Early impacts of the COVID-19 pandemic on mental health care and on people with mental health conditions: framework synthesis of international experiences and responses
Authors: Sheridan Rains Luke , Johnson Sonia , Barnett Phoebe , Steare Thomas , Needle Justin J. , Carr Sarah , Lever Taylor Billie , Bentivegna Francesca , Edbrooke-Childs Julian , Scott Hannah Rachel , Rees Jessica , Shah Prisha , Lomani Jo , Chipp Beverley , Barber Nick , Dedat Zainab , Oram Sian , Morant Nicola , Simpson Alan ,   The COVID-19 Mental Health Policy Research Unit Group, Papamichail Alexia , Moore Anna , Jeffery Annie , De Estrada Blanca Sanz-Magallón Duque , Hallam Brendan , Lloyd-Evans Brynmor , Contreras Carolina Yanez , Serna Celia Esteban , Ntephe Chukwuma , Lamirel Daphne , Cooke Eleanor , Pearce Eiluned , Lemmel Frederike , Koutsoubelis Freya , Cragnolini Guendalina , Harju-Seppänen Jasmine , Wang Jingyi , Botham Joseph , Abdou Karima , Krause Karolin , Turner Kati Jane , Poursanidou Konstantina , Gruenwald Lisa , Jagmetti Louisa , Mazzocchi Lucia , Tomaskova Magdalena , Montagnese Marcella , Mahé Mélanie , Schlief Merle , Günak Mia Maria , Leverton Monica , Lyons Natasha , Vera Norha , Gao Qian , Griffiths Raza , Lane Rebecca , Busato Riccardo , Ledden Sarah , Mac-Ginty Scarlett , Hardt Selina , Orlando Sofia , Gillard Steve , Jeynes Tamar , Ondrušková Tamara , Stefanidou Theodora , Foye Una , Tzouvara Vasiliki , Cavero Victoria 
Published: August 2020

Abstract
Purpose
The COVID-19 pandemic has many potential impacts on people with mental health conditions and on mental health care, including direct consequences of infection, effects of infection control measures and subsequent societal changes. We aimed to map early impacts of the pandemic on people with pre-existing mental health conditions and services they use, and to identify individual and service-level strategies adopted to manage these.

Methods
We searched for relevant material in the public domain published before 30 April 2020, including papers in scientific and professional journals, published first person accounts, media articles, and publications by governments, charities and professional associations. Search languages were English, French, German, Italian, Spanish, and Mandarin Chinese. Relevant content was retrieved and summarised via a rapid qualitative framework synthesis approach.

Results
We found 872 eligible sources from 28 countries. Most documented observations and experiences rather than reporting research data. We found many reports of deteriorations in symptoms, and of impacts of loneliness and social isolation and of lack of access to services and resources, but sometimes also of resilience, effective self-management and peer support. Immediate service challenges related to controlling infection, especially in inpatient and residential settings, and establishing remote working, especially in the community. We summarise reports of swiftly implemented adaptations and innovations, but also of pressing ethical challenges and concerns for the future.

Conclusion
Our analysis captures the range of stakeholder perspectives and experiences publicly reported in the early stages of the COVID-19 pandemic in several countries. We identify potential foci for service planning and research.