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How mental health care should change as a consequence of the COVID-19 pandemic
Open accessAbstract
The unpredictability and uncertainty of the COVID-19 pandemic; the associated lockdowns, physical distancing, and other containment strategies; and the resulting economic breakdown could increase the risk of mental health problems and exacerbate health inequalities. Preliminary findings suggest adverse mental health effects in previously healthy people and especially in people with pre-existing mental health disorders. Despite the heterogeneity of worldwide health systems, efforts have been made to adapt the delivery of mental health care to the demands of COVID-19. Mental health concerns have been addressed via the public mental health response and by adapting mental health services, mostly focusing on infection control, modifying access to diagnosis and treatment, ensuring continuity of care for mental health service users, and paying attention to new cases of mental ill health and populations at high risk of mental health problems. Sustainable adaptations of delivery systems for mental health care should be developed by experts, clinicians, and service users, and should be specifically designed to mitigate disparities in health-care provision. Thorough and continuous assessment of health and service-use outcomes in mental health clinical practice will be crucial for defining which practices should be further developed and which discontinued. For this Position Paper, an international group of clinicians, mental health experts, and users of mental health services has come together to reflect on the challenges for mental health that COVID-19 poses. The interconnectedness of the world made society vulnerable to this infection, but it also provides the infrastructure to address previous system failings by disseminating good practices that can result in sustained, efficient, and equitable delivery of mental health-care delivery. Thus, the COVID-19 pandemic could be an opportunity to improve mental health services.
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“Cancer survivors, including YAs, rural or geographically distant, and economically distressed individuals, may find this modality inviting due to familiarity or enhanced access to care.9, 10, 11, 12”
From Cancer during a pandemic: A psychosocial telehealth intervention for young adults (2022) · cites this paper as [10]
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“It is also important to note that the model is informed by the COVID-19 pandemic, which has emphasized the urgent need for mental health-oriented interventions designed specifically for young people, given that 75 % of those aged 18–24 indicate at least one pandemic-related mental or behavioral health symptom, and one-quarter reporting suicidal ideation (Czeisler et al., 2020; Moreno et al., 2020”
From Intervention development to improve foster youth mental health by targeting coping self-efficacy and help-seeking (2023) · cites this paper as Moreno et al., 2020
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“Previous research has clearly shown that healthcare needs to adapt to the new demands put on the healthcare system, for instance, be able to deliver treatment on distance (46).”
From A systematic review on the efficacy of virtual reality and gamification interventions for managing anxiety and depression (2023) · cites this paper as [46]
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“These inequalities are likely to increase with the current COVID-19 pandemic”
From Preventive psychiatry: a blueprint for improving the mental health of young people (2021) · cites this paper as [286]
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“Some cross-sectional studies have already shown the emotional impact of the lockdown and the early stages of the pandemic, highlighting high levels of distress [7,8], post-traumatic symptoms [7,9], worry [10,11], and anxiety [7,11], underlining the strong link between compliance with restrictions and moral disengageme…”
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“Research, funded by government programs, will be needed [86]: for instance, digitization is one of the pillars of the €750-billion Next Generation European Union plan (equivalent to approximately US $891 billion), which aims to support recovery from the COVID-19 crisis and also to invest in the future and resilience o…”
BackgroundGulliver, A., Calear, A. L., Sunderland, M., Kay-Lambkin, F., Farrer, L. M., & Batterham, P. J. (2021) · Internet Interventions · doi:10.1016/j.invent.2021.100400 · Cited by 44
Digital Health COVID-19 Impact Assessment: Lessons Learned and Compelling Needs
Microsoft, Lee, P., Abernethy, A., Verily, Shaywitz, D., HealthTech, A., Gundlapalli, A., Prevention, U. S. C. F. D. C. A., Weinstein, J., Healthcare, M., et al. (2022) · NAM Perspectives · doi:10.31478/202201c · Cited by 49
Zhang, Y. S. D., Young-Leslie, H., Sharafaddin-zadeh, Y., Noels, K. A., & Lou, N. M. (2021) · Journal of Community Health · doi:10.1007/s10900-021-00971-8 · Cited by 48
Daniels, R. A., Miller, L. A., Mian, M. Z., & Black, S. L. (2022) · Business and Society Review · doi:10.1111/basr.12256 · Cited by 47
Carl, J. R., Jones, D. J., Lindhiem, O. J., Doss, B. D., Weingardt, K. R., Timmons, A. C., & Comer, J. S. (2021) · British Journal of Clinical Psychology · doi:10.1111/bjc.12286 · Cited by 46
Child and youth mental health needs and service utilization during COVID-19.
