Webinar: Investing in Mental Health Policy

Robert Yates

Good evening, good afternoon, good morning, wherever you’re watching in the world and welcome to Chatham House. Well, in fact, needless to say it’s my study in South West London masquerading as Chatham House, but we’re in lockdown here in London, as I’m sure many of our viewers are, as well, today.

I’d like to welcome you to this special members’ event that we’re having, discussing an extremely important topic and that’s mental health, which you’ll see is getting a lot of attention in the midst of this COVID-19 crisis, so, you know, quite justifiably. But today we’re going to just, sort of, be talking in broader terms about mental health and the importance of investing in mental health services. I’d like to emphasise that this is a public meeting, it’s not held on the famous – using the Chatham House Rule. It’s on the record, so it’s being publicised and we’re very keen for you to tweet and really, sort of, discuss amongst your friends and colleagues, what we’re discussing today.

We’re absolutely thrilled to be co-hosting this meeting with United for Global Mental Health, our partners in this event, who have been doing wonderful work in really promoting the cause of mental health. And today they have been – they’re just about to re – to do a report, to publish a report on the return on the individual of mental health services. We recognise that a lot of the discussion around, sort of, mental health and the return on mental health will typically just be looking at the financial return. You know, there’s a very well-known formula that $1 invested in mental health services brings a $4 return. But, obviously, we’re recognising that it’s much more than that, you know, that mental health is so important for individuals and society as a whole.

So, today, we’re going to be discussing the broader implications of mental health and investing in mental health services and very much be thinking about how this impacts on discussions around universal health coverage Sort of, coming out of this whole crisis, COVID-19 crisis, it’s absolutely obvious there are going to be calls for greater investments in health and in universal health coverage, so that everyone’s covered, but it’s vital that this covers the full spectrum of services, not just infectious diseases, but also non-communicable diseases, including mental health services. And I think, you know, we are seeing, starkly, the importance of mental health to everyone, through this crisis and, hopefully, one of the few silver linings out of this will be the realisation that we need to invest in mental health.

So, I think we’re going to start the discussions today with a short video and then, we’re going to be having our panel of speakers who are going to be talking to us about their perspectives. We have a very eminent panel with us today. We have, from the Philippines, giving us the view from the Ministry of Health in the Philippines, Undersecretary Myrna Cabotaje, who’s going to be talking to us as the Undersecretary in the Health Team in the Philippines. Then we have Dévora Kestel, who’s the Director of Mental Health and Substance Use at WHO, the World Health Organization, absolutely vital organisation through this crisis, despite what President Trump might have to say, and we’re all very firm supporters of WHO here. And then, finally, we’re going to have the corporate view and we were very pleased to have with us the Chief Executive Officer of Unilever, and that’s Alan Jope, who’s speaking to us from Glasgow. And we’re hoping, we’re really hoping that we’re going to have, also, a mental health activist from Liberia, who’s trying to join us at the moment, but is having internet problems, but we’re fingers crossed that Josephine’s going to be able to join us, as well.

But without any further ado, if I can hand over to Ludivine, who’s going to show a video and then we’ll come back to the panel in a moment.

[Video and music].

Female

Hello.

Female

Hi.

Male

Hi.

Female

Hi.

Female

I’m from Melbourne.

Male

Hong Kong.

Female

Columbia.

Female

Canada.

Female

South Africa

Female

England.

Female

Every 40 seconds someone dies by suicide.

Female

Every time someone dies by suicide, you lose all the brilliance they could’ve brought into the world.

Female

I, personally, have struggled with anxiety my whole life.

Male

We need mental health to be taken as seriously as physical health.

Female

For my son, for our youth, for our families and our communities.

Female

I’m calling on my leaders to act on mental health, because people in Pakistan and all over the world deserve better.

António Guterres

It concerns us all and greater action is urgent. We need stronger investments in services.

James Chau

It’s about saving the promise, the potential that each of us holds inside and offers to the people around us.

Naeem Dalal

So, time to invest should not just be financially, but it should also be human capital, it should also be social inclusion in communities, as well.

Jazz Thornton

The world is speaking. We have the blueprint of what works. It’s time to invest in mental health

[Music].

Robert Yates

Thank you very much, indeed, the United for Global Mental Health for that excellent video, and I very much encourage people to read their excellent report that has just been published.

So, to kick off, I’d really like to handover, I think, first to Dévora, who’s going to give us WHO’s perspective. But just to say to the audience that we are going to be very keen to get your input and your questions that we’re going to put to the panel and I’d like you to use, please, the ‘Q&A’ function that you have at the bottom of your screen to ask questions. Please don’t use the ‘Chat’, that’s been disabled, we think, but the ‘Q&A’ function we find is the best way to collate questions. So, if you’re asking your questions, we’ll be able to bring you in later.

So, Dévora, if I can handover to you and if you can, sort of, give us the perspective on WHO and, really, the importance of investing in mental health.

