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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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Oudshoorn, C. E. M., Frielink, N., Riper, H. M., & Embregts, P. J. C. M. (2021) · International Journal of Developmental Disabilities · doi:10.1080/20473869.2021.1967078 · Cited by 22
Irarrázaval, M., Norambuena, P., Montenegro, C., Toro, O., Vargas, B., & Caqueo‐Urízar, A. (2021) · Frontiers in Public Health · doi:10.3389/fpubh.2021.590335 · Cited by 25
Arango, C., Buitelaar, J. K., Correll, C. U., Díaz‐Caneja, C. M., Figueira, M. L., Fleischhacker, W. W., Marcotulli, D., Parellada, M., & Vitiello, B. (2022) · European Neuropsychopharmacology · doi:10.1016/j.euroneuro.2022.04.005 · Cited by 25
“In this regard, young people with EOS might also be more susceptible to changes in daily living and to the social isolation imposed with the recent COVID-19 pandemic ( Moreno et al., 2020 ).”
Self-citationJenkins, E., Slemon, A., Richardson, C. G., Pumarino, J., McAuliffe, C., Thomson, K., Goodyear, T., Daly, Z., McGuinness, L., & Gadermann, A. (2022) · International Journal of Public Health · doi:10.3389/ijph.2022.1604685 · Cited by 22
Probiotics in the Management of Mental and Gastrointestinal Post-COVID Symptomes
Łoniewski, I., Skonieczna‐Żydecka, K., Sołek-Pastuszka, J., & Marlicz, W. M. (2022) · Journal of Clinical Medicine · doi:10.3390/jcm11175155 · Cited by 22
Oetzmann, C., White, K. M., Ivan, A., Julie, J., Leightley, D., Lavelle, G., Lamers, F., Siddi, S., Annas, P., Arranz, S., et al. (2022) · npj Digital Medicine · doi:10.1038/s41746-022-00680-z · Cited by 20
Self-citationXiao, Y., Brown, T. T., Snowden, L. R., Chow, J. C., & Mann, J. J. (2023) · JAMA Network Open · doi:10.1001/jamanetworkopen.2023.2716 · Cited by 24
Jackson‐Triche, M., Vetal, D., Turner, E.-M., Dahiya, P., & Mangurian, C. V. (2023) · Journal of Medical Internet Research · doi:10.2196/40635 · Cited by 22
“With the traditional in-person, face-to-face approach to providing mental health interventions being less feasible during the pandemic, mental health chatbots and other digital services are reliable tools to improve access to mental health screening, treatment, and psychoeducation [31,32].”
Dommershuijsen, L. J., van der Heide, A., den Berg, E. M. V., Labrecque, J. A., Ikram, M. K., Ikram, M. A., Bloem, B. R., Helmich, R. C. G., & Darweesh, S. K. L. (2021) · npj Parkinson s Disease · doi:10.1038/s41531-021-00238-y · Cited by 21
Beks, H., King, O., Clapham, R. P., Alston, L. V., Glenister, K., McKinstry, C., Quilliam, C., Wellwood, I., Williams, C., & Shee, A. W. (2021) · Journal of Medical Internet Research · doi:10.2196/26515 · Cited by 21
“During the COVID-19 pandemic, the need for improved accessibility to mental health programs has also been identified [156].”
Upadhyay, P., Narayanan, S., Khera, T., Kelly, L., Mathur, P. A., Shanker, A., Novack, L., Pérez-Robles, R., Hoffman, K. A., Sadhasivam, S. K., et al. (2022) · Frontiers in Public Health · doi:10.3389/fpubh.2022.813664 · Cited by 21
“Median (IQR) 42 (33, 50) 41 (33, 50) 43 (36, 52)”
BackgroundBonnini, S., & Borghesi, M. (2022) · Mathematics · doi:10.3390/math10183237 · Cited by 20
Metaverse as a possible tool for reshaping schema modes in treating personality disorders
Yin, B., Wang, Y., Fei, C.-Y., & Jiang, K. (2022) · Frontiers in Psychology · doi:10.3389/fpsyg.2022.1010971 · Cited by 28
“The COVID-19 pandemic has exacerbated this situation and urged changes in how we practice mental health care (Moreno et al., 2020; Peng et al., 2020; Vadivel et al., 2021).”
