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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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InfluentialArya, S., Ghosh, A., Mishra, S., Swami, M. K., Prasad, S., Somani, A., Basu, A., Sharma, K., Padhy, S. K., Nebhinani, N., et al. (2022) · Indian Journal of Psychiatry · doi:10.4103/indianjpsychiatry.indianjpsychiatry_557_21 · Cited by 6
“The majority 6].”
Cama, S. F., Miyamoto, B. E., & DeJong, S. M. (2022) · Psychiatric Clinics of North America · doi:10.1016/j.psc.2021.11.009 · Cited by 6
Increasing psychological distress among Californians from 2013 to 2020: Race/ethnic differences
Tran, S., Wormley, A. S., Louie, P., & Sheehan, C. M. (2022) · SSM - Mental Health · doi:10.1016/j.ssmmh.2022.100101 · Cited by 7
Shakeri, A., Chu, C., Stamenova, V., Fang, J., Barker, L. C., Vigod, S. N., Bhatia, R. S., & Tadrous, M. (2022) · Schizophrenia Bulletin Open · doi:10.1093/schizbullopen/sgac046 · Cited by 6
Mori, M., Seko, T., & Ogawa, S. (2022) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph19159415 · Cited by 7
Paniagua-Ávila, A., Ramírez, D. E., Barrera-Pérez, A., Calgua, E., Castro, C., Peralta-García, A., Mascayano, F., Susser, E., Alvarado, R., & Puac‐Polanco, V. (2022) · American Journal of Public Health · doi:10.2105/ajph.2021.306648 · Cited by 6
Reali, L., Nijman, R., Hadjipanayis, A., del Torso, S., Calamita, P., Rafele, I., Katz, M., Barak, S., & Grossman, Z. (2022) · Frontiers in Pediatrics · doi:10.3389/fped.2022.1006596 · Cited by 6
“The unpredictability and uncertainty of the COVID-19 pandemic would have required a more sustainable and flexible adaptations of delivery systems for mental health care, even specifically designed to mitigate disparities in health-care provision (61).”
BackgroundMalik, K., Shetty, T., Mathur, S., Jose, J. E., Mathews, R., Sahay, M., Chauhan, P., Nair, P., Patel, V., & Michelson, D. (2023) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph20031722 · Cited by 7
“The COVID-19 pandemic has led to severe disruptions and adverse physical and mental health outcomes for communities across the globe, with young people disproportionately affected by interrupted education, social isolation, and limited employment opportunities [1,2].”
BackgroundYu, G., Panagioti, M., Tang, E. Y. H., Robinson, D., Husain, N., Lasrado, R., Lovell, K., Kaner, E., & Fu, Y. (2023) · PLoS ONE · doi:10.1371/journal.pone.0282445 · Cited by 6
“People with existing psychiatric diagnoses have also reported increased symptoms and poorer access to services and support leading to relapse and suicidal behaviour [1].”
BackgroundZhang, T., Chen, Z., Xiao, X., Zhou, L., Hu, Y., Xu, L., Wei, Y., Tang, X., Liu, H., Chen, T., et al. (2023) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2023.1146277 · Cited by 6
“The unpredictable emergence of COVID-19 cases in China and the impact of the pandemic on psychological health may persist for a long time (2).”
BackgroundInvoluntary psychiatric treatment during the COVID-19 pandemic. An international qualitative study
Carbone, A., & Knapp, M. R. J. (2023) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2023.1200888 · Cited by 6
Kim, S. J. (2023) · Primary care diabetes · doi:10.1016/j.pcd.2023.05.006 · Cited by 6
Adverse sequelae of the COVID -19 pandemic on mental health services in Chile
Toro, O., Araya, C. S., Soto-Brandt, G., Sepúlveda-Queipul, C., Pino, P., Loyola, F., Irarrázaval, M., Thornicroft, G., Hanlon, C., & Rubén Alvarado, M. (2023) · Revista Panamericana de Salud Pública · doi:10.26633/rpsp.2023.87 · Cited by 6
“elderly people, and people with mental health conditions) were exposed to a higher risk of infection, psychological distress, worsening social conditions and discrimination in the contexts of health emergencies (20-22).”
Zhang, T., Zhang, X., Meng, X., Huang, Y., Zhang, W., Gong, H.-H., Chan, S. K. W., Chen, X.-C., Gao, R., Lewis‐Fernández, R., et al. (2023) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2023.1170540 · Cited by 6
“A prolonged COVID-19 pandemic is also likely to elevate the risk of mental disorders (14).”
BackgroundA Scoping Review to Guide Social Work Policy-Practice for Pandemic Recovery
Ashcroft, R., Hussain, A., Lam, S., Kourgiantakis, T., Begun, S., Craig, S. L., Cadell, S., Adamson, K., Nelson, M. L. A., Greenblatt, A., et al. (2023) · Research on Social Work Practice · doi:10.1177/10497315231185754 · Cited by 6
Psychiatric emergency department visits during the coronavirus disease-2019 pandemic
Sun, H., Liu, H., Ma, C., Chen, Z., Wei, Y., Tang, X., Xu, L., Hu, Y., Xie, Y., Chen, T., et al. (2023) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2023.1236584 · Cited by 6
“Since the evolution of COVID-19 remains unpredictable, the impact of the pandemic on mental health may persist for a long time (1).”
