Countries across the world were ill-prepared to adequately respond to the growing mental health crisis triggered by the COVID-19 outbreak. Global mental health statistics were already dire and mental health services had been grossly under-funded and under-resourced for decades. At the time of the COVID-19 outbreak, a large majority of countries were spending less than 2% of their national health budgets on mental health. COVID-19 exacerbated gaps within national mental health programs and disrupted essential mental health services in 93% of countries worldwide.( WHO survey, 2020).

The pandemic not only strained fragile mental health service delivery systems, but also magnified the demand for mental health services. World-over,there was an alarming surge in mental health conditions, triggered by isolation, bereavement, loss of livelihood, uncertainty, and fear. Countries around the world reported increased levels of alcohol and drug use, insomnia, and anxiety—particularly among marginalized and vulnerable communities. Essential mental health services buckled under the strain, and WHO immediately issued guidance to countries on maintaining essential mental health services and integrating mental health components within COVID-19 response and recovery plans.

WHO’s Country Office in Tunisia (WCO) worked closely with the Ministry of Health (MoH) to ensure that essential mental health services were included within the national COVID-19 response plan. MoH re-activated a national Psychological Support Unit that had been established in 2015 after a terrorist attack. The Unit was initially designed to provide mental health services to people suffering from trauma in crisis situations.At the beginning of the pandemic, it was re-activated to provide mental health services to vulnerable populations, health care workers, and COVID-19 patients, who were highly affected due to stigma, social isolation, fear of contagion, anxiety over loss of income and fear of unemployment. WCO provided initial financial support (over $200 000 USD) towards establishing the call centre of the Psychological Support Unit within a public hospital in Tunisia’s capital, as well as policy guidance regarding service delivery, monitoring patients and referral protocols.

The reactivated Unit provides mental health and psychosocial support via a national toll-free helpline that was staffed by around 300 trained volunteers and healthcare providers. Within the first month of re-activation, the Psychological Support Unit received over 10 000 calls (March 30, 2020—May 05, 2020). A staggering 62% of callers were women and over 75% of the callers reported anxiety-related symptoms.

During the initial months, the unit’s work was mainly based on volunteers’ contributions. Over 240 mental health professionals across the country—psychiatrists, child psychiatrists, and psychologists—volunteered to provide mental health services in response to the COVID-19 crisis. The call centre was provided for free by partners in the private sector. Additionally, CSOs, NGOs and private sector health professionals contributed.

Photo caption: Mental health support unit in Tunisia’s capital city, funded by WHO.

Photo credit: WHO