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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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Essadek, A., Gressier, F., Krebs, T., Corruble, E., Falissard, B., & Rabeyron, T. (2022) · European Journal of Psychotraumatology · doi:10.1080/20008066.2022.2141510 · Cited by 12
Probst-Hensch, N. M., Jeong, A., Keidel, D., Imboden, M., & Lovison, G. (2023) · Public Health · doi:10.1016/j.puhe.2023.01.010 · Cited by 15
Intergenerational Trauma in the Context of the 1947 India–Pakistan Partition
Kaur, H., & Jaggi, P. (2023) · Psychological Studies · doi:10.1007/s12646-023-00730-w · Cited by 19
TikTok as a Stage: Performing Rural #farmqueer Utopias on TikTok
Biggs, H. R., Marcotte, A. S., & Bardzell, S. (2023) · Designing Interactive Systems Conference · doi:10.1145/3563657.3596038 · Cited by 16
“critique of many intersecting contemporary societal issues like climate change, the mental health impacts of COVID-19, food justice, and the mental health crisis plaguing farmers right now [40, 52].”
BackgroundAccess and efficacy of university mental health services during the COVID-19 pandemic
Wagner, B. A., Snoubar, Y., & Mahdi, Y. S. (2023) · Frontiers in Public Health · doi:10.3389/fpubh.2023.1269010 · Cited by 15
“Despite this uptick in mental health concerns, and pandemic-related research suggesting that the delivery of mental health support had changed to mitigate disparities in mental health-care provisions, use of mental health services among college students remains low (8–10).”
BackgroundBoltri, M., Brusa, F., Apicella, E., & Mendolicchio, L. (2024) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2024.1360529 · Cited by 15
Axelsson, M., Churamani, N., Caldir, A., & Güneş, H. (2025) · ACM Transactions on Human-Robot Interaction · doi:10.1145/3711937 · Cited by 22
“People have found it particularly difficult to seek mental health advice and treatment due to social distancing regulations imposed Li [2020].”
Psychiatric and neuropsychiatric sequelae of COVID-19 within 2 years: a multinational cohort study
Chai, Y., Lam, I. C. H., Man, K. K. C., Hayes, J., Wan, E. Y. F., Li, X., Chui, C. S. L., Lau, W. C. Y., Lin, X., Yin, C., et al. (2025) · BMC Medicine · doi:10.1186/s12916-025-03952-z · Cited by 14
Jin, S., Kim, B., & Han, K. (2025) · CHI Conference on Human Factors in Computing Systems · doi:10.1145/3706598.3713732 · Cited by 25
“…is one of the most urgent global healthcare problems, and its prevalence has accelerated during the COVID-19 pandemic [148, 160, 164, 172, 193, 204, 209], putting additional strain on traditional healthcare systems as they struggle to meet the increased demand for mental health services [55, 136].”
Correlates of psychological distress in epileptic patients during the COVID-19 outbreak
Giordano, A., Siciliano, M., Micco, R. D., Sant’Elia, V., Russo, A., Tedeschi, G., & Tessitore, A. (2020) · Epilepsy & Behavior · doi:10.1016/j.yebeh.2020.107632 · Cited by 15
Moon, K. J., Montiel, G. I., Cantero, P. J., & Nawaz, S. (2021) · Preventing Chronic Disease · doi:10.5888/pcd18.200656 · Cited by 15
MENTAL HEALTH CARE IN OLDER ADULTS DURING THE COVID-19 POST – NEW NORMALITY TRANSITION
Mazatán-Ochoa, C. I., González-Soto, C. E., Grande, J. A. A., & Guerrero-Castañeda, R. F. (2021) · Cogitare Enfermagem · doi:10.5380/ce.v26i0.78463 · Cited by 15
An investigation of COVID-19 related worry in a United States population sample
SAMUELS, J. F., Holingue, C., Nestadt, P. S., Bienvenu, O. J., Phan, P., & Nestadt, G. (2021) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2021.10.036 · Cited by 15
“In addition, community strategies can be designed to identify, and target for intervention, those most at risk for COVID-19 related worry and its potential psychological impacts (Campion et al., 2020; Moreno et al., 2020).”
Hoefnagels, J. W., Schoen, A. B., van der Laan, S. E. I., Rodijk, L. H., van der Ent, C. K., van de Putte, E. M., Dalmeijer, G. W., & Nijhof, S. L. (2022) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph19052953 · Cited by 15
“At-risk individuals may experience new onset of mental health problems, while those with preexisting mental health problems may experience symptomatic exacerbation—especially if access to mental health services is impeded due to COVID-19 regulations [21,22].”