BackgroundMethodRosario, R. V., Araújo, S. B., Silva, A., & Barros, S. (2023) · PLoS ONE · doi:10.1371/journal.pone.0291748 · Cited by 10
“Additionally, the pandemic has had substantial implications for mental health, with numerous studies highlighting its impact [25, 26].”
BackgroundPark, J., Tsou, M., Nara, A., Cassels, S. L., & Dodge, S. (2024) · Urban Informatics · doi:10.1007/s44212-023-00033-5 · Cited by 8
“Furthermore, global events may impact mental health collectively, as seen during the COVID-19 pandemic (Moreno et al., 2020; Abbott, 2021; Boden et al., 2021; Li et al., 2022).”
Manning, J. C., Bramley, L., Coad, J. E., Evans, C., Evans, K., Tinkler, L., & Cooper, J. E. (2021) · Journal of research in nursing · doi:10.1177/17449871211018737 · Cited by 6
Sammarra, I., Martino, I., Caligiuri, M. E., Giugno, A., Fortunato, F., Labate, A., & Gambardella, A. (2022) · Epilepsy & Behavior · doi:10.1016/j.yebeh.2022.108600 · Cited by 6
“In the general population, the social lockdown, physical distancing, and other containment strategies contributed to increasing symptoms of depression, anxiety, anger, stress, as well as higher alcohol assumption and domestic violence [2].”
Shaku, F., Ishiburo, M., Miwa, M., & Maruoka, S. (2022) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph19042488 · Cited by 6
“[5] reported that mental health problems are apparent in the general population, as well as in people with mental disorders and in frontline workers.”
BackgroundSu, Y., Yu, H., Liu, T.-Y., Lu, K., Tu, C., Lin, Y.-C., & Chen, R. (2022) · Psychological Medicine · doi:10.1017/s0033291722001155 · Cited by 7
García-Garro, P. A., Aibar‐Almazán, A., Rivas-Campo, Y., Vega-Ávila, G. C., Afanador-Restrepo, D. F., Martínez‐Amat, A., Afanador-Rodríguez, M. I., & Hita‐Contreras, F. (2022) · Healthcare · doi:10.3390/healthcare10061050 · Cited by 6
“These measures have led to multiple negative effects on HRQoL [8].”
BackgroundRosas, Y. G., Sigal, M., Park, A. L., & Barnett, M. L. (2022) · Global Implementation Research and Applications · doi:10.1007/s43477-022-00057-0 · Cited by 6
Goulart, F. D. M., & Ono, R. (2022) · Frontiers in Built Environment · doi:10.3389/fbuil.2022.962940 · Cited by 6
“that follow, are etiologically related to losses in Mental Health (Maulik et al., 2020; Moreno et al., 2020; Holland et al., 2021; Sung et al., 2021).”
BackgroundInfluentialAssessing perceptions of resilience: The understanding from network analysis
Liu, R., & Duan, W. (2023) · Frontiers in Public Health · doi:10.3389/fpubh.2023.1017871 · Cited by 7
“For the present study, the long-term adverse risks to people’s mental health, such as anxiety and depression, have increased remarkably with the spread of the COVID-19 pandemic, making mental illness a more serious influence on individual and even public health (48, 49).”
BackgroundHealthcare associated infections
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“Changes in lifestyle behaviors, social isolation, boredom, financial security, and general uncertainty appear to have had a negative impact on the mental health of populations globally, with potential long-lasting psychological and physical consequences (Brooks et al., 2020; Moreno et al., 2020; Salari et al., 2020).”
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Roos, R., Witteveen, A. B., Ayuso-Mateos, J. L., Barbui, C., Bryant, R. A., Felez-Nobrega, M., Figueiredo, N., Kalisch, R., Haro, J. M., McDaid, D., et al. (2023) · BMC Psychiatry · doi:10.1186/s12888-023-05288-5 · Cited by 7
“…while recently developed non-invasive, low-burden digital phenotyping measures that integrate voice, speech, movement and facial expression data from smart devices (e.g. smartphones) may be a promising and scalable way for assessing psychological wellbeing (e.g. depression, PTSD) [34–36].”
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Self-citationPsychosocial Care Center: daily work and articulation with the network in the pandemic
Silvano, A. D., Rézio, L. D. A., Martins, F. A., Bittencourt, M. N., Cebalho, M. T. D. O., da Silva, A. K. L., & Borges, F. A. (2022) · Rev Rene · doi:10.15253/2175-6783.20222371660 · Cited by 5
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Wang, J., Tönis, K. J. M., Kraiss, J. T., Drossaert, C. H. C., Schroevers, M. J., & Bohlmeijer, E. T. (2025) · The Journal of Positive Psychology · doi:10.1080/17439760.2025.2568840 · Cited by 7
“The Covid-19 pandemic not only profoundly impacted individuals’ mental health (Guillen-Burgos et al., 2023), but also disrupted access to face-to-face psychological services, prompting the rapid adoption of digital mental health interventions, including self-help applications (Moreno et al., 2020).”
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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