Dévora Kestel

Thank you. Thank you very much, everybody, for having me here and having us given the opportunity to comment on this. I have to say that when I first learnt about the report being produced, I thought why do we need another report highlighting the need for investment? But actually, the answer came right away and the answer is very easy, it’s because despite the recommendation of the dimension of the problem and the implications of mental ill-health, we will – we can – we may have read already the numbers in the report, right, of the number of people affected, the burden that it implies, the cost of that for the economy. But despite all of that, mental health remains seriously underfunded. There is approximately 2% of the national health budget globally that goes to mental health and that’s clearly very, very little. So, we need a significant investment in mental health, and we need it now.

Now, we appreciate that this report outlines different aspects of the return on investment. It’s the value of mental health and wellbeing, in itself, the impact that mental health has on our physical health, the – and vice versa. The human rights issues are highlighted are the impact of caregiver mental health on children, all of that on top of the first one that one may think about, that is the economic aspects of the investment and including, then, the value of mental health in the workplace. So, the reports tell us that this is not only for monetary reasons that it’s important to invest in mental health, but it is also for social reasons or for, simply, human reasons that this investment is needed. The return on the individual then puts the people at the centre of the report and highlights the returns to the whole individual.

And so, what the report shows is that when we invest in mental health, the impact is seen at different levels. It creates return on the individual, of course, and then on the family and the communities and the businesses, clearly, and therefore, in their society and the economy of the country. Now, more than ever, in this moment, we know that the time to invest in mental health is – has arrived. The COVID-19 pandemic, as we all know, with the health threats to millions of people, the large number of casualties, the physical distancing measures, that unemployment rates, the economic and financial crisis that we are all listening or witnessing, actually, already, the increased violence that also we hear about, all of that poses a greater risk for the mental health of the world.

Investing in mental health means that we will be able to prepare for the implications of all of these. If we do not invest, we will not have the capacity, at country level, in the various contexts, to be prepared for what’s coming. In previous emergencies, we have seen that there may be a possibility for accelerate efforts around mental health and we have, in the past, witnessed what we call ‘Build for Back Better’, right, developing systems where they were not, in many cases.

So, let me remind us, in general, that mental health or our psychosocial wellbeing are an integral part of an individual capacity to live a fulfilling life, develop healthy mental and neurological – in mental and neurological way, form and establish romantic relationships, study, work, enjoy life, have a good time, according to what he and she thinks is worth doing. And this helps making decisions about educations, employment, the future, housing, everything.

Now, if we do not have that, then, the consequences are clear, right there. We need to invest in mental health, because health, both physical and mental health, is a right, and I think that’s the first thing we need to remember, it’s a basic human right, access to health, and that is the right of individuals that should be at the centre of the discussion.

The importance is to invest on mental health across a lifespan. We can start thinking about the needs to invest in maternal mental health, women during pregnancy and then early childhood and children and youth, adults and older adults. The investment should serve to promote mental health, to – for example, right now, the issues of – around communication are – about mental health and the implications that the current crisis could have in mental health are very important, but it is also important to invest to prevent mental disorders and to work on those conditions that could lead to suicide, for example. So, suicide prevention is very relevant, of course. Ensured access to care, for those with existing mental health conditions, you were talking, Rob, about services and that’s precisely what we need, and to make sure that recovery is possible, no matter where you are or no matter the conditions that brought you to some challenging situation.

We know enough about what needs to be done and how could it be done, how all of what I said, from promotion, to recovery, could be done, where, in which – how it could be different, from context-to- context, from country-to-country, at every level, from the low income to high income, everything we know how to do? Then, the need is to get – have the means to do that, to make sure that countries will have the capacity possibility to do what is needed.

So, we know, then, that when we invest in mental health, that this will have a positive impact at every level, again, from the individuals and families and the health outcomes in general, communities, business and economy. Individuals will live longer, will be more productive, will have fulfilled a potential, have healthier families and hopefully, contribute and participate actively in society. On the contrary, then, poor mental health has a negative impact on people’s physical health, family, social relationships, but also, will impact negatively the family, the society, sorry, at large. We are talking here about the problems of individuals that will have limited capacity, that may be victims of stigma and discrimination, individuals with mental health issues, their family and then, the impact that all of that will have, again, in the community and the society at large and then, the local perspective.

And knowing who was sharing the panel and in the audience, I thought I wanted to spend a few words, only, on this, the impact in the productivity costs, because we talk about, a lot about absenteeism and presenteeism and being – the cost of presenteeism often considered, in terms of the economic loss, and it makes sense, because it’s the lost – or the cost of going to work, but not performing well, as opposed to the cost of not going to work at all, with absenteeism. But it was interesting to think, in these days, during this time, that we do not always have an easy way of measure the – and to put an economic value to the other effects of work, going to work when you do not feel at our best because of stress or mental health issues. And, for example, in the case of health workers, we can see it’s now happening, when a health worker goes to work with poor mental health, it’s more likely to have what is call – known as patient safety incidents, right, or errors, medical errors. And in this context of COVID, that means a serious risk for the person, for the health worker in this case, then, their own health and, potentially, also, to others. So, how – what value do we give to that is something that we need to incorporate, also, maybe in our discussions, when we talk about the business around investment in mental health.

