MHGCJ – 2021

Mental Health: Global Challenges Journal

ISSN 2612-2138

COVID-19 the Trigger for SDG Solutions in a Revised

WHO Mental Health Action Plan

Paul Illingworth

Leicester School of Allied Health Sciences, Faculty of Health and Life Sciences, De Montfort University, Leicester, England

Abstract

Introduction. This paper explores COVID-19 impact on Global attempts to achieve Sustainable

Development Goal 3, specifically Target 3.4.
Purpose. Suggest a new WHO Mental Health Action Plan needs to be refocused to help achieve

universal mental health.
Approach. The author discusses the context of COVID-19s impact on Governments inability to

progress the UN Sustainable Development Goals, specifically Target 3.4, reviewing this against

the WHO Mental Health Action Plan (MHAP) 2013-2020 (WHO 2013). Utilizing relevant

publications, progress/lack of progress are discussed, suggestions made as to how, by

refocusing the MHAP to one more culturally sensitive and localized, to progress towards

universal mental health.
Discussion. Contextualizing the lack of specific Sustainable Development Goals mental health

target. The continual use by the WHO of promoting western medical approaches to achieve

universal global mental health is explored, while using COVID-19 pandemic as a means of

triggering change in how localized, culturally specific non-medical approaches could be

championed.
Limitation/Strengths. The paper does not involve an extensive literature search. However,

subject matter is timely and relevant. It challenges traditional approaches of how Global Mental

Health has been addressed by organizations led by the UN/WHO. It identifies positive ways of

progressing global mental health, by utilizing localized and culturally sensitive approaches.
Practical/Social value. The suggestions made are cost effective, given the financial challenges

COVID-19 has brought, that is a practical and social value in its own right. Additionally, the

practical local and culturally sensitive solutions can be used globally. They could be undertaken

on their own or in conjunction with traditional western/medical models. The potential social

value could be considerable, should it be the focus of the latest WHO Mental Health Action

Plan.
Conclusion. Any new WHO Mental Health Action Plan must ensure non-traditional interventions

are central and increasingly used to achieve universal mental health for all

Keywords

COVID-19, Mental Health, cultural sensitivity, cost effectiveness, resilience, SDGs.

Address for correspondence:

Paul Illingworth, Head of the Leicester School of Allied Health Sciences, Faculty of Health and

Life

Sciences,

Montfort

University,

Leicester,

England.

e-mail:

paul.illingworth@dmu.ac.uk

This work is licensed under a Creative Commons Attribution-

NonCommercial 4.0 International License (CC BY-NC 4.0).

©Copyright: Illingworth, 2021

Licensee NDSAN (MFC- Coordinator of the NDSAN), Italy

doi:

https://doi.org/10.32437/mhgcj.v4i1.103

Submitted for publication:

March 2021

Received:

12 March 2021

Accepted for publication:

May 2021

MHGCJ – 2021

Mental Health: Global Challenges Journal

https://mhgcj.org

ISSN 2612-2138

Introduction

The COVID-19 pandemic has brought about

great  disturbance  for  the  global  health
community.  Governments  and  all  the  other
different  organizations  involved  with  the  fight  to
control it, is having to do so on many fronts. These
include  identifying  people  who  test  positive
through  test  and  trace,  directly  fighting  the
disease  by  caring  for  those  needing  acute  in-
patient  care,  plus  vaccination  and  where
needed  resultant  end  of  life  care.  Increasingly
care is undertaken, in many countries, by Primary

Care  staff  and  this  can  include  helping  people
with  the  so  called  long  COVID  and  also  those
having  also  recovered  but  who  have  been  left
with  post  COVID  anxiety.  Additionally,  this  ‘fight’
involves  supporting  health  and  social  care
workers,  and  any  others  involved  directly  or  in
directly,  as  well  as  protecting  children’s  learning
and  people’s  livelihoods.  This  is  the  focus  of  the
world’s  attention.  However,  this  work  has  often

been hampered by challenges of access, safety,
supplies, and financial stress and increasingly the
isolation and mental anguish, the likes of which
has never been seen before, at least as far as
can be remembered or on record.

