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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]
Experimental — accuracy not yet measuredIn the citing paper
“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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Murphy, J., Khan, A., Sun, Q., Minas, H., Hatcher, S., Ng, C. H., Withers, M. H., Greenshaw, A. J., Michalak, E. E., Chakraborty, P. A., et al. (2021) · International Journal for Equity in Health · doi:10.1186/s12939-021-01484-5 · Cited by 35
“argue [161], this a considerable challenge that also presents an opportunity to mobilize resources to address population mental health in a way that is equitable, ensuring access to care by those most in need, and addresses many underlying risk factors contributing to mental illness and distress.”
BackgroundOberman, L. M., Hynd, M., Nielson, D. M., Towbin, K. E., Lisanby, S. H., & Stringaris, A. K. (2021) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2021.642847 · Cited by 30
“The value of swift antidepressant interventions becomes particularly relevant during the COVID pandemic, when access to therapy can be hindered and also adherence to longer therapy is a greater problem (203).”
BackgroundBrowne, A., Stafford, O., Berry, A., Murphy, E., Taylor, L. K., Shevlin, M. E., McHugh, L., Carr, A., & Burke, T. (2022) · Journal of Clinical Medicine · doi:10.3390/jcm11020377 · Cited by 40
“, Scotland National Health Service, such as improved screening [72]; and introducing a national trauma training programme in all settings (schools, prisons, police force, hospitals, etc.”
BackgroundLim, S., Song, Y., Nam, Y.-Y., Lee, Y., & Kim, D. (2022) · Medicina · doi:10.3390/medicina58020171 · Cited by 30
“In particular, considering that health disparities—limited health care access, including disinfection, diagnosis, and treatment, among certain socioeconomically and culturally vulnerable populations—in various parts of the world may exacerbate the prognosis of COVID-19, nursing professionals who are capable of underst…”
BackgroundBouza, E., Arango, C., Moreno, C., Gracia, D., Martín, M., Pérez, V., Lázaro, L., Ferre, F., Salazar, G., Tejerina, F., et al. (2023) · Revista Española de Quimioterapia · doi:10.37201/req/018.2023 · Cited by 35
Self-citation“How is your thesis going?” – Ph. D. Students’ perspectives on mental health and stress in academia
Friedrich, J., Bareis, A., Bross, M., Bürger, Z., Cortés Rodríguez, Á., Effenberger, N., Kleinhansl, M., Kremer, F., & Schröder, C. (2023) · PLOS ONE · doi:10.1371/journal.pone.0288103 · Cited by 26
“Another research group [49] investigated how mental health care should change as a consequence of the COVID-19 pandemic and concluded that the pandemic could even be seen as a chance to improve mental health services [49].”
BackgroundGlobal, N., & Kazanskaia, A. N. (2025) · doi:10.64357/mental-health-leadership-2025 · Cited by 30
Wilson, C. A., Dalton‐Locke, C., Johnson, S., Simpson, A., Oram, S., & Howard, L. M. (2021) · Archives of Women s Mental Health · doi:10.1007/s00737-021-01108-5 · Cited by 29
Self-citationSpruill, T. M., Friedman, D. J., Díaz, L., Butler, M. J., Goldfeld, K. S., O’Kula, S. S., Montesdeoca, J., Payano, L., Shallcross, A. J., Kaur, K., et al. (2021) · Translational Behavioral Medicine · doi:10.1093/tbm/ibab045 · Cited by 29
“Because minority communities have been disproportionately affected, programs like UPLIFT could improve mental health equity [59].”
BackgroundSilfee, V., Williams, K. R., Leber, B. D., Kogan, J. N., Nikolajski, C., Szigethy, E., & Serio, C. D. (2021) · JMIR Formative Research · doi:10.2196/28538 · Cited by 29
“4 billion in the United Sates (2020) have been made to develop, validate, and regulate these apps for clinical use [18,19].”