So, in summary and to make the introduction not too long, I think that there are clearly very good reasons for investing in mental health. You need to enhance the individual and population health and wellbeing. We need to protect human rights, improve economic efficiency, and move towards universal health coverage, as you said at the beginning. So, from our perspective, we welcome the report and we look forward to see it happening. Thank you.

Robert Yates

Thank you. Thank you very much, indeed, Dévora. That’s an excellent introduction and we couldn’t agree more about, you know, we would like to, very much, see the recommendations of the report implemented. And so, to the frontline, to the Philippines and Undersecretary, what’s your perspective, from the Ministry of Health in the Philippines, about the importance of investing in mental health?

Undersecretary Myrna Cabotaje

Thank you and hello, everyone. We are happy to be part of this discussion involving global mental health and we are recognising the fact that mental health problems will be our next wave of health emergency, if countries will not invest on mental health. While our prevalence data will only be available by the end of the year, like many of us, we suffer from serious mental illness, with epilepsy, with about 60% of people attending primary care clinics and having almost 1 per 100,000 households with mental disability. And, also, we all recognise the problem of suicide, especially among our adolescents. We had a study that 11.5% of students aged 13 to 15 seriously considered attempting suicide, with 17% actually attempting the suicide.

Of course, our problems are our resources. We have limited Psychiatrists and very few mental health workers. But what keeps us going are three things. First, we have our Philippine Mental Health Law, signed by the President in June 2018, which placed mental health at the centre of the universal healthcare and the law seeks to improve mental health facilities and to promote mental health education in community schools and workplaces. And, of course, we have passed the Universal Health Law last year, which will ensure that every Filipino has access to both primary and special care services. And, of course, we have our strategy, the reformed strategy in the department, which is the formula one for health, with a crosscutting pillar of performance accountability, so that we can provide affordable and quality services.

The good thing about our Philippine Mental Health Act is the creation of a Philippine Council for Mental Health. Now, together with the Department of Health, this is the policymaking body organised and mandated by law, to ensure setting out of basal – basic mental health services at the hospital and community level. We have increased our services. We are developing high – guidelines. What I’d like to zero in is we have a crisis hotline. This was launched middle of last year, based at the National Centre for Mental Health, and we have trained responders, assisted by a pool of Psychologists, Nurses, Senior House Officers and Junior Consultants. And we have used this platform, during the start of the COVID epidemic, when we had Filipinos, you know, Filipinos are all over the world, they have been locked down in Wuhan and this was the – one of the platforms for our Filipinos in Wuhan were able to communicate with the Philippines, in terms of asking some health problems. And we continue to do that all over the Philippines, in co-ordination with our Department of Foreign Affairs and we have organised a group of duty bearers and stakeholders for the implementation of this Mental Health Act.

We are part of the WHO Special Initiative for Mental Health. This is the UHC for mental health and we are committed to collaborate with WHO and other countries, in advancing mental health policy. In February of this year, an investment case for mental health has been conducted. We and WHO, UNDP and the UN Inter-Agency Task Force on Mental Health and we look into understanding the economic burden of mental health conditions, its direct and indirect costs, as has been mentioned, absenteeism and presenteeism, the cost of interventions and the analysis and the potential return of our investment.

Our preliminary findings show that 3% are governmental health expenditure, the cost of absenteeism is at 74%. The cost of presenteeism is at 14%, and the losses due to premature death are at 90% - at 9%. In 2020, the combined total cost of the seven main mental health condition in the Philippines is estimated at 92.3 billion Philippine pesos, or about 0.6% of our GDP. Our preliminary discussions were to focus these investments, have zeroed in on primary healthcare, which is providing access to affordable medicines, with the inclusion of essential psychiatric and neurologic medications and mental health inpatient and outpatient services.

In summary, we are – we see the need to scale up our efforts, if we want to see some changes. We have got challenges ahead, but if we work together and recognise that working together, we can have collective action. We have made progress in including mental health in conversations and talking about mental health as a serious issue, but the next step is doing something about it. We have put an end to the stigma surrounding mental illness and addressed the discrimination faced by those who suffer from mental, neurological and substance abuse disorders. But even in this COVID pandemic, there is some discrimination that is against the health workers, who are helping, because people are afraid of them, they do not allow them in their houses, in their apartments, no. So, this is one area that we will have to look into. We recognise that to move forward to implement mental health law, we need to bring actors together and that is what we have been doing in this COVID epidemic, which can be a template for future collaboration. There is an urgency to put our investments in places where they should be, and we hope to see the returns of our human capital. Thank you.

Robert Yates

Great. Thank you very much, indeed, and I think you make a very good point about, sort of, the COVID-19 potentially bringing everyone together, you know, and, you know, this has been one of the promising things that we’ve seen here in the UK. We all take out, on a Thursday evening, to applaud our NHS workers and I think, you know, this feeling of solidarity and we’re all in this together is extremely important.