This global challenge has resulted in short-term

consequences  which  are  evident  everywhere,
but  the  long-term  costs  of  the  pandemic  have
only  recently  started  to  emerge  and  be
considered.  Just  how  COVID19  will  reconfigure

health  and  social  care,  organizations  operating
practices,  (and  not  just  health  and  social  care
organizations,  but  also  schools  plus  further  and
higher  education  establishments,  to  name  a
few),  livelihoods,  professions  and  priorities  is  only
beginning to emerge

There is now an opportunity to refocus and

reform how we do things. This paper suggests that
by using the COVID-19 pandemics impact on

people’s mental health globally, the WHO
Sustainable

Development

Goals

(SDGs),

specifically

Target

3.4,

https://sdgs.un.org/goals/goal3

could be better

achieved  and  that  a  revised  and  reconfigured
WHO  Mental  Health  Action  Plan  needs  updating
and refocusing. By doing so, it will greatly assist to
get  the  globe  back  on  track,  from  a  mental
health perspective.

Purpose

This paper explores the impact of COVID-19

on Global attempts to achieve Sustainable

Development Goal 3, specifically Target 3.4 and
suggest how a new WHO Mental Health Action
Plan needs to be refocused to help achieve
universal mental health.

Approach

The author discusses the current context of

COVID-19s  impact  on  Governments  ability  to
progress the UN Sustainable Development Goals,
in  particular  Target  3.4  and  reviews  this  against
the  he  WHO  Mental  Health  Action  Plan  (MHAP)
2013-2020  (WHO  2013).  Utilizing  relevant
publications,  progress  and  lack  of  progress  are
discussed and suggestions are made as to how,
by refocusing the MHAP away from the traditional
Western  medical  model  to  one  more  culturally
sensitive and localized, could help to bring about

great progress towards universal mental health.

Sustainable Development Goals
The Sustainable Development Goals are the

recovery framework developed by the United

Nations/World  Health  Organization  (UN/WHO)  (UN
2021).  Their  aim  is  to  make  everyone  globally
have  an  improved  and  more  maintainable  life.
The  UN/WHO  see  this  being  accomplished  by
addressing  major  global  challenges,  which  they
see  as;  poverty,  inequality,  climate  change,
environmental  degradation,  peace  and  justice.
These  challenges  are  to  be  addressed  globally
by governments through the 17 SDGs included in

Table 1. Each Goal is broken down into targets
relating to specific areas.

Table

The

Seventeen

Sustainable

Development Goals

The 17 Sustainable Development Goals

1: No Poverty 2: Zero Hunger 3: Good Health

and Well-being

4: Quality
Education

5: Gender
Equality

6: Clean Water
and Sanitation

7: Affordable
and Clean
Energy

8: Decent
Work and
Economic
Growth

9: Industry,
Innovation and
Infrastructure

10: Reduced
Inequality

11: Sustainable
Cities and
Communities

12: Responsible
Consumption
and Production

13: Climate
Action

14: Life Below
Water

15: Life on Land

16: Peace
and Justice
Strong
Institutions

17:
Partnerships to
achieve the
Goal

COVID-19 Pandemic
Millions of lives have been and continue to be

affected globally as a result of the COVID-19

pandemic, it is very likely many more will be
before the acute phase as run its course. At the
time of writing, it is just over 12 months since the

MHGCJ – 2021

Mental Health: Global Challenges Journal

https://mhgcj.org

ISSN 2612-2138

COVID-19 virus had become more widely known.
However, the Public Health community had been
predicting  a  similar  SARS  type  virus  would  strike
again,  much  earlier.  Devi  Sridhar,  Professor  of
Global Public Health at Edinburgh University, had
predicted  a  coronavirus-like  crisis  in  2018.
Speaking at the launch of her book, co-authored
with  Chelsea  Clinton,  at  the  Hay  Book  Festival  in
Hay-on-Wye  in  Wales,  she  not  only  predicted  it,

but said it would most likely come from animal to
human transfer in China and then be brought to
the West by airline (Allen-Mills & Gregory 2020).

Estimates of how many will eventually be

directly  impacted  vary,  but  there  is  no  doubt,
there  will  be  few  globally  not  impacted.  Lives
have  been  and  will  continue  to  be  disrupted,
people losing their jobs many forced into poverty,
some into extreme poverty. While those with jobs
and money and developed countries are and will

continue to find this all a great challenge, the
impact will be even greater in low-middle
income countries (LMICs) and among vulnerable
groups everywhere.