Stewart, S. L., Vasudeva, A. S., Dyke, J. N. V., & Poss, J. W. (2021) · Traumatology An International Journal · doi:10.1037/trm0000345 · Cited by 55
COVID-19 as a policy window: policy entrepreneurs responding to violence against women
Mintrom, M., & True, J. (2022) · Policy and Society · doi:10.1093/polsoc/puab017 · Cited by 50
Long COVID in the context of social determinants of health
Lukkahatai, N., Rodney, T. W., Ling, C. G., Daniel, B., & Han, H. (2023) · Frontiers in Public Health · doi:10.3389/fpubh.2023.1098443 · Cited by 46
“COVID-19 has increased the prevalence of mental health disorders and there is an expectation that this trend will also be reflected in individuals with long COVID symptoms (68, 69).”
BackgroundFutterman, I. D., Grace, H., Weingarten, S. J., Borjian, A., & Clare, C. A. (2023) · The Journal of Maternal-Fetal & Neonatal Medicine · doi:10.1080/14767058.2023.2199345 · Cited by 46
“Although clinical diagnosis and treatment via psychological or pharmacological treatment remain front line as therapeutic approaches, the COVID-19 pandemic has introduced a new challenge, namely, reduced access and/or attendance to health care visits [54].”
BackgroundLandi, G., Pakenham, K. I., Mattioli, E., Crocetti, E., Agostini, A., Grandi, S., & Tossani, E. (2022) · Journal of Contextual Behavioral Science · doi:10.1016/j.jcbs.2022.08.008 · Cited by 59
Rameez, S., & Nasir, A. (2023) · Journal of Family Medicine and Primary Care · doi:10.4103/jfmpc.jfmpc_391_22 · Cited by 46
Implications of COVID‐19 for an ageing population
Holt, N. R., Neumann, F., McNeil, J. J., & Cheng, A. C. (2020) · The Medical Journal of Australia · doi:10.5694/mja2.50785 · Cited by 46
Solmi, M., Estradé, A., Thompson, T., Agorastos, A., Raduà, J., Cortese, S., Dragioti, E., Leisch, F., Vancampfort, D., Thygesen, L. C., et al. (2021) · Journal of Affective Disorders · doi:10.1016/j.jad.2021.07.048 · Cited by 45
Self-citationDarcy, A., Beaudette, A., Chiauzzi, E., Daniels, J., Goodwin, K., Mariano, T. Y., Wicks, P., & Robinson, A. (2022) · Expert Review of Medical Devices · doi:10.1080/17434440.2022.2075726 · Cited by 40
“Zoom, WebEx, Skype) to enable faceto-face therapy to take place virtually Convenient for the individual, relatively more accessible and scalable (albeit still limited to the ratio of those interested: those available to treat) Access and comfort with technology, privacy, security, data allowance, clinician reimburseme…”
BackgroundRetractedDite, G. S., Murphy, N. M., & Allman, R. (2021) · PLoS ONE · doi:10.1371/journal.pone.0247205 · Cited by 43
“The economic and social impacts of these interventions have been devastating, with foundational damage to local economies [3] and unprecedented increases in mental health diagnoses being reported [4].”
BackgroundSources of Resilience in Frontline Health Professionals during COVID-19
Brown, L., Haines, S. J., Amonoo, H. L., Jones, C. H., Woods, J., Huffman, J. C., & Morris, M. E. (2021) · Healthcare · doi:10.3390/healthcare9121699 · Cited by 51
“This could help safeguard clinician mental health, which is especially important given clinicians have been identified as a group vulnerable to mental health symptoms during the pandemic [36].”