Alan, if I can turn to you in Glasgow, now, you know, the – it’s excellent to see the corporate sector, the private sector, getting so involved and interested in mental health, and why do you think that’s the case and perhaps give your perspective? Thank you.

Alan Jope

Well, thanks, Rob, and thanks to Chatham House and thanks to United for Global Mental Health for this great report. You know, Unilever, as a big company, has operated for a long time now with what we call a multi-stakeholder model, and what it means is, we’re not just obsessed with profit maximisation and rewarding our shareholders. We believe that if we look after our people, if we look after our customers, if we look after our partners, our suppliers, if we look after society, if we look after the planet, then, at the end of that, the shareholder will be well rewarded. And it does begin with our people and we see mental health as simply an extension of inclusion and equality, building a truly diverse workplace where everybody should feel comfortable to come to work. We’ve already hit the goal of, fully, of our 13,000 Managers, 50% are women now and we’ve been working on anxiety and depression issues for a long time. We’ve got about 150,000 employees, which means, if the statistics in the report are right, that we, at any point in time, have got about 10,000 employees who are dealing with some kind of anxiety or depression issue.

We have been greatly helped by some brave role models and leaders in our company. So, our Head of Human Resources, Leena, Leena Nair, has championed this. Our Global Head of Learning, Tim Munden, has both championed the issue and spoken very openly about his own struggles with mental health issues. Our Global Head of R&D, who retired recently, had talked very openly in our organisation about how mental health issues had destroyed parts of his family and the difficulties he even had with his children. And we have our own video, much like the one that Ludivine opened up with, where we have people across Unilever, sharing the difficulties they’ve been having with mental health, and I think what this has done is, it’s helped to destigmatise it and make mental health just we’re working on people with physical disabilities feeling fully included in our company.

And in peacetime, we’ve really got a three-step approach, which is, first, to support employees. We have an Employee Assistance Programme, which means that we’re all only ever one click, one call or one chat away from professional help. We have our Global Wellbeing Hub pride of place on the front of our intranet site and so on. That’s the first thing is, making sure we support employees.

We believe our brand can be a force for good, so I won’t go into a lot of detail, unless anyone’s interested, but Lipton, the biggest tea brand in the world, is trying to drive conversations, reopening conversations over a cup of tea. One of our haircare brands, Clear, is helping young people with self-confidence, and Wall’s, one of our ice cream brands, is trying to promote happiness and neighbours treating each other well, and we think these are contributions to mental wellbeing. So, that’s the second thing. And then, the third thing is, we want to change the system itself through partnerships, partnerships like Head Together, destigmatising mental health issues, and also working with United for Global Mental Health, which is creating this evidence-based roadmap for the private sector and why there’s a return on investment and a return on the individual, when we tackle mental health properly.

That’s our peacetime approach. I think we’re now in a wartime mode, frankly, with coronavirus. Coronavirus is a, first and foremost, a human tragedy. I had the dreadful news last night that we lost our fifth employee, someone I knew from our Research Laboratories in the United States. This is killing indiscriminately and it’s creating new stresses. About – we have about 70,000 people working in isolation, from home, and another 70,000 people who are still coming to work, to work in factories or frontline field sales, and we know that isolation and stress issues are going through the roof right now.

We’ve innovated in our commun – we’re trying to do a lot of communication and for the last two weeks, we’ve done a global town hall meeting. We had 24,000 people attend and much like this, we have a chat session and people can ask questions and fully 10% of the questions were about people struggling with anxiety or stress. And I’m glad we did this, ‘cause we had the opportunity to direct people to good practices and the support that we’re able to provide and that’s – by the way, that does not include the number one question, which was anxiety about jobs. So, the 10% was hardcore mental health issues, the number one issue is people worrying about their jobs.

I could say a lot more, but I’ll pause there, just to say this report could not be more timely. It’s relevant in peacetime and it’s altogether even more relevant in these difficult days that we are in and that we have ahead of us. Thanks, Rob.

Robert Yates

Thank you very much, indeed, for that, Alan and deepest commiserations to your poor colleagues, you know, that must be extremely disturbing for you all there. But we’re trying – we’re very keen to try and get Josephine to join us from Liberia, that I’m privileged to be able to see Josephine on the screen here. But Ludivine, I’m not sure, is it possible for us to connect to Josephine, maybe via phone? So, it’s – Josephine, can you hear us okay in Liberia?

Josephine Karwah

The issue when it comes to mental health or how people can invest in mental health in the world, because I don’t want to limit it to Liberia only, I think these are things that people can do: show effort, because it is serious, Josephine suffered from a mental health issue for, like, two years. Although she came into our] our recover centre, who are helping her, after I saw her two parents were being cremated, I lost my mind. Well, I didn’t know anything. I never recognised this for months and, unfortunately, I haven’t been a lot better that I could not even recognise because of what I saw, the trauma I went through at the particular time. But after I came in contact with this organisation who try to talk to me, things started to get better. So, this is Josephine.