BackgroundKim, K. H., Lee, S. M., Hong, M., Han, K., & Paik, J. (2023) · Epidemiology and Health · doi:10.4178/epih.e2023022 · Cited by 20
“As patients with mental disorders have been at an increased risk of infection and vulnerable to complications since the beginning of the pandemic, research has claimed that it is necessary to accelerate the community management of mental disorders and reduce admissions to overcrowded psychiatric hospitals as much as p…”
Villarreal‐Zegarra, D., Reátegui-Rivera, C. M., Otazú-Alfaro, S., Yantas-Alcantara, G., Soto-Becerra, P., & Meléndez‐Torres, G. J. (2023) · Social Psychiatry and Psychiatric Epidemiology · doi:10.1007/s00127-023-02446-8 · Cited by 26
“Although an increase in treated cases with psychiatric symptoms such as moderate and severe depressive symptoms was expected as a result of the pandemic, various barriers to access to diagnosis and treatment persist, including stigma, and others specific to the current situation such as the extension of the confinemen…”
BackgroundXiao, W., Liu, X., Wang, H., Huang, Y., Dai, Z., Si, M., Fu, J., Chen, X., Jia, M., Leng, Z., et al. (2023) · Infectious Diseases of Poverty · doi:10.1186/s40249-023-01074-3 · Cited by 21
Mutuality as a method: advancing a social paradigm for global mental health through mutual learning
Bemme, D., Roberts, T., Ae-Ngibise, K. A., Gumbonzvanda, N., Joag, K., Kagee, A., Machisa, M., van der Westhuizen, C., van Rensburg, A. J., Willan, S., et al. (2023) · Social Psychiatry and Psychiatric Epidemiology · doi:10.1007/s00127-023-02493-1 · Cited by 20
Du, W., Jia, Y.-J., Hu, F.-H., Ge, M.-W., Cheng, Y.-J., Qu, X., & Chen, H.-L. (2023) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2023.07.040 · Cited by 22
Kim, H. J., Kim, M. H., Choi, M. G., & Chun, E. M. (2024) · Molecular Psychiatry · doi:10.1038/s41380-024-02627-0 · Cited by 22
“Especially in mental illness, COVID-19 showed an increased risk of mental health problems together with lockdown, social distan-cing, and uncertain causes [3, 4].”
BackgroundGregorio, S. W., Deshields, T. L., Flowers, S. R., Taylor-Irwin, N. E., Robbins, M. A., Johnson, R., Dwyer, M., Siston, A. K., Cooley, M. E., & Kayser, K. (2021) · Psycho-Oncology · doi:10.1002/pon.5791 · Cited by 22
“requiring a reconsideration of how psychosocial training and care is delivered.(37) For instance, PSO service users should be central to defining changes to mental health care services and systems.”