Background‘Living in a Zoom world’: Survey mapping how COVID‐19 is changing family therapy practice in the UK
Kenny, R. M., Galloghly, E., Porter, C. M., & Burbach, F. (2021) · Journal of Family Therapy · doi:10.1111/1467-6427.12332 · Cited by 42
Polygenic contribution to the relationship of loneliness and social isolation with schizophrenia
Andreu-Bernabeu, Á., Díaz‐Caneja, C. M., Costas, J., de Hoyos, L., Stella, C., Gurriarán, X., Alloza, C., Fañanás, L., Bobes, J., González-Pinto, A. M., et al. (2022) · Nature Communications · doi:10.1038/s41467-021-27598-6 · Cited by 43
Self-citationRobinson, T., Condell, J. V., Ramsey, E., & Leavey, G. (2023) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph20032636 · Cited by 51
Milz, R., Benson, C. J., Knight, K., Antunes, J., Najarian, D. M., Rengel, P. M. L., Wang, S., Richarz, U., Gopal, S., & Kane, J. M. (2023) · Neuropsychiatric Disease and Treatment · doi:10.2147/ndt.s395383 · Cited by 47
“healthcare (eg, homeless or patients without caregivers, remote communities), socially isolated people, or those with a history of violence or incarceration who may be more predisposed to be nonadherent.(40,41) Given the increasing”
BackgroundAlqahtani, J. S., AlRabeeah, S. M., Aldhahir, A. M., Siraj, R. A., Aldabayan, Y. S., Alghamdi, S. M., Alqahtani, A., Alsaif, S. S., Naser, A. Y., & Alwafi, H. H. (2022) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph19094940 · Cited by 48
“According to Moreno et al. (2020) [6], uncertainty with the resolution and adaptation of the COVID-19 pandemic could potentially increase mental health risks.”
BackgroundEdge, D., Watkins, E. R., Limond, J., & Mugadza, J. (2023) · Behaviour Research and Therapy · doi:10.1016/j.brat.2023.104292 · Cited by 42
Bottemanne, H., Gouraud, C., Hulot, J., Blanchard, A., Ranque, B., Lahlou‐Laforêt, K., Limosin, F., Günther, S., Lebeaux, D., & Lemogne, C. (2021) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2021.757685 · Cited by 42
“The coronavirus disease 2019 (COVID-19), caused by the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has widely spread worldwide (1).”
BackgroundMakhmud, A., Thornicroft, G., & Gronholm, P. C. (2022) · Epidemiology and Psychiatric Sciences · doi:10.1017/s2045796022000622 · Cited by 65
“The COVID-19 pandemic has led to an increase in risk factors for mental health conditions and exacerbated barriers to support for people with pre-existing mental health needs (Moreno et al., 2020).”
BackgroundEis, S., Solà-Morales, O., Duarte‐Díaz, A., Vidal‐Alaball, J., Perestelo‐Pérez, L., Robles, N., & Carrión, C. (2022) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph19042186 · Cited by 43
“Physical health, economic crisis, confinement, social distancing, or burnout syndrome are beginning to have important impacts on the mental health of the global population, even on people without previous mental pathologies [9].”
BackgroundRobins–Browne, K., Lewis, M., Burchill, L. J., Gilbert, C. A., Johnson, C., O'Donnell, M. L., Kotevski, A., Poonian, J., & Palmer, V. J. (2022) · BMJ Open · doi:10.1136/bmjopen-2022-061317 · Cited by 44
Willis, C., & Chalder, T. (2021) · Journal of Mental Health · doi:10.1080/09638237.2021.1875418 · Cited by 45
“Beyond the most commonly reported covid-19 symptoms, calls to action have been made to address the psychological impact of the disease (Byrne & Wykes, 2020; Kumar & Rajasekharan Nayar, 2020; Moreno et al., 2020).”
BackgroundHorgan, S. A., Prorok, J. C., Ellis, K., Mullaly, L., Cassidy, K.-L., Seitz, D. P., & Checkland, C. (2024) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph21060664 · Cited by 44
“Meso (community programs and healthcare services): There is evidence that the integration of mental health services/supports into LTC contexts can improve mental health and care outcomes [135,152,153].”
