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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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Religious leaders’ trust in mental health professionals
Vaidyanathan, B., Charles, J. L. K., Nguyen, T. H., & Brodsky, S. (2021) · Mental Health Religion & Culture · doi:10.1080/13674676.2021.1967901 · Cited by 8
Stabler, L., MacPhee, M., Collins, B., Carroll, S., Davison, K., Thakkar, V., Fuller‐Thomson, E., Lin, S., & Hey, B. (2021) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph182312292 · Cited by 11
Self-Reported Anxiety in Spain: A Gendered Approach One Year After the Start of COVID-19 Pandemic
Jacques‐Aviñó, C., López‐Jiménez, T., Bennett, M., Medina‐Perucha, L., León-Gómez, B. B., & Berenguera, A. (2022) · Frontiers in Public Health · doi:10.3389/fpubh.2022.873891 · Cited by 8
“Thus, the COVID-19 pandemic could have mental health effects both in previously healthy people as well as in people with pre-existing mental health disorders (28).”
BackgroundNilsson, E., Johanson, S., Behm, L., & Bejerholm, U. (2023) · BMC Nursing · doi:10.1186/s12912-023-01340-7 · Cited by 11
“Mental health promotion is not currently seen as a natural part of the care provided by the PHC for the population [8, 15, 34].”
BackgroundWerkmeister, B. J., Haase, A. M., Fleming, T. M., & Officer, T. N. (2023) · JMIR Formative Research · doi:10.2196/50486 · Cited by 8
Wellbeing-responsive community: a growth target for intentional mental health promotion
Raymond, I. J., Burke, K. J., Agnew, K. J., & Kelly, D. M. (2023) · Frontiers in Public Health · doi:10.3389/fpubh.2023.1271954 · Cited by 9
Psychological distress among South African healthcare workers during the COVID-19 pandemic
Ramlagan, S., Sewpaul, R., Shean, Y., Schmidt, T., North, A., & Reddy, S. P. (2024) · Curationis · doi:10.4102/curationis.v47i1.2477 · Cited by 10
“…frustration, boredom, limited access to basic supplies and services, concerns about finances and more, clearly exacerbated the potential increase of mental health disorders as well as an increase in the severity of existing mental health conditions (Moreno et al. 2020; Wettstein et al. 2021).”
BackgroundIncidence of mental health diagnoses during the COVID-19 pandemic: a multinational network study
Chai, Y., Man, K. K. C., Luo, H., Torre, C. O., Wing, Y. K., Hayes, J., Osborn, D., Chang, W. C., Lin, X., Yin, C., et al. (2024) · Epidemiology and Psychiatric Sciences · doi:10.1017/s2045796024000088 · Cited by 8
“The unpredictability and uncertainty of the pandemic itself, along with the policy restrictions and economic recession, may have caused great mental health consequences amongst the global population (Ahmed et al. , 2023; Aknin et al. , 2022; Moreno et al. , 2020).”
BackgroundMa, R., Yu, S., Li, Y., Lin, Y., & Ma, X. (2024) · Frontiers in Environmental Science · doi:10.3389/fenvs.2024.1350170 · Cited by 8
Prevalence of depression and anxiety in Colombia: What happened during Covid-19 pandemic?