BackgroundMacKinnon, A., Simpson, K. M., Salisbury, M. R., Bobula, J., Penner‐Goeke, L., Berard, L. D. H., Rioux, C., Giesbrecht, G. F., Giuliano, R. J., Lebel, C. A., et al. (2022) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2022.880972 · Cited by 38
Truths and myths about superfoods in the era of the COVID-19 pandemic
Hassoun, A., Harastani, R., Jagtap, S., Trollman, H., Garcia‐Garcia, G., Awad, N. M. H., Zannou, O., Galanakis, C. M., Gökşen, G., Nayik, G. A., et al. (2022) · Critical Reviews in Food Science and Nutrition · doi:10.1080/10408398.2022.2106939 · Cited by 29
“…health conditions as the pressure on healthcare facilities stemming from urgent requirements has reduced the availability and quality of their services for less severe illnesses (Moreno et al. 2020; Duda-Chodak et al. 2020; Ferreira Rodrigues et al. 2021; Han et al. 2021; Moynihan et al. 2021).”
BackgroundLiu, S., Ji, Y., Li, J., Peng, Y., Li, Z., Lai, W., & Feng, T. (2022) · Frontiers in Public Health · doi:10.3389/fpubh.2022.888295 · Cited by 29
COVID‐19: Implications for Nursing and Health Care in the United States
Reynolds, N. R., Baker, D. C., D’Aoust, R., Docal, M., Goldstein, N. S., Grubb, L. M., Hladek, M. D., Koirala, B., Kverno, K. S., Ling, C. G., et al. (2022) · Journal of Nursing Scholarship · doi:10.1111/jnu.12853 · Cited by 33
“…community- led, user- led, and family- led initiatives to provide immediate help and guidance, and the presence of community health workers (CHWs) (Moreno et al., 2020; U.S. Department of Health and Human Services, Health Resources and Services Administration, Bureau of Health Professions, 2007)…”
BackgroundInfluentialYu, X., & Ren, X. (2023) · BMC Public Health · doi:10.1186/s12889-023-15885-4 · Cited by 28
Anatomy of a Woebot® (WB001): agent guided CBT for women with postpartum depression
Darcy, A. M., Beaudette, A., Chiauzzi, E. J., Daniels, J., Goodwin, K., Mariano, T. Y., Wicks, P. J., & Robinson, A. H. (2023) · Expert Review of Medical Devices · doi:10.1080/17434440.2023.2280686 · Cited by 32
“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…”
BackgroundTelemental Health For Youth With Chronic Illnesses: Systematic Review
Lau, N., Colt, S. F., Waldbaum, S., O’Daffer, A., Fladeboe, K., Yi‐Frazier, J. P., McCauley, E., & Rosenberg, A. R. (2021) · JMIR Mental Health · doi:10.2196/30098 · Cited by 32
Nakanishi, M., Richards, M., Stanyon, D., Yamasaki, S., Endo, K., Sakai, M., Yoshii, H., & Nishida, A. (2022) · Journal of Adolescent Health · doi:10.1016/j.jadohealth.2022.01.228 · Cited by 28
“system, and health service delivery [2].”
Depression, stress, anxiety among jordanian people during COVID-19 pandemic: A survey-based study
Abuhammad, S., Khabour, O. F., Alomari, M. A., & Alzoubi, K. H. (2022) · Informatics in Medicine Unlocked · doi:10.1016/j.imu.2022.100936 · Cited by 29
Hip fracture surgery initiation after admission to the hospital, 2017 (or nearest year)
(2020) · Health at a glance. Europe · doi:10.1787/295f3095-en · Cited by 28
Time to Scale-up Research Collaborations to Address the Global Impact of COVID-19 – A Commentary
Nguyen, A. L., Brown, B. J., Tantawi, M. E., Ndembi, N., Okeibunor, J., Abdulaziz, M., & Foláyan, M. O. (2021) · Health Behavior and Policy Review · doi:10.14485/hbpr.8.3.9 · Cited by 27
Monnier, M., Moulin, F., Thierry, X., Vandentorren, S., Côté, S. M., Barbosa, S., Falissard, B., Plancoulaine, S., Charles, M.-A. A., Simeon, T., et al. (2021) · Scientific Reports · doi:10.1038/s41598-021-01676-7 · Cited by 30
“Efforts must be made to address the pandemic situation while considering children’s mental health and to adapt the delivery of care to meet the demands of COVID-19 71 .”
