“The World Has Not Yet Learned From the COVID Crisis” Experts Warn

New research published today in The Lancet Psychiatry warn that lessons have not been learned from the pandemic when it comes to mental health. The researchers recommend that mental health should be treated as a core consideration when it comes to pandemic preparedness, rather than a downstream consequence.

The research was performed by an international group of experts, including from low and middle-income countries, and people with lived experience of mental ill-health or long COVID.

The work builds directly on a widely cited 2020 Lancet Psychiatry Position Paper that first mapped urgent research priorities for COVID-19 and mental health. The five-year time frame was necessary because it took some time for higher-quality, often large longitudinal studies or systematic literature reviews to emerge following an initial deluge of small and less informative surveys.

The findings have been published in two papers. The first paper, titled ‘The implications of the COVID-19 pandemic for clinical mental health care’ examined how mental health services changed during the pandemic. The researchers found that symptoms of anxiety and depression generally increased in the fist months of the pandemic, then stabilised or returned close to pre-pandemic levels in many high-income countries – but that vulnerable groups, including socioeconomically disadvantaged communities, minoritised ethnic groups, children and young people, and people with pre-existing mental illness, experienced greater and more persistent harms.

Despite these changes in symptoms, levels of clinical mental illnesses showed less change overall, though eating disorders increased, particularly in young women. Mental health services in many countries were disrupted, meaning existing mental health patients lost access to face-to-face care. Healthcare providers and community services were often forced to improvise with little evidence to guide them.

In some communities, digital platforms allowed for some continuity of care.

However, for communities with little access to digital technology missed out. There was a rapid, uneven expansion of remote and digital care, community-based support, and new crisis pathways. Telepsychiatry and online interventions allowed some continuity of care and, in some settings, increased reach – but they also exacerbated digital exclusion for people without reliable devices, connectivity, or private space. Innovative approaches emerged, including community-delivered psychological support, task-sharing models, and new ways of involving families and peer support, yet robust trials and economic evaluations were rare.

The recommendation from the first paper include:

• Consolidating the most promising changes to how mental health care can be delivered, such as blended digital and in-person care
• Whilst also addressing the gaps in inequality, such as digital poverty and lack of service access. 

The second paper, titled 'Policy and public health implications for mental health after the COVID-19 pandemic',  took a wider view of population-level mental health and the effects of different policy responses. It found that the policies that benefitted mental health included wage subsidies and furlough schemes, eviction bans, school and university-based mental health services, support for survivors of domestic violence and adapted community interventions in low-resource settings.

However, the researchers found that these policies were unevenly lamented around the world, and that digital and economic divides often widened inequalities.

The recommendations from the second paper include:

• Mental health be treated as a core criterion in economic and social policy making
• Embed mental health in social protection and recovery plans
• Integrate clear, trusted communications strategies into disaster planning
• and develop financial models that protect mental health budgets during crises.

The study was carried out by 43 experts from around the world, brought together by MQ Mental Health Research and the Lancet Standing Commission on the COVID-19 Pandemic and Mental Health.

Professor Peter B. Jones, Professor of Psychiatry at Cambridge University and the Commission Co-chair, says

“It was a privilege to work with the Commission members who became so immersed in a rapidly accumulating and ultimately vast evidence base. To have extracted sense and meaningful recommendations is rewarding but the biggest impact will come from their implementation.”

“The effects of the pandemic on mental health services and the need for care where nuanced. It is true that we were all in the same storm, but not in the same boat.”

“The construct of candidacy as a mechanism through which people with mental health disorders stopped seeking help, and mental health services stopped providing care during the pandemic. It holds real promise for guiding responses to future emergences. Protecting health services should not be the aim if it is at the expense of the people who need them.”

Together, the papers show that there was no single global “mental health catastrophe”, but there were clear surges in distress early in the pandemic, deepening inequalities, and serious disruptions to mental health care. The evidence shows that many of the most harmful effects were driven less by the virus itself than by long-standing structural problems in mental health systems and wider social inequalities which the pandemic exposed and intensified.

Professor Etheldreda Nakimuli-Mpungu, Professor of Epidemiology at the London School of Hygiene and Tropical Medicine and the Commission Co-chair said:

“In low-resource settings, COVID-19 showed that mental health suffers most when people lose income, food, safety, schooling, and trust — and improves when governments protect livelihoods and communities. The lesson is clear: mental health must be built into social protection, community services, and crisis planning from the start. If we rely only on specialist services after harm has occurred, we will always be too late.”

The authors also highlighted a need for more long-term, cross-national research, especially in low and middle-income countries, to understand the enduring mental health effects of the pandemic and policy choices.

In summary - the commission recommends that policy makers embed mental health in social protection and recovery plans for future disasters, and invest in blended digital and community based services that reduce, rather than widen, inequalities.

You can learn more about this research by listening to the Lancet’s ‘In conversation’ podcast with interviews from the commission co-chairs Peter Jones and Ethel Nakimuli-Mpungu.