Martı́nez, S., Roncancio, M. V. P., Carrasquilla, G., Casas, G., & González-Uribe, C. (2024) · PLoS ONE · doi:10.1371/journal.pone.0282760 · Cited by 8
Síntomas psicóticos en relación con cuarentena por COVID-19
Villar, S. C., & Sahún, J. L. D. (2020) · Revista Colombiana de Psiquiatría · doi:10.1016/j.rcp.2020.10.009 · Cited by 8
Population Health and Health Services: Old Challenges and New Realities in the COVID-19 Era
Sarría‐Santamera, A., Yeskendir, A., Maulenkul, T., Orazumbekova, B., Gaipov, A., Imaz-Iglesia, I., Pinilla-Navas, L., Moreno‐Casbas, T., & Corral, T. (2021) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph18041658 · Cited by 8
“Social isolation, remote education and working, loss of income, limited physical activity, increased access to food and drinks, financial and emotional insecurity, and absence of social support can cause a variety of psychological problems including but not limited to distress, insomnia, anxiety, depression, eating di…”
BackgroundRivas‐Ramírez, Á. R., Tendilla‐Beltrán, H., Gómez‐Mendoza, L. E., Loaiza, G., & Flores, G. (2021) · International Journal of Clinical Practice · doi:10.1111/ijcp.14528 · Cited by 8
Shetty, K. V., Sonkar, S., & Mahadevaiah, M. (2021) · Journal of Mental Health and Human Behaviour · doi:10.4103/jmhhb.jmhhb_225_20 · Cited by 8
Ladekarl, M., Olsen, N. J., Winckler, K., Brødsgaard, A., Nohr, E. A., Heitmann, B. L., & Specht, I. O. (2021) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph182211734 · Cited by 8
“Other cross-sectional studies giving early accounts of the effect of the early COVID-19 pandemic on mental wellbeing in the general population have tended to show higher stress, depression, and anxiety levels, even if the results are somewhat mixed due to differences in methods, populations, location, and timing regar…”
BackgroundInfluentialSharma, V., Gompers, A. D., Kelly, J. T. D., Patrick, E. M., Heckman, C., Solomon, A., & Scott, J. A. (2021) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph182413387 · Cited by 9
“In addition, there has been widespread job loss, economic strain, and stress and other mental health outcomes due to the pandemic that likely contribute to the increased risk of GBV [15,16].”
BackgroundDuden, G. S., Gersdorf, S., Trautmann, K., Steinhart, I., Riedel-Heller, S. G., & Stengler, K. (2022) · Social Psychiatry and Psychiatric Epidemiology · doi:10.1007/s00127-022-02274-2 · Cited by 8
“This development paralleled an increasing impairment of service accessibility with growing waitlists and newly introduced pre-registration, which has also been reported by others [4, 5, 34, 36, 39, 41].”
BackgroundInfluentialBrătucu, G., Tudor, A. I. M., Litră, A. V., Nichifor, E., Chițu, I. B., & Bratucu, T.-O. (2022) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph19137868 · Cited by 8
“These, together with the measures of social distancing imposed at the level of each state, have affected the mental well-being of individuals [49,54], especially for people with such pre-existing problems [55], which implies an even greater need for the involvement of public authorities (especially those”
BackgroundYu, G., Craig, D., & Fu, Y. (2022) · BMJ Open · doi:10.1136/bmjopen-2022-062078 · Cited by 8
Antiracist Practice in Psychiatry: Principles and Recommendations
Fani, N., White, D. T., Marshall-Lee, E. D., & Hampton-Anderson, J. N. (2022) · FOCUS The Journal of Lifelong Learning in Psychiatry · doi:10.1176/appi.focus.20220045 · Cited by 8
The Relationship between Social Mentality and Health in Promoting Well-Being and Sustainable City
Liu, Z., Han, G., Yan, J., Liu, Z., & Osmani, M. (2022) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph191811529 · Cited by 8
“At present, the coronavirus disease 2019 (COVID-19) has already affected mental health worldwide and a number of effects are likely to persist [1], such as anxiety, depression, and post-traumatic symptoms [2].”
BackgroundBadesha, K., Wilde, S., & Dawson, D. L. (2022) · Psychology and Psychotherapy Theory Research and Practice · doi:10.1111/papt.12436 · Cited by 10
“Nonetheless, while the COVID-19 pandemic has highlighted the role for digital interventions (Moreno et al., 2020), the use and recommendation of mobile apps remain under scrutiny (Skorburg & Yam, 2022; Torous, Myrick et al.”