BackgroundSoto‐Añari, M., Camargo, L., Ramos‐Henderson, M., Rivera-Fernández, C., Denegri-Solís, L., Calle, U., Mori, N., Ocampo-Barba, N., López, F., Porto, M. F., et al. (2021) · Dementia and Geriatric Cognitive Disorders Extra · doi:10.1159/000518922 · Cited by 20
Vissink, C. E., van Hell, H. H., Galenkamp, N., & Rossum, I. W.-V. (2021) · Journal of Affective Disorders Reports · doi:10.1016/j.jadr.2021.100102 · Cited by 19
Cuthbert, K., Parsons, E. M., Smith, L. M., & Otto, M. W. (2022) · Journal of Behavioral and Cognitive Therapy · doi:10.1016/j.jbct.2022.01.001 · Cited by 19
Priority setting in mental health research: a scoping review of participatory methods
Güell, E., Amat, C. B., & Molas‐Gallart, J. (2023) · Mental Health & Prevention · doi:10.1016/j.mhp.2023.200279 · Cited by 19
Najarian, D. M., Turkoz, I., Knight, R. K., Galderisi, S., Lamaison, H. F., Zalitacz, P., Aravind, S., & Richarz, U. (2023) · The International Journal of Neuropsychopharmacology · doi:10.1093/ijnp/pyad028 · Cited by 19
“…oral antipsychotics with improved treatment outcomes, including improved medication adherence, lower rates of rehospitali-zations, improved relapse rates and functional outcomes, and decreased health-care costs (Brissos et al., 2014; Marcus et al., 2015; Correll et al., 2016; Moreno et al., 2020).”
BackgroundSelf-citationMoisoglou, I., Katsiroumpa, A., Kolisiati, A., Vraka, I., Kosiara, K., Siskou, O., Kaitelidou, D., Konstantakopoulou, O., Katsoulas, T., Gallos, P., et al. (2024) · European Journal of Investigation in Health, Psychology and Education · doi:10.3390/ejihpe14010015 · Cited by 24
“Patients who experienced long COVID-19 may have already had compromised mental health [29–31].”
BackgroundLi, L., Bibi, M., Hussain, Y., & Xiao, D. (2025) · Journal of Environmental Management · doi:10.1016/j.jenvman.2024.123922 · Cited by 24
Carrasco, J. P., Herraiz, B., Sanchez, L. O., Luengo, A., Fusalba, O. R., & Aguilar, E. J. (2020) · Revista de Psiquiatría y Salud Mental · doi:10.1016/j.rpsm.2020.11.003 · Cited by 19
Adams, W. E., Rogers, E. S., Edwards, J. P., Lord, E. M., McKnight, L., & Barbone, M. (2021) · Psychiatric Services · doi:10.1176/appi.ps.202000915 · Cited by 19
“Moreno and colleagues (22) argued that the mental health care system must adopt greater inclusion of service users as it adapts to the pandemic and implements long-lasting changes.”
BackgroundResultInfluentialThe COVID-19 pandemic and its impact on mental health services: the provider perspective
Nair, S. G., Kannan, P., Mehta, K., Raju, A., Mathew, J., & Ramachandran, P. (2021) · Journal of Public Health · doi:10.1093/pubmed/fdab163 · Cited by 19
El‐Monshed, A. H., Loutfy, A., Saad, M. T. E., Ali, A. S., El‐Gilany, A., Mohamed, A. S., Salah, M., & Zoromba, M. A. (2022) · African Journal of Primary Health Care & Family Medicine · doi:10.4102/phcfm.v14i1.2896 · Cited by 19
Mental Health and the COVID-19 Pandemic: Observational Evidence from Malaysia
Tan, E. S. S., Chin, S. A. F. X., Sathapan, M. S. P., Dewi, A. D., Amini, F., Bustami, N. A., Tan, P. Y., Ho, Y. B., & Tan, C. K. (2023) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph20054046 · Cited by 19
Cancer during a pandemic: A psychosocial telehealth intervention for young adults
Lichiello, S., Rainwater, L., Russell, G. B., Pulgar, C., Clark, J., Daniel, S., McCall, M. H., Bentley, P., & Duckworth, K. E. (2022) · Current Problems in Cancer · doi:10.1016/j.currproblcancer.2022.100865 · Cited by 18
“• Coronavirus Anxiety Scale (CAS) [F(2, 10) = 2.”
Abuzied, Y., Al-amer, R. M., Saleh, M., Somduth, S., Albashtawy, M., & Ali, A. (2024) · International Journal of Nursing Practice · doi:10.1111/ijn.13268 · Cited by 19
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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