OECD (2015) Fit Mind, Fit Job
|Tackling Covid-19||Health||New societal contract|
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