Robert Yates

Ooh, I think we might, actually, have lost Josephine there. But I think that was – and we were, sort of, planning to get Josephine on. We’d actually hoped to start with Josephine speaking to us about her experiences and just to tell the audience that, you know, Josephine, you know, survived the Ebola epidemic, but, tragically, lost a number of her close family and was, obviously, completely traumatised by that whole experience. And, you know, just really showing how this interaction of infectious diseases and pandemics can really cause great mental health problems.

And, Dévora, maybe, sort of, moving onto the questions now, you know, can I ask you, you know, sort of, of – what are we finding, vis-à-vis the COVID-19 pandemic now and the impact it’s having on mental health on people, are we, sort of, seeing similar things to what we’ve seen, say, for example, in the Ebola outbreaks?

Dévora Kestel

Thank you, Rob. Actually, you know, in – we know that in emergencies we see – we estimate one in five persons will have a mental health issue, which is quite high, and this is a very special one, the one we are going through right now. I think one of the main reasons is because it’s global. So far, as you said, Ebola was happening in a few regions in Africa, or you have the tsunami happening somewhere far in Asia, or you have things happening to the poor or things happening to those of some colour. Well, right now, this is happening to everybody, everywhere, no matter where you are.

Now, one of the issues of what is COVID-19 now is that it’s not discriminatory, it’s affecting everybody. Now, some countries better developed were affected first and we hope that we will be able to learn from that to other countries find how to position themselves on some of the issues. We know that it’s affecting everybody, because the fear of being infected or the fear of dying, the fear of having somebody that we love that is infected or could die, but also, the stress of – caused by not knowing what’s going to happen, the uncertainty, whether we will be able to and when to go back to work, to go back to our routine, to go back to say hello by hugging somebody, this uncertainty definitely generates anxiety. We do know, also, that there is a lot of – at [inaudible – 35:35] there is some stigma and discrimination for people affected with COVID and that generates older – further challenges. We know that the economic consequences in – for everybody, but in some context, are really very tough, if a person cannot go to work on daily basis. I have a salary and even if I work from home, others do not. And so, how this is going to be faced when, in normal circumstances, the unemployment has a very clear link to mental health issues, including leading to suicide.

We also have the problems of – related to health workers, themselves. On one hand, health workers being exhausted and stressed and getting sick, in many cases that same stress and fatigue will lead to problems, as I mentioned earlier, right? That could make them fragile and then more prone to get – to make mistakes to their own security and to others. Some terrible decisions that they have to take right now will have – they do have already and will have implications on their mental health. We have, also, the services for people with mental health issues, mental health conditions, existing services that are being empty from personnel, because personnel is called to do something else. So, what kind of continuity of care can we offer to people with existing mental health conditions, as well as people with other health issues and their needs relating to the continuity of care in general, access to medications, etc.?

So, on top of that, we hear about violence in the family context, against women, against children. I saw a question there about suicide. We do not have official figures right now. We only have anecdotical stories coming, and mostly from the health workforce, precisely. But all that is happening and to deal with all that, there are already some tools, some messages, some initiatives that could be undertaken by Managers, by employers, as we heard before, by governments, of course, and at the – at every level. We cannot delegate anymore to a high level only, because there are some priorities. We cannot delegate the care of mental health only to health professionals, because they are busy on many other things, as well, right now. So, we need to find modalities and strategies to engage others, to engage the community, the neighbours nearby, to give them a role that will help being better, but also help others being better.

And to finish, the telemedicine, the digital technology, with all the challenges that are coming together with it, that is something that we need to consider. We need to be smart right now, more than ever, to see how can we really expand the capacities of – the limited capacities of health system to go beyond that and to reach out as many as possible, because the needs are big, are becoming huge.

Robert Yates

Yeah, yeah, and thank you very much, indeed, Dévora, and I think, you know, very important you emphasising the role of communities, neighbourhoods at the moment, you know, that with the formal health services being so stretched at the moment, you know, it is absolutely vital that we reach beyond the facilities and into the communities.

Just to remind our audience that we are taking questions at the moment and we can see questions pouring in at the moment in the Q&A function, so, do please ask specific questions of individuals, or to the panel in general. And I think you have the function, as well, of being able, if you see a question and you think, oh, that’s a very good question and I was going to ask something similar to that, if you just click on the, sort of, the thumbs up, then that will get upvoted and then, they’ll, sort of, get promoted up and we’ll be able to spot them more easily and, hopefully, then, that’ll be more efficient, will, in effect, answer more of your questions.