BackgroundIkeuchi, T., Taniguchi, Y., Abe, T., Seino, S., Shimada, C., Kitamura, A., & Shinkai, S. (2021) · Animals · doi:10.3390/ani11030595 · Cited by 41
“The coronavirus disease 2019 (COVID-19) pandemic, which has impacted the physical and psychological health of millions of people worldwide [10,11], has required older adults to self-isolate by remaining at home and avoiding social contact with family and friends [12].”
BackgroundDiaz‐Martinez, J., Tamargo, J. A., Delgado‐Enciso, I., Liu, Q., Acuña, L., Laverde, E. E., Barbieri, M. A., Trepka, M. J., Campa, A. L., Siminski, S. M., et al. (2021) · AIDS and Behavior · doi:10.1007/s10461-021-03292-y · Cited by 42
“Community outreach, through partnerships between healthcare providers and other social services, can help promote mental health literacy, identify stressors in the community, and encourage vulnerable individuals to seek care [46].”
BackgroundInfluentialMental Health and the City in the Post-COVID-19 Era
Bil, J. S., Buława, B., & Świerzawski, J. (2021) · Sustainability · doi:10.3390/su13147533 · Cited by 41
“The spatial structure may play a key preventive role and may be an effective reaction against the new mental health pandemic with a decline in wellbeing, mental health, and care services [1,9,17,20].”
BackgroundSocial Policies and Theories on Quality of Life under COVID-19: In Search of the Missing Links
Shek, D. T. L., Leung, J. T. Y., & Tan, L. (2023) · Applied Research in Quality of Life · doi:10.1007/s11482-023-10147-2 · Cited by 45
The COVID-19 Pandemic and Mental Health of Refugees, Asylum Seekers, and Migrants
Pinzón-Espinosa, J., Valdés-Florido, M. J., Riboldi, I., Baysak, E., & Vieta, E. (2020) · Journal of Affective Disorders · doi:10.1016/j.jad.2020.11.029 · Cited by 40
Self-citationMarthoenis, M., Maskur, Fathiariani, L., & Nassimbwa, J. (2021) · BMC Nursing · doi:10.1186/s12912-021-00596-1 · Cited by 40
“With increased unpredictability of the evolution of the extremely communicable virus and consequent uncertainty of the end of this pandemic [2], many countries instituted preventive protocols, and measures to control the spread.”
BackgroundStepanova, E., Thompson, A., Yu, G., & Fu, Y. (2024) · BMC Psychiatry · doi:10.1186/s12888-024-05497-6 · Cited by 47
“…those with worsening pre-existing mental health conditions who encountered poor access to services reported experiencing relapse and suicidal behaviour [6] and adults with mental health conditions identified that disruptions to health services were impacting their mental health trajectory [13].”
BackgroundInfluentialTheoretical Mapping of Suicidal Risk Factors During the COVID-19 Pandemic: A Mini-Review
Raj, S., Ghosh, D., Singh, T., Verma, S. K., & Arya, Y. K. (2021) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2020.589614 · Cited by 43
“People with psychiatric conditions, especially those who require institutionalized care and in-person psychotherapy sessions, have been adversely affected (3).”
Background
Metadata
- Authors
- Moreno, C., Wykes, T., Galderisi, S., Nordentoft, M., Crossley, N., Jones, N., Cannon, M., Correll, C. U., Byrne, L., Carr, S., Chen, E. Y. H., Gorwood, P., Johnson, S., Kärkkäinen, H., Krystal, J. H., Lee, J., Lieberman, J., López-Jaramillo, C., Männikkö, M., Phillips, M. R., Uchida, H., Vieta, E., Vita, A., & Arango, C.
