Mental health is a very important issue for everyone. Mental health challenges can affect anyone at any time in their lives, but recovery is possible for anyone with the right support. The COVID-19 pandemic has affected everyone’s mental health and well-being. This must be doubled for those affected by TB. Globally, the delivery of mental health services has been disrupted. Those who had pre-existing mental health problems and psychosocial disabilities were affected the most yet there is no comprehensive initiative to address mental health problems at the moment. Despite the impact mental health can have on every aspect of someone’s general wellbeing, it is an area of health that has not been given the global attention needed. October the 10th marked World Mental Health Day, and this year’s theme was ‘mental health in an unequal world’. The global pandemic has emphasized and highlighted the issues around inequalities and health, which includes mental health. The COVID-19 pandemic and lockdowns have also shown how important and relevant mental health is to everyone. This is particularly true for many people in our community as TB patients and survivors are often negatively impacted by health inequalities, and also have a higher risk of suffering from mental health issues.

According to the WHO report 2021, Tuberculosis (TB) for the first time in more than a decade, deaths due to TB have increased and progress made has been reversed by the COVID pandemic. 

The interconnected relationships between TB and mental health are diverse and complex. Not only are many mental health challenges associated with a higher risk of contracting and transmitting TB, but both TB and many mental health issues, such as anxiety and depression share some of the same risk factors. Furthermore, poor mental health has been associated with an increased risk of poorer treatment adherence. Conversely, TB diagnosis also increases the risk of poor mental health. 

Patients with TB have been reported to have higher incidences of psychiatric morbidities and mental health issues both before and after TB onset. This not only leads to a poorer quality of life among these patients, but it also results in various other poor outcome measures like a loss to follow-up, failure to seek treatment, and poor adherence to treatment. Studies have reported particularly high prevalence rates of psychiatric comorbidity and other effects like renal damage, gastrointestinal disturbances among patients with drug-resistant tuberculosis due to long treatment of DR-TB. 

It shouldn’t be forgotten that TB is referred to as a poverty-related disease according to classification by the World Bank and many people have limited access to treatment services. Even in countries that offer free diagnosis and treatment, the associated costs are still high, for example, the cost of time off work and other indirect costs such as childcare, and food. This increases the financial constraints of care on the patients and family in addition to already existing difficulties, and this can easily add to stress and affect their mental health. The cost of TB treatment, both direct and indirect, is often high, especially for DR-TB patients or those taking newer drugs. The lack of food and other basic resources and the stigma associated with TB can also contribute to poor mental health outcomes.

If ignored, mental health may lead to increased negative treatment outcomes, decreased quality of life, greater disability, and even mortality. Poor medication adherence is also frequently found in cases where physical illnesses and mental health issues are present. Evidence has shown that  HIV is a driving force behind the global burden of TB and the development of drug-resistant tuberculosis (DR-TB). As known, management of multidrug-resistant TB (MDR-TB) patients co-infected with HIV is highly challenging with growing evidence showing mental health issues such as depression, anxiety, and psychosis to be associated with MDR-TB and HIV. Mental health care for patients with these two stigmatising and debilitating diseases demands attention.

While mental health has become more high-profile and is talked about more now than ever before, more needs to be done. Mental health services should be made more easily available for TB patients in order to improve treatment and quality of life. There is a stigma attached to mental health and it is seen as a taboo, it is still perceived by some as a sign of weakness, so many people end up suffering in silence – which can exacerbate matters as they don’t get help at an early stage and it can mean they end up with a more serious mental health problem as a result, It is also associated with higher rates of suicide.

This is why things like World Mental Health Awareness Day are important and should be included in any TB advocacy work – to raise the profile and understanding of TB and mental health. 

The more mental health is out in the open being talked about, whether it is through awareness days or weeks, anti-stigma campaigns, storylines on TV soap operas, or on debate shows, the better. The more the public knows about mental health, the more confident they will be to talk about it – or listen to others – which can make all the difference.

There is a desperate need to increase funding for TB and mental health. Supporting TB civil society to build staff capacity, raise awareness around mental health, and provide linkage to care services would go a long way to ensuring the TB-affected person’s mental health needs are addressed. By raising awareness Let it become normal to talk about mental health. The human rights approach is crucial when advocating for mental health not only for TB patients but for everyone in addressing challenges for mental health. It is time to address social inequality everywhere by integrating the psychosocial aspect of life within the services offered to TB patients. “Treating mental health is strongly aligned to every aspect of the End TB strategy,” “Effectively treating depression is essential to the fight to end TB.” Said Dr. Sweetland, co-chair of The Union’s TB and Mental Health Working Group and Assistant Professor of Clinical Sociomedical Sciences in Psychiatry at Columbia University.

Bringing about change in TB and mental health will require us to go beyond simply biomedical solutions and instead adopt a public health, human rights, recovery-oriented and psychosocial approach to TB and mental health. Only then; can we shape policies and services that effectively address the needs of TB patients and survivors and address the mental health needs of those affected.

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TB and mental health