BackgroundZhou, B., Miao, R., Jiang, D., & Zhang, L. (2022) · Information Processing & Management · doi:10.1016/j.ipm.2022.102997 · Cited by 16
“Besides the physical health damage, the pandemic could trigger mental health problems (Abbas et al., 2021; Moreno et al., 2020; Saltzman et al., 2020).”
Lee, K., Sung, H. K., Lee, S. H., Hyun, J., Kim, H., Lee, J.-S., Paik, J., Kim, S.-J., Sohn, S., & Choi, Y. (2022) · Journal of Korean Medical Science · doi:10.3346/jkms.2022.37.e199 · Cited by 16
Self-citationGrieger, J. A., Habibi, N., O'Reilly, S. L., Harrison, C. L., Moran, L., Vo, H., Sabir, S., Enticott, J., Teede, H. J., & Lim, S. S. (2022) · Nutrition · doi:10.1016/j.nut.2022.111794 · Cited by 17
“The social effect of the COVID-19 pandemic has also been considerable, including employment instability, financial insecurity, increased isolation, loneliness, fear, anxiety, and depression [8].”
Uribe-Restrepo, J. M., Waich, A., Ospina‐Pinillos, L., Marroquín-Rivera, A., Castro, S., Trejos, J. A. P., Rondón, M., Ariza-Salazar, K., Porras, L. F. C., Gómez–Restrepo, C., et al. (2022) · AIMS Public Health · doi:10.3934/publichealth.2022044 · Cited by 16
“To effectively transform the mental health programs for young people, it is necessary to include them in the design and implementation of innovative strategies [34].”
BackgroundWang, H., Farokhnia, F., & Sanchuli, N. (2022) · Work · doi:10.3233/wor-220136 · Cited by 15
“Moreover, community leaders in 116 countries put extended mental health programs in their pandemic response plans, although over 80% of these countries failed to allocate efficient financial resources to such projects [52].”
COVID-19: Psychosocial impact and mental health in Latin America
Gallegos, M., Consoli, A. J., Ferrari, I. F., Cervigni, M., de Castro, V., Martino, P., Caycho‐Rodríguez, T., & Razumovskiy, A. (2022) · Fractal Revista de Psicologia · doi:10.22409/1984-0292/v33i3/51234 · Cited by 17
Mental health service coverage and gaps among adults in Europe: a systematic review
Barbui, C., Alonso, J., Chisholm, D., Evans-Lacko, S. E., Keynejad, R. C., Lazëri, L., Miah, N., Valuckienė, Ž., & Gastaldon, C. (2025) · The Lancet Regional Health - Europe · doi:10.1016/j.lanepe.2025.101458 · Cited by 16
“6,8 Notably, the WHO reported a 25% global increase in anxiety and depression during the pandemic’s first year.”
Influence of post-COVID-19 deconfinement on psychiatric visits to the emergency department
Flament, J., Scius, N., Zdanowicz, N., Régnier, M., Cannière, L. D., & Thonon, H. (2021) · The American Journal of Emergency Medicine · doi:10.1016/j.ajem.2021.05.014 · Cited by 14
“As others around the world have written [21], we would add our voice to the call for preserving emergency care for psychiatric disorders, because these disorders might change or grow over time.”
Impact of COVID-19 pandemic on the neuropsychiatric status of Wilson’s disease
Lanza, G., Godani, M., Ferri, R., & Raggi, A. (2021) · World Journal of Gastroenterology · doi:10.3748/wjg.v27.i39.6733 · Cited by 14
Irigoyen-Otiñano, M., González-Pinto, A. M., Llorca-Bofí, V., Adrados-Pérez, M., Arenas‐Pijoan, L., Torterolo, G., Sánchez-Cazalilla, M., Buil-Reiné, E., Nicolau-Subires, E., Albert-Porcar, C., et al. (2021) · Revista de Psiquiatría y Salud Mental · doi:10.1016/j.rpsm.2021.11.005 · Cited by 14
Moral injury and psychological resilience among healthcare professionals amid COVID-19 pandemic
Akhtar, M., Faize, F. A., Malik, R. Z., & Tabusam, A. (2022) · Pakistan Journal of Medical Sciences · doi:10.12669/pjms.38.5.5122 · Cited by 14
Holmberg, C., Gremyr, A., Karlsson, V., & Asztély, K. (2022) · The European Journal of Psychiatry · doi:10.1016/j.ejpsy.2022.04.005 · Cited by 14
The Impact of COVID-19 on Anxious and Depressive Symptomatology in the Postpartum Period
Pereira, D., Wildenberg, B., Gaspar, A. D. V., Cabaços, C., Madeira, N. G. G. F., Macedo, A., & Pereira, A. T. (2022) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph19137833 · Cited by 14
“anxiety, and stress in the general population [3], and women in the perinatal period were no exception.”