- Affiliations
- Universidad Complutense de Madrid (ES)
- King's College London (GB)
- University of Campania "Luigi Vanvitelli" (IT)
- University of Copenhagen (DK)
- Pontificia Universidad Católica de Chile (CL)
- University of South Florida (US)
- Royal College of Surgeons in Ireland (IE)
- Northwell Health (US)
- Yale University (US)
- University of Birmingham (GB)
- University of Hong Kong (HK)
- Inserm (FR)
- University College London (GB)
- Global Alliance of Mental Illness Advocacy Networks-Europe (BE)
- Yale New Haven Hospital (US)
- Nanyang Technological University (SG)
- Columbia University (US)
- Shanghai Jiao Tong University (CN)
- Keio University (JP)
- Centro de Investigación Biomédica en Red de Salud Mental (ES)
- Azienda Socio Sanitaria Territoriale degli Spedali Civili di Brescia (IT)
- Corresponding author
- Moreno, Carmen
- ORCID
- Moreno, Carmen
- Wykes, Til
- Galderisi, Silvana
- Nordentoft, Merete
- Crossley, Nicolas
- Jones, Nev
- Cannon, Mary
- Correll, Christoph U
- Byrne, Louise
- Carr, Sarah
- Chen, Eric Y H
- Gorwood, Philip
- Johnson, Sonia
- Kärkkäinen, Hilkka
- Krystal, John H
- Lee, Jimmy
- Lieberman, Jeffrey
- Phillips, Michael R
- Uchida, Hiroyuki
- Vieta, Eduard
- Vita, Antonio
- Arango, Celso
- Venue
- The Lancet Psychiatry
- Publisher
- Elsevier BV
- Published
- 2020-09
- Volume
- 7
- Issue
- 9
- Pages
- 813-824
- ISSN
- 2215-0366 (ISSN-L)
- PMC
- PMC7365642
- OpenAlex
- W3043299460
- Cited by
- 1,840
- References
- 144
- Citations by year
- 2026: 80 · 2025: 141 · 2024: 203 · 2023: 303 · 2022: 368 · 2021: 472 · 2020: 271
- FWCI
- 28.00
- Type
- journal article
- Language
- en
- Update notices
- erratum (2021-07-01)
- Open access
- bronze
- doi.org
- Locations
- The Lancet Psychiatry (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Institutional Repository University of Antioquia (University of Antioquia) (publishedVersion, cc-by-nc-nd)
- Research at the University of Copenhagen (University of Copenhagen) (publishedVersion, other-oa)
- HAL (submittedVersion)
- RMIT Research Repository (RMIT University Library) (submittedVersion)
- DR-NTU (Nanyang Technological University) (submittedVersion)
- UCL Discovery (University College London) (submittedVersion)
- Figshare (submittedVersion)
- Institutional Research Information System (Università degli Studi di Brescia) (submittedVersion)
- Archivio Istituzionale della Ricerca - Università degli Studi della Campania "Luigi Vanvitelli" (submittedVersion)
- Research Portal (King's College London) (submittedVersion, other-oa)
- Funders
- European Commission
- European Research Council (724809)
- National Natural Science Foundation of China (81371502, 81761128031, PI15/00283, PI18/00805)
- Departament de Salut, Generalitat de Catalunya (SLT006/17/00357)
- National Institute for Health and Care Research (NF-SI-0514-10028)
- Innovative Medicines Initiative (115916, 777394)
- King's College London (IS-BRC-1215-20018)
- Fundación Mutua Madrileña
- Centro de Investigación Biomédica en Red de Salud Mental
- Fundación Alicia Koplowitz
- European Regional Development Fund
- Horizon 2020 Framework Programme
- Instituto de Salud Carlos III (PI16/02012, PI17/02227, PI19/024, SAM16PE07CP1)
- Ministerio de Ciencia e Innovación
- Seventh Framework Programme (FP7-4-HEALTH-2009-2.2.1-2-241909, FP7-HEALTH-2013-2.2.1-2-602478)
- Topics
- Social Sciences › Psychology › Clinical Psychology › COVID-19 and Mental Health
- Social Sciences › Psychology › Clinical Psychology › Psychiatric care and mental health services
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Telemedicine and Telehealth Implementation
- Keywords
- COVID-19 pandemic, mental health services, mental health service delivery, health disparities, continuity of care, infection control, lockdown, economic impact, service user involvement
- MeSH terms
- Betacoronavirus, COVID-19, SARS-CoV-2, Mental Disorders, Health Personnel, Humans, Mental Health Services, Pneumonia, Viral, Telemedicine, Coronavirus Infections, Pandemics
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