So, sort of, maybe, sort of, turning to some of these, sort of, questions now, and one that caught my eye, a moment ago, was from Pakistan and this was, sort of, specifically directed at the Undersecretary in the Philippines, and if I can just find it now, amongst the, sort of, the questions that came up, and I think I can remember it. It was you’ve been successful in promoting mental health up the agenda and passing a whole act in the Philippines, how do you think that you were able to do that? Because I know that a lot of people, in developing countries, fear that mental health, you know, hasn’t been given the attention it deserves, so, how do you think you were so successful in the Philippines, and what might’ve been the role of civil society in promoting mental health?

Undersecretary Myrna Cabotaje

Thank you for the question. We had a group of very passionate individuals, mostly from the civil society, who wanted to pass on the Mental Health Act, so that we can address, not only psychologic – even neurologic disorders. And we have in this group, also, the users themselves, know, like one of our panellists. It’s important that we recognise that from their perspective, they have the right and what they want to have done. But I think it was just ripe, when our President was also available, the legislators were cognisant of the fact that we really needed to address mental health issues. Even as I was saying earlier, we do not have the data, no, we don’t have prevalence data, we just have estimates, but it’s prevalent and everybody really wanted to get together and have something specially at community level. So, I think that is the difference in the Mental Health Act from the Philippines. We wanted to integrate and have it at the community level, not behind – although there’s a referral system, it’s not behind consultation with the public and with the specialists. So, we want to have mental health integrated at the community level.

Robert Yates

Great, thank you very much, indeed, and I can see that the next upvoted question at the moment is, actually, for you, Alan, at Unilever, and this is from another Alan, Alan Court, and he’s asking, “With 10% of the issues of the global town hall meeting reporting stress or other mental health issues, how is the company responding to this, specifically?”

Alan Jope

Okay, thanks, Rob, and thanks, Alan, for the question. So, the first thing is preventive measures, trying to make resources available to people around mindfulness, around healthy work practices. Some of the work practices on working from home are not intuitive. Many of us don’t feel that we’re working from home, we feel more like we’re sleeping in the office and we’ve got to get – snap those bad practices, and balance – tips on balancing family and work. So, for instance, my guidance to the team is, “Take care of your family first and squeeze work into anything – any time that’s left over.” The reverse does not work, so, preventive measures.

Second is support resources. We have this Employee Assistance Programme, where you can phone a number that everyone has access to or click on a chat and get access to properly trained Counsellors, who can provide a first contact care on mental wellbeing.

Third thing is, we’re quite worried at the moment about domestic abuse, because we’re forcing people into a situation where they will spend longer and more time with potential abusers, and we’ve created quite a world leading resource for people who might be or are suffering from domestic abuse, with very concrete support on how to get away from that.

And the fourth area, I think, is more controversial, which is we’re using data and analytics to watch for those who are being left behind. So, most of us feel that we are being sucked into a vortex of too many virtual meetings, too many emails, too many calls, but, actually, there’s a group of people who are not being invited to attend meetings, who are not part of digital networks, who don’t have access to comfortable tools and nice offices, like I’m sitting in, and were actually able to – and who are not actu – who are falling behind on email contact and social contact. So, whilst, obviously, respecting individual privacy, we are watching for people, using data tools and analytics, who might be being left behind and feeling lonely and isolated. So, we have prevention tools, resources, watch out for domestic violence and use advanced analytics, we think we can have quite a good impact on helping our people.

Robert Yates

Hmmm, thank you, Alan. That’s very useful and very interesting, as well, particularly around the email and, sort of, the digital access issues. Yes, because, you know, there seems to be an overconsumption by some and a feeling of being excluded by others, and I think in this digital age, you know, these are all vital things to take into consideration.

The most upvoted question at the moment, very interesting, more than double any others, and this is from Mohammed Ali-Hasnan, and I – who I think may be from Pakistan and it’s, sort of, directed to the whole panel, but I suppose maybe, sort of, Dévora might have a view on taking this first, and it’s about the role of the WHO and the wider UN system working with governments and international funds to ensure mental health is integrated into the COVID-19 response. So, how do you think, you know, the WHO and the UN system can do that with governments?

Dévora Kestel

Thank you. Thank you very much and I wish I knew precisely how to do it, you know, which mean – will mean that we will get the resources that are needed. What I – what we are doing, apart from the drugs, is to make sure that in every context where there is the possibility to outline the needs around health, in particular, mental health is embedded. We are talking about mental health and psychosocial support and we work with a number of other UN and – organisations and other NGOs, under the big umbrella of the ISC, which is the Inter-Agency Standing Committee, and it is within that network that we are all advocating together, for what we call mental health or psychosocial support that belongs to health, but also, is related to many other areas, such as education, protection, etc. So, we are trying to make sure that mental health is precisely, as a crosscutting issue, mentioned and incorporated in many different aspects.

We are working, specifically under the health sector, on the different levels of interventions that could be needed. We are trying to make sure that when countries are working on the essential health services that are going to be needed, that are needed, no matter what mental health is included there, at its very basic level, but it’s there. We are trying to make sure that another important guidance that is being developed are these outreach services that is mostly for communicable diseases, like HIV, malaria, etc., but also, for areas like us, like mental health and psychosocial support, we are working in communication at different levels to make sure that this is happening.