It is, and will be for the foreseeable future,

challenging for any country to attain the SDGs,
but they can and must be achieved. Prior to the
COVID-19 pandemic, the majority of countries
had begun to make advances towards the SDGs,

the  Sustainable  Development  Report  2020  (SDG
2020).  The  report  exposed  that  there  was  no
country on course to achieve all of the SDGs, but
the  majority were continuing to  progress towards
their goals. It is interesting to note that Sach et al.
(2020)  identified  that  East  and  South  Asia  have
progressed more than any other area, with Latin
America  and  the  Caribbean  progressing  the
least. However, Sach et al. (2020) cautioned that

despite the progress made to date, any further
progress has been negatively impacted by
COVID-19.

In respect of mental health, there is growing

evidence  that  the  pandemic  has,  is  and  will
continue  to  impact  on  the  mental  health  of  the
world’s population across the age range, (Girdhar
et  al  2020;  Shuja  et  al  2020  and  Tanaka  &
Okamoto  2021).  The  next  pandemic  is  already
with us and it is the mental health pandemic.

Discussion

Had SDGs and especially Target 3.D,

https://sdgs.un.org/goals/goal3

which asks for

“early  warning,  risk  reduction  and  management
of  national  and  global  health  risks,”  been  fully
operationalized by now, countries globally would
have been in a better position and been able to
react  and  thereby  control  the  COVID-19
pandemic  better  than  they  have.  As  mentioned
earlier,  there  was  clearly  early  warnings.  Had

there  been  better  forethought  and  greater
decisiveness,  by  Governments  globally,  many
more  lives  would  likely  have  been  saved.  It  is
worth  noting  that  several  low-income  countries,
such  as  Cambodia  and  Vietnam,  for  example,
have  for  the  most  part  stifled  it  with  very  little
financial cost.

At the time of writing COVID-19 continues to

have a major impact globally, it has also seriously

resulted  in  increased  inequalities.  One  area  that
has  especially  being  affected  is  the  mental
health  of  communities  globally.  A  wealth  of
publications  globally  has  emerged  since  the
pandemic  began,  relating  to  the  negative
impact COVID-19 has had on the mental health
of  people  across  different  age  ranges,  for
example;  perinatal  and  offspring  in  Spain
(Caparros-Gonzalez  et  al.,  2020),  children  and
adolescents  in  China  (Duan  et  al.,  2020)  and

adults in Indonesia (Siste et al., 2020). While Girdar
et  al.  (2020)  cautioned  that  the  elderly  in  India
was  at  risk  from  social  isolation  as  a  result  of
COVID-19,  García-Fernández  et  al.  (2020)  found
that elderly people in Spain had significantly less
emotional  distress  than  other  age  groups.  No
longer  should  countries  be  delaying  their
response to the SDGs in relation to this, and other
areas.  Given  the  ensuing  mental  ill-health

pandemic, action needs to be enhanced to
address SDG 3 which is all encompassing “Ensure
healthy lives and promote well-being for all at all
ages”.

The SDG declaration emphasizes that to

achieve  the  overall  health  goal,  'we  must
achieve  universal  health  coverage  (UHC)  and
access  to  quality  health  care”  (WHO  2019).
However, this is not specific enough. SDG3 Target

3.4  mentions  mental  health  but  does  not  even
give  it  its  own  target.  Instead  it  states;  “By  2030,
reduce  by  one  third  premature  mortality  from
non-communicable  diseases  through  prevention
and  treatment  and  promote  mental  health  and
well-being.  Within  Target  3.4,  suicide  rate  is  an
indicator  (3.4.2).  One  has  to  question  why  such
an  important  and  growing  global  concern  has
not  got  its  own  target.  Why  does  the  WHO  not
build  on  work  already  being  undertaken  to

strengthen  mental  health  resilience,  rather  than
focusing  on  traditional  western  medical
intervention, as it does in the Mental Health Action
Plan  (MHAP)  2013-2020  (WHO,  2013)?  Clearly  it
was not on track before the COVID-19 pandemic
struck.  There  is  growing  evidence  that  non-
medical,  local  and  culturally  aware  interventions
are  successful  (Doukani  et  al.,  2021,  Jakovljevic
(2018) and Raghavan et al., 2020).

