Individuals with chronic health conditions are more likely to also struggle with mental health, a problem that only intensified during the COVID-19 pandemic. Researchers from Canada and the UK have now uncovered the 'best practices' for addressing the needs of this population.
The results of their study, a rapid review of articles examining mental health programs in 10 countries -; including the US, Canada, Australia, UK, China, Ukraine, Italy, Germany, France and Spain -; identified five key elements common to successful health interventions: social connectedness, resilience, accountability, trust, and power-sharing.
These mechanisms are interconnected, and crucial for the development of effective mental health interventions at all levels and will encourage positive relationships between stakeholders."
Ben Collins, Educational Specialist, Rady Faculty of Health Sciences, University of Manitoba
Not taking these mechanisms into account may lead to a greater risk of creating and implementing policies that produce less effective interventions for people at higher risk of COVID-19."
The research team's rapid review examined publications in English and Chinese that reported on key elements of successful mental health interventions during the pandemic for those with chronic physical health conditions. A diverse range of programs were studied including telehealth interventions and the use of FaceTime with Alzheimer's patients. These were contrasted with literature from before the pandemic.
"While public health measures are necessary to manage the spread of COVID-19, social-distancing can have negative impacts on mental health, particularly for those with chronic health conditions," says Lorna Stabler, research associate at Cardiff University and lead author of the review. "To maintain and promote mental health, social connectedness is essential. Although we all may have Zoom fatigue, for some, finding ways to stay in touch could be a key component of keeping our health on track through the pandemic."
In the UK, additional funding to help health providers connect people with resources within their community was used to try to maintain these important social connections. Other strategies used by governments and health care providers included transitioning services online and funding new technology-facilitated interventions. For example, in China, funding was provided for mental health outreach teams in communities, 24/7 mental health hotlines and online platforms to manage mental health consultations and prescriptions.
While governments must be resilient to enact quick changes, prior research has shown that decisions need to be made in partnership with policy-makers, health care professionals and individuals and their communities. The researchers found that unilateral decision-making risks exclusion and marginalisation of those suffering with chronic health conditions.
"Organizational and service resilience are just as important as individual resilience," says Maura MacPhee, Professor of Nursing, University of British Columbia-Vancouver, Canada. Without organizational and service delivery adaptability during crises, individual resilience is not sufficient to carry the burden of a pandemic."
The importance of the study's findings extends beyond the current pandemic. In particular, the need to share decision making power among those who deliver and those who access services is key to developing services and policies that meet the needs of the community.
"The mental health and substance use health impacts of the COVID-19 pandemic are expected to be delayed, complex and long lasting. That is why we have been working with the Canadian Centre on Substance Use and Addiction (CCSA) to both track the relationship and explore the intersections between the two," says Brandon Hey, policy and research analyst for the Mental Health Commission of Canada. "Our rapid review underlines the importance of making those with chronic health conditions an integral part of how we think about and plan for mental health and substance use needs."
The researchers argue that building accountability and shared responsibility for mental health policy at all levels is vital. "In the face of the challenges created by COVID-19 and the public health response, this study addressed the need to provide guidance for a comprehensive, multi-level, systems approach to interventions that promote mental health, particularly for vulnerable people living with physical and mental health comorbidities," says Simon Carroll, co-author and Adjunct Professor in the Department of Sociology at the University of Victoria. "Building back better means getting all levels of our health and social care systems in alignment, with accountability shared between stakeholders. Mental health should be a priority in health policy"
"Our study provides important guidance for social workers, doctors, public health policy makers and other health professionals on how to devise effective interventions to mitigate the short-term and long-term mental health consequences of the pandemic" said co-author, Esme Fuller-Thomson, social work professor and director of the Institute for Life Course and Aging at the University of Toronto. "Professionals in these roles have important trusted relationships that are essential to engage the community in developing effective mental health policies – these are the people who are working in this area every day."
"We hope that these findings will act as lessons learned during the pandemic to help improve the effectiveness and robustness of mental health interventions in the future," says Stabler. "Mental health cannot be an afterthought."
This rapid realist review was published online in the latest issue of the International Journal of Environmental Research and Public Health.
Stabler, L., et al. (2021) A Rapid Realist Review of Effective Mental Health Interventions for Individuals with Chronic Physical Health Conditions during the COVID-19 Pandemic Using a Systems-Level Mental Health Promotion Framework. International Journal of Environmental Research and Public Health. doi.org/10.3390/ijerph182312292.