I just wanted to mention that we are also working, I said, self-education and I was recalling a very nice book that we just launched that is amazing. It’s been translated in 90 languages, 9-0 and it’s COVID for children, it’s called, “My Hero.” And you, it’s – I don’t know if you have seen it, but it’s another way of reaching out to parents that will read to children about COVID-19 and in that way, then, the community gets involved and gets informed, as well.

If I may, I saw a question that is related to elders, older adults that I would like also to address, because I think it is…

Robert Yates

Hmmm.

Dévora Kestel

…very important. We are – we have been listening a lot about how this is one of the groups that is most severely targeted, in terms of getting the disease. And I think it is very important that we don’t forget how to make sure that we communicate properly to older adults living in isolation, living maybe in homes, not necessarily with all their functions in good shape. Let’s say, so many of them may have some challenges and we need to make sure that we provide information, basic information, but clear information, with a very clear language, making sure that they understand and are aware of what is happening. I think that it is important to activate the neighbour – the networks that may be around. I was talking about it earlier, a personal experience, my mother became a widow, I – my father passed away a few weeks ago and, suddenly, out of nowhere, a neighbour knocks at the door and say, “If you need anything from the shop – supermarket, I can get it for you.” For me, that was an amazing gesture and I think that with those simple issues, we are making sure that an elder that is only alone at home receives care. If there is no access to social media and smartphones are not available, the phone is always there. Grab the phone, call, and say what’s happening, how the family members are doing, ask how they are doing. Those key communications, I think, are important. Then, if the government is capable of organising a more supportive system, of course, it’s welcome.

Robert Yates

Great.

Dévora Kestel

That’s something, basically, I wanted to share.

Robert Yates

Thank you. Thank you very much, and now we have a question from Ghana and so, this is, I think, very much directed to you, Undersecretary, and it’s about mental health services in the Philippines and what you’re doing to support drug users and persons addicted to drugs, now, which I know is, sort of, quite a controversial topic in the Philippines. And I’m just wondering how you’re managing to integrate that into your mental health services?

Undersecretary Myrna Cabotaje

That is part of our substance abuse, of course, from the health perspective we always see that it is a prob – a mental health issue, it’s a problem of the user and not really an abuse. We are trying to integrate more the how to rehabilitate the user, how to prevent them, so, it’s from different aspects, first, prevention of substance abuse, when they are there, how can they be assisted into rehabilitation? And from the medical point of view, it’s really how to assist the one who is problematic, the one who is with the substance disorder, rather than looking at them as what do you call that? Those who are breaking the law, etc.

Robert Yates

Hmmm hmm. Hmmm, thank you. Thank you. Now, here’s an interesting one and we might – this might be the last one, I’m afraid to say, but that – and this is looking at the social determinates of health and particular causes of mental health, and this is from Jeremy Ross and he says, “You cannot separate discussion on mental health from a discussion on social and economic equality. Surely, investment in formal services is less important than social transformation.” I think we’re referring here to the social dimensions of health and, you know, the clear evidence that more unequal societies are unhappier societies. So, I’m just wondering what the panel are thinking about, particularly coming out of the COVID-19 crisis, where we are likely to see growing levels of inequality, how this is going to impact on mental health services and how do we, potentially, move to a more equal society? So, I don’t know who would like to start with that. Alan, perhaps if you start with that one?

Alan Jope

I can have a crack at that. Look, I’m an optimist at heart and I do believe that the future belongs to young people and I believe that coming out of the coronavirus catastrophe, young people are going to rise up and be less tolerant of the big problems in the world. And most of the big problems in the world are derivative of two things, which is either climate change and the consequences that that’s having on nature, the consequences it’s having on water, the consequences it’s having on land use. And I think young people are going to be intolerant of an economy that spews out carbon and continues to degrade. It’s like the warnings we were having on corona – on pandemics. But the other big problem of our day, alongside climate change, is inequality.

Now, there are statist – because China and India have succeeded in dragging hundreds of millions of people out of poverty, the global statistics are extremely misleading, ‘cause they say inequality is reducing. But, actually, when you click down to a national level and look country-after-country, inequality is actually increasing in many countries. And my optimism is that young people are not going to stand for this anymore, that the big – the power that sits with government, the power that sits with NGOs, the power that sits with business, and the young people are going to demand that that is used to address these issues of inequality. And one of the most important dimensions of inequality is inclusion and certainly at Unilever and I think in many other companies, we want everyone to come to work, regardless of their gender, their age, their sexual preference, their race, their religion, and their ability status. We welcome people with different abilities into our organisation and so, I’m quite optimistic that the young people will be a force for change, social change, and change around equality.

Robert Yates

Right, thank you very much indeed, Alan. I – and I know that you have a hard stop now. You were – I think you have other meetings to attend, as well. But thank you so much for joining us today. We really do appreciate your…

Alan Jope

Thanks, Rob, and apologies if I slip off. Thank you.