BackgroundWu, J., Yang, H., Qin, Y., Wu, J., Yan, H., Xu, Y., Sun, X., Zhang, L., & Liu, X. (2022) · Asian Journal of Psychiatry · doi:10.1016/j.ajp.2022.103327 · Cited by 14
“The pandemic and efforts to contain it lead to abrupt and unpredictable changes to residents’ daily lives, and could increase the risk of mental health problems (Moreno et al., 2020).”
Wang, R., Lyu, H., Lu, Z., Huang, X., Wu, H., Xiong, J., & Yang, G. (2023) · JMIR Human Factors · doi:10.2196/42870 · Cited by 14
“Despite being first and foremost a health crisis, COVID-19 has the seeds of a mental health crisis [2,3].”
The Therapy of Desire in Times of Crisis: Lessons Learned from Buddhism and Stoicism
Ding, X., Ma, Y., Yu, F., & Abadal, L. M. (2023) · Religions · doi:10.3390/rel14020237 · Cited by 14
Mirbahaeddin, E., & Chreim, S. (2024) · BMC Health Services Research · doi:10.1186/s12913-024-10943-y · Cited by 17
“Concerns regarding security and privacy in virtual health care communities have been highlighted in research [10, 50].”
BackgroundJia, J., Zhang, X., & Zhang, W. (2024) · Land Use Policy · doi:10.1016/j.landusepol.2024.107384 · Cited by 14
Carrillo-González, A., & Atará-Piraquive, Á. P. (2020) · Revista de Investigación e Innovación en Ciencias de la Salud · doi:10.46634/riics.38 · Cited by 14
Kwobah, E. K., Jaguga, F., Kiptoo, R., Ndolo, E., & Kariuki, J. N. (2021) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2020.588216 · Cited by 14
“It is clear that provision of mental healthcare has to be adjusted to meet the need of patients (14).”
BackgroundHeyen, J. M., Weigl, N., Müller, M., Müller, S., Eberle, U., Manoliu, A., Vetter, S., Brown, A. D., Berger, T., & Kleim, B. (2021) · JMIR Formative Research · doi:10.2196/28055 · Cited by 14
“With physical distancing and other restrictions in place and a decreased mental health system capacity, calls for increased investment in telehealth and telepsychiatry, as well as other digital mental health solutions, have emerged [9-11].”
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Kvarstein, E., Zahl, K., Stänicke, L., Pettersen, M., Baltzersen, Å., Johansen, M., Eikenaes, I., Arnevik, E., Hummelen, B., Wilberg, T., et al. (2021) · Nordic Journal of Psychiatry · doi:10.1080/08039488.2021.1934110 · Cited by 13
“Due concern is therefore raised about the consequences of Covid-19 and associated discontinuation of treatments [24].”
BackgroundBergeron, C. D., Boolani, A., Jansen, E. C., & Smith, M. L. (2021) · Frontiers in Public Health · doi:10.3389/fpubh.2021.674847 · Cited by 14
“Older adults with preexisting mental health disorders may be more prone to relapse of substance misuse, social isolation, and suicidal behavior (58), especially due to limited access to mental healthcare services (58).”
BackgroundTyler, N., Daker‐White, G., Grundy, A. C., Quinlivan, L. M., Armitage, C. J., Campbell, S., & Panagioti, M. (2021) · BJPsych Open · doi:10.1192/bjo.2021.996 · Cited by 14
“38 The group proposed that sustainable adaptations of systems and mental healthcare should be developed collaboratively by experts, clinicians and patients.”
Assuaging COVID-19 Peritraumatic Distress Among Mental Health Clinicians: The Potential of Self-Care
Miller, J. “., Barnhart, S., Robinson, T. D., Pryor, M. D., & Arnett, K. D. (2021) · Clinical Social Work Journal · doi:10.1007/s10615-021-00815-x · Cited by 14
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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