BackgroundThe effects of COVID‐19 on the dispensing rates of antidepressants and benzodiazepines in Canada
Uthayakumar, S., Tadrous, M., Vigod, S. N., Kitchen, S. A., & Gomes, T. (2021) · Depression and Anxiety · doi:10.1002/da.23228 · Cited by 31
Shiratori, Y., Ogawa, T., Ota, M., Sodeyama, N., Sakamoto, T., Arai, T., & Tachikawa, H. (2022) · Journal of Affective Disorders Reports · doi:10.1016/j.jadr.2022.100314 · Cited by 28
Mental health in the post COVID-19 era: future perspectives
Costa, A. C. D. S., Menon, V., Phadke, R., Dapke, K., Miranda, A. V., Ahmad, S., Essar, M. Y., & Hashim, H. T. (2022) · Einstein (São Paulo) · doi:10.31744/einstein_journal/2022ce6760 · Cited by 32
“In this context, the professionals most affected were those who were on the front lines fighting the pandemic.(2) As an example, a study in China, which used Self-rating Anxiety Scale and Self-rating Depression Scale, showed that the median score of the frontline professionals on these two scales was significantly hig…”
BackgroundInfluentialDellafiore, F., Arrigoni, C., Nania, T., Caruso, R., Baroni, I., Vangone, I., Russo, S., & Barello, S. (2022) · Acta bio-medica dell'Ateneo parmense/Acta biomedica · doi:10.23750/abm.v93is2.12979 · Cited by 28
Godara, M., Silveira, S., Matthaeus, H., & Singer, T. (2022) · Adversity and Resilience Science · doi:10.1007/s42844-022-00069-7 · Cited by 29
Currie, G., Finlay, B., Seth, A., Roth, C. G., Elsabbagh, M., Hudon, A., Hunt, M. R., Jodoin, S., Lach, L., Lencucha, R., et al. (2022) · International Journal of Qualitative Studies on Health and Well-Being · doi:10.1080/17482631.2022.2136090 · Cited by 31
Khoury-Malhame, M. E., Sfeir, M., Hallit, S. R., & Sawma, T. (2023) · Current Psychology · doi:10.1007/s12144-022-04159-8 · Cited by 27
Mind the gap: a review of optimisation in mental healthcare service delivery
Noorain, S., Scaparra, M. P., & Kotiadis, K. (2022) · Health Systems · doi:10.1080/20476965.2022.2035260 · Cited by 28
“Linear programming is employed in various application areas, including production planning, inventory control, and workforce planning (Mula et al., 2006; Taha, 2017).”
MethodJiang, Y., Deng, W., & Mei, Z. (2025) · Scientific Reports · doi:10.1038/s41598-025-87593-5 · Cited by 32
de Neira, M. D., Blasco-Fontecilla, H., Murillo, L. G., Pérez-Balaguer, A., Mallol, L., Buratti, A. F., del Sol, P., & Palanca, I. (2021) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2020.557508 · Cited by 25
“Our findings may be explained by (1) the fear of contagion, (2) the strict confinement measures, and (3) the initial shock as an adaptive”
BackgroundMethodResultInfluentialThe effect of the COVID-19 pandemic on mental health calls for police service
Koziarski, J. (2021) · Crime Science · doi:10.1186/s40163-021-00157-6 · Cited by 29
Hope and Resilience Related to Fear of COVID-19 in Young People
Javier-Aliaga, D., Quispe, G., Zúñiga, D. Q., Rengifo, C. A., & White, M. (2022) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph19095004 · Cited by 27
“The studies that have been undertaken in the context of the COVID-19 pandemic reveal that a prolonged and increasing exposure to risk factors deteriorates mental health, quality of life, and its perception [69].”
BackgroundOECD, & World Health Organization (2020) · Health at a glance. Asia/Pacific · doi:10.1787/1ad1c42a-en · Cited by 27
Li, S.-F., Xu, Q.-Y., Xie, J., Wang, L., Li, H.-N., Ma, L., & Xia, R.-X. (2022) · Social Science & Medicine (1967) · doi:10.1016/j.socscimed.2022.115301 · Cited by 23
“The COVID-19 pandemic and related containment strategies exposed people to new stressors, such as health concerns, social isolation, job loss, and financial insecurity (Moreno et al., 2020; Pfefferbaum and North, 2020), all these factors negatively impacted people’s mental health (Fontanesi et al.”
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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