Robert Yates

Don’t worry, that’s absolutely fine, and we had really hoped to, as I say, to, sort of, get more inputs from Josephine in Liberia, but we’ve been, sort of, struggling with the connections there, but Ludivine, am I right in thinking that there might be one of our colleagues who can, maybe, make more interventions on behalf of Liberia?

Ludivine Rebet

Hi, sorry, I’ve just unmuted myself there. We actually have an intervention from one of our colleagues at one of our partners for this event and the person’s name is Neelesh. If you would be happy for me to unmute their mic?

Robert Yates

Yes, please. Yes, please, and Neelesh, we – would you – so please, do join us and give us your perspective.

Neelesh Heredia

Good afternoon and thank you very much for inviting me. So, by way of introduction, I work at HSBC, so, I’m under the similar sector to your panellist who just left, and I also happen to recently have become a Trustee on United for Global Mental Health. But thank you very much for inviting me to share my experiences on the work that we have been doing at HSBC, and while we have invested in enabling mental health in the workplace, which is really where we’re most interested in the subject. But before I do that, I have to tell you, I’ve read the report fairly closely, because we’ve been associated with the Speak Your Mind Campaign, which we know – which, as you know, is powered by United for Global Mental Health and we think there’s probably going to never – there’s never been a better time for a report like this, just like your panellists said, because something like this needs to inform and influence the thinking and the action that’s going to take and forthwith. You know, at HSBC the reason we do this is not dissimilar to Unilever, it’s simply because human capital is a precious commodity in financial services, as it is in any sector.

And our real journey probably started about two years ago, Rob, and our focus has been on driving several outcomes. We’ve looked to educate our people on the subject of mental health. We’ve looked to alleviate the stigma that we all know is associated with the subject and we have fundamentally sought to ensure that the support we were providing our people and their families, especially when they go through bouts of ill-health, is look – we looked for that to be world class. And like what they’re doing at Unilever, we have ensured that our efforts have been leader-led at the top of the house. So, for example, the Group Chief Executive at HSBC has led that whole dialogue, and when you have a hierarchical organisation, as many corporates do, when you start to have these conversations at the top of the house, it starts to make it normal, over a period of time. People feel that it’s okay, it’s a safe environment in which they can start to talk about this and not feel judged.

So, we have 238,000 people in 60 different countries. We’ve launched education that we’ve had specifically curated for us and, importantly, we have had the education curated against the cultural context in which these conversations were taking place. So, I’m ethnically Indian, I can tell you that the subject of mental health would have a fairly different backdrop in South Asia to what it would have, perhaps, in Western Europe or in the Western World. So, we were very careful to ensure that the conversations and that the education we were having was curated against that backdrop.

The second thing we’ve done is we’ve really upped our support for our colleagues through the employment – Employee Assistance programmes that we have. So, for example, in the UK we’ve doubled the outpatient allowance that people have on mental health and then, of course, we’ve partnered with United for Global Mental Health on the Speak Your Mind Campaign. But I – all of that having been done, I would suggest to you that we are at the beginning of our journey as a multinational. We’ve got a ton of work to do. I don’t expect our education efforts to support, but critically, where we can also play a role is education on financial wellbeing, because we know that the – there is an inextricable link between mental health and financial wellbeing, and there’s a lot more that we can and should be doing in that space.

Robert Yates

Thank you very much, indeed, Neelesh, yes, and I think…

Neelesh Heredia

No problem at all.

Robert Yates

…to engage the private sector more. And I think, as well, you know, there’s certain sectors that we know have a very big impact on mental health and, you know, so, say, the tech sector as well and, you know, the – all the issues around safety on the internets, as well, and, you know, so, to involve as many multinationals and tech companies as possible, I think, is extremely important.

I’ll, basically, wrap up, then, our session today and, you know, that we’ve had interventions from three continents and, you know, we’ve had questions from all over the world, you know, which is one of the beauties of sessions like this now that we’re able to do this, and I’m sure that we’re going to be, sort of, working a lot more like this in the future. I, personally, heave learnt a lot through, you know, working with you on this project and, you know, I’ve found this extremely interesting, and I think that we’ve all really recognised the importance of mental health, particularly recently, through this COVID-19 crisis. I mean, you know, every email you send, every conversation you have at the moment is, you know, “How are you, how are you feeling?” You know, people, you know, are very, very concerned about each other’s, you know, health and wellbeing.

So, let’s hope, you know, that, you know, one of the few things that will really come out of this whole experience we’re all collectively going through at the moment is recognising the importance of mental health, investing in mental health, particularly as the likelihood is, is that, sort of, coming out of COVID-19 we are going to be seeing countries much more committed to universal health coverage, to that being publicly financed. And then there are going to be big debates about where the investment should be made between communicable diseases, non-communicable diseases, hospitals, community, but I think one thing that we can all be agreed on is the importance investing in mental health. So, thank you very much indeed for joining us today and best wishes to you all, and stay well and stay healthy.