BackgroundLiu, X., Wu, J., Yang, H., Zhao, F., Qin, Y., Wu, J., Yan, H., Xu, Y., & Zhang, L. (2023) · JMIR Public Health and Surveillance · doi:10.2196/43689 · Cited by 8
Shacham, M., Hamama‐Raz, Y., Ben‐Ezra, M., & Levin, Y. (2023) · Vaccines · doi:10.3390/vaccines11020403 · Cited by 8
“The impact on mental health during the COVID-19 pandemic has been widely addressed [26], along with elevated psychological impacts since the introduction of COVID-19 vaccines, mainly anxiety and vaccine hesitancy [27].”
Komlenac, N., Lamp, E., Maresch, F., Walther, A., & Hochleitner, M. (2023) · Journal of Interpersonal Violence · doi:10.1177/08862605231169766 · Cited by 9
“Thus, increased awareness and higher demands for mental health services were not met with an increased availability of such services (Moreno et al., 2020).”
Xia, X., Zhang, Y., Jiang, W., & Wu, C. Y. H. (2023) · Journal of Medical Internet Research · doi:10.2196/45757 · Cited by 8
“Mental health care also similarly exacerbates mental health disorders and emotional trauma [47].”
Khanra, S., Mukherjee, A., Goyal, N., Das, B., & Munda, S. K. (2021) · Asian Journal of Psychiatry · doi:10.1016/j.ajp.2021.102568 · Cited by 8
“With evolving mental health effects, ongoing COVID-19 pandemics gave us several opportunities to rethink about existing and develop mental health care delivery approaches (Tandon, 2020; Moreno et al., 2020).”
BackgroundMet and unmet need for mental health care before and during the COVID-19 pandemic
Knudsen, A., Skogen, J., Stene-Larsen, K., Gustavson, K., & Reneflot, A. (2021) · European Journal of Public Health · doi:10.1093/eurpub/ckab183 · Cited by 6
Lawati, A. A., Ghafri, T. A., Anwar, H., Ajmi, F. A., Hasani, S. A., Chan, M. F., Mahadevan, S. K., & Al‐Adawi, S. (2021) · Primary Health Care Research & Development · doi:10.1017/s1463423621000335 · Cited by 8
“Several studies are beginning to reflect on and investigate the biopsychosocial aspects of COVID-19 (Moreno et al., 2020).”
BackgroundFernández‐Arana, A., Olórtegui‐Yzú, A., Vega‐Dienstmaier, J. M., & Cuesta, M. J. (2021) · Brain and Behavior · doi:10.1002/brb3.2452 · Cited by 11
Butter, S., Murphy, J., Hyland, P., McBride, O., Shevlin, M. E., Hartman, T. K., Bennett, K. M., Miller, J. G., Levita, L., Martínez, A. P., et al. (2021) · Social Psychiatry and Psychiatric Epidemiology · doi:10.1007/s00127-021-02210-w · Cited by 8
Radomski, A. D., Cloutier, P., Gardner, W. P., PAJER, K. A., Sheridan, N., Sundar, P. D., & Cappelli, M. (2022) · Canadian Journal of Community Mental Health · doi:10.7870/cjcmh-2022-006 · Cited by 8
OECD, & World Health Organization (2020) · Health at a glance. Asia/Pacific · doi:10.1787/f494a701-en · Cited by 12
Siddiqui, S., Gonsalves, P. P., & Naslund, J. A. (2022) · Mental Health in a Digital World · doi:10.1016/b978-0-12-822201-0.00004-6 · Cited by 7
Ramano, E. M., Pretorius, W. P., Jager, M. D., Oldfield, T. O., Scriba, D. S., & Moriti, B. M. (2022) · South African Journal of Occupational Therapy · doi:10.17159/2310-3833/2022/vol52n3a4 · Cited by 7
“These experts recommend acknowledging the mental health consequences of IPCs for MHCUs, families, the elderly and children and providing support via therapeutic programmes 25 .”
Platt, R. E., Martin, C. P., Perry, O., Cooper, L., Tandon, S. D., Richman, R., Bettencourt, A. F., & Polk, S. (2023) · Women s Health Issues · doi:10.1016/j.whi.2023.05.005 · Cited by 7
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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