How mental health care should change as a consequence of the COVID-19 pandemic

Abstract

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.

Call for Action to Address Equity and Justice Divide During COVID-19

“…In the COVID-19 era, social distancing, increasing joblessness and limited access to mental health services, mental health burden is bound to aggravate during and beyond the pandemic (110). Several surveys on general public have reported increase in COVID-19 related depression, anxiety, and stress owing to the psychosocial stressors (114)(115)(116)(117).…”

Personality Disorders in Time of Pandemic

“…For instance, it is plausible to expect that patients with paranoid, schizoid, or schizotypal PDs would significantly reduce their social contacts during pandemic emergencies, with great difficulties in restoring them when lockdown measures end. As a consequence of their prevailing traits of detachment [5], cluster A PDs patients are likely to show reduced emotional wellbeing [27••] and higher levels of depression, anxiety, and *Impact reported for both pandemics (e.g., [4]) and quarantine (e.g., [1]); P, pandemic impact; Q, quarantine impact stress [28••] during pandemics. Furthermore, social isolation, and limitations in contacts with mental health professionals, may lead patients to experience feelings of depression and loneliness, especially in the case of schizotypal PD.…”

Gender-based approach on the social impact and mental health in Spain during COVID-19 lockdown: a cross-sectional study

“…1 Also, loss of income, loneliness, physical inactivity, limited access to basic services, increased access to online gambling and decreased family and social support. 2 In previous epidemics, lockdown was associated with psychological effects, such as anxiety, depression and post-traumatic stress, which can be far-reaching and long-lasting. 3 Additionally, measures such as social or physical distancing and uncertainty over disease status can affect mental health.…”