Global Mental Health in the Wake of COVID-19: Reflections from a Rhodes Discussion Group
In late May 2020, Laura Nelson (Massachusetts & New College 2011) and Oscar Lyons (New Zealand & Balliol 2016) put out a call to current and recent Rhodes Scholars to facilitate virtual discussion groups on a topic of their choice, with the goal of “collectively envisioning and reimagining society in the current moment.” As a 2019 Scholar working remotely from outside of Oxford, I was thrilled by this opportunity for virtual connection with the Rhodes community and the chance to discuss how COVID-19 has changed my perceptions of myself, society, and the future I’m working towards.
A fascinating range of discussion topics were put forward by current and past scholars, and I felt extremely lucky to take part in Khameer Kidia’s (Zimbabwe & St Hugh’s 2011) group on Global Mental Health in the Wake of COVID-19. For three weeks, our group of eight scholars – coming from 2011-2019 Rhodes classes, six countries, and a wide range of academic backgrounds – gathered via Zoom to delve into themes of burnout, trauma, and vulnerability in the present crisis and beyond. I joined this group for personal and academic reasons, grappling both with the recent upheaval of my own circumstances and, as a medical student studying epidemiology, the immense mental health challenges to be faced by physicians, patients, and populations alike in the wake of COVID-19.
The Issue: Global Mental Health
The 2018 Lancet Commission on Global Mental Health and Sustainable Development not only identified mental health services as a core component of universal health coverage, but also highlighted the significant gaps in the provision of these services that persist globally. These gaps were noted before COVID-19, a public health crisis that has both profoundly disrupted healthcare systems and heralded widespread emotional distress as a result of social distancing and isolation, fear of illness and bereavement of loved ones, unprecedented global uncertainty, and profound economic losses. While consequences like anxiety, depression, substance use and other mental health disorders are well-known in the field of disaster mental health, COVID-19 is novel in the truly global scope of the disaster.
Addressing existing care gaps in the face of these enormous new challenges will arguably require a much more global mental health response, which considers the differing impacts of COVID-19, mental health, and societal disruption within and between countries. One of the topics we discussed in our group, for example, was how the response to global mental health during and after COVID-19 must recognize the specific challenges faced by low- and middle-income countries, as well as the issues that arise when applying a Eurocentric psychiatric lens to trauma experiences across different social and cultural contexts.
Key Themes: Trauma and Resilience
We also discussed as a group how our personal understandings and definitions of trauma have changed in the context of the current crisis. Through one of our main readings, we contemplated the tensions that exist between medical and neurobiological definitions of trauma and sociopolitical experiences that traumatize communities. Many of us had found the upheaval of COVID-19 to be profoundly traumatic to our communities, for example, despite perhaps not meeting the definition for trauma proposed by medical diagnostic criteria. While the medicalization of trauma in psychiatry has been necessary to promote awareness, funding, research, and treatment, we recognized that such medical definitions can exclude certain experiences from global mental health discourse. Rigorous medical criteria for the experience of trauma can, for example, fail to capture how trauma responses change across space, time, and ethnocultural contexts, or to recognize the importance of social narratives in normalizing distress, navigating loss, and building resilience at the community level.
Discussions about trauma often go hand-in-hand with conversations about resilience, which Eileen Zimmermann describes as the “ability to recover from difficult experiences and setbacks, to adapt, move forward and sometimes even experience growth.” In her New York Times article, Zimmerman explains that resilience in any one person is shaped by genetics, personal history, environment, and situational context. A central theme in our discussion group, however, was a critique of such theories that place so much onus on the individual to be resilient. As we expand our understanding of trauma to recognize sociopolitical contexts and collective grief in the face of 2020’s global upheaval, why must it be down to any one person’s resilience to determine how well they cope, survive, endure? How can we instead foster resilient systems, designed to care for the individuals within them?
The Road Ahead: Connectedness
In our final discussion session, our group discussed how we – as individuals deeply involved in various academic, professional, and social systems – could nurture spaces and cultures that promote resilience
throughout COVID-19 and beyond. We weighed the pros and cons of “top-down” approaches implemented by institutions, and contrasted these with more grassroots, peer-led wellness initiatives. Ultimately, we agreed that both were necessary steps towards addressing mental health in our communities in the wake of COVID-19, guided by the idea that – physically-distant or not – connection with others is fundamental to living wholly. Moreover, we recognized that any approach to promoting mental wellness must both recognize and celebrate the crucial work involved in caring for one another.
As we closed our final session and I let those key messages settle, I realized I was taking part in a truly incredible virtual space. Over the course of just three weeks and from the physical solitude of my bedroom, I had connected meaningfully with people I had never met in person, been vulnerable with people who were oceans away, and been poignantly reminded again and again how vital, nourishing and possible such connections were. As I look ahead to a more physically-distant future, the reflection I did in this group about the global scope of mental health, the changing paradigms of trauma and resilience, and my own role in building caring communities makes me cautiously optimistic that more global narratives of healing, connection and resilience in the wake of COVID-19 are possible.
Julia Sawatzky (Prairies & Green Templeton 2019) is studying for the Master of Public Policy (MPP) at the University of Oxford.