However, one has to be careful and a

distinction made between non-medical and
medical or professional interventions, for

MHGCJ – 2021

Mental Health: Global Challenges Journal

https://mhgcj.org

ISSN 2612-2138

example, a very good review was undertaken by
Rathod  et  al.  (2018)  into  “culturally  adapted
interventions  for  mental  health  disorders”.  They
concluded,  there  was  value  in  cultural
adaptation but there was not strong evidence of
what  adaptation  and  for  whom.  In  other  words,
traditional,  westernized  interventions  that  had
been  adapted  to  address  cultural  differences.,
can  work  but  more  research  is  needed  to

ascertain what exactly works and what does not.

What this paper calls for, is not a western

medical  or  psychological  model  that  has  been
culturally adapted for local needs. Instead it asks
for  non-medical  interventions  that  emerge  from
cultures  within  which  there  are  people  with
mental  health  problems,  where  the  ‘medical
model’  is  not  accepted  for  whatever  reason  or
not  working.  This  could  be  that  the  cost  is
prohibitive,  or  more  likely  availability  is  scarce.  In

many  LMICs  the  ratio  of  mental  health
professional  to  the  population  is  high  and  that
what  care  provided  is  in  urban  areas.  A  non-
medical  intervention  could  be  something  as
simple  as  a  bench  (Chibamba  and  London,
2019)  or religious involvement (Iheanacho  et al.,
2021), or theatre (Crossley et al., 2019).

To ensure this is prioritized, we require a robust

framework for guiding governments to move

away

from

the

costly

medical

and

pharmacological  models,  to  one  where
immediate  post-pandemic  recovery  and  long-
term  strategies  focus  attention  on  low  cost,
localized, culturally sensitive and effective means
of  building  mental  health  resilience.  However,
both  the  UN  (2020)  policy  brief  on  the  need  for
action  on  mental  health  in  relation  to  COVID-19
and  the  WHO  (2021)  report  into  how

preparedness  and  response  to  COVID-19  into
mental  health,  emphasize  a  more  traditional
medical model response.

The WHO Mental Health Action Plan 2013-2020

(WHO  2013)  recognized  the  importance  of
mental health in achieving health for all. The four
objectives;  1)  more  effective  leadership  and
governance for mental health; 2) the provision of
comprehensive,  integrated  mental  health  and
social care services in community-based settings;

3)  implementation  of  strategies  for  promotion
and  prevention  and  4)  strengthened  information
systems,  evidence  and  research,  were  well
received.  However,  with  the  Covis-19  pandemic
and  it  is  now  2021,  a  new  Action  Plan  going
forward is needed and one that offers something
different  to  those  previously  championed  which
has had limited success.

Limitations of the study\Strengths of the
study:

The paper does not involve an extensive

literature search and has been undertaken by a
sole author. However, the subject matter is timely

and  highly  relevant.  It  challenges  traditional
approaches  of  how  Global  Mental  Health  has
been  addressed  by  organizations  led  by  the
UN/WHO  and  who  have  championed  the
western/medical model over other approaches. It
identifies  positive  ways  of  progressing  global
mental health, by utilizing localized and culturally
sensitive approaches.

Conclusion

The COVID-19 pandemic and resulting

growing mental health related problems must be
the trigger to drive change in how mental health

is  achieved  by  all.  There  is  a  long  history  of
attempting  to  fix  it  be  traditional  westernized
approaches,  medical  interventions  and  the  use
of  medicines.  Despite  recommendations  and
guidance  from  the  UN  and  WHO  and  countries
responding  to  those,  the  mental  health
pandemic  is  growing.  The  concern  is  once  the
viral  aspects  of  COVID-19  are  beginning  to  be
better  controlled,  the  mental  health  pandemic
will  hit.  There  are  increasing  numbers  of

publications demonstrating that locally based,
culturally

sensitive

and

non-traditional

interventions  are  having  a  significant  impact  on
improving mental ill-health. Any new WHO Mental
Health  Action  Plan  should,  indeed  must,  ensure
these non-traditional interventions are central and
increasingly  used  to  achieve  universal  mental
health for all.

Conflict of interest

The author declares no conflict of interests

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