Mental health care and COVID-19
Authors: Celso Arango, Til Wykes, Carmen Moreno
Journal: The Lancet Psychiatry (2020)

We would like to thank Hailemariam and Pathare for their letter in which, among other issues, they refer to our recently published Position Paper.1Moreno C Wykes T Galderisi S et al.How mental health care should change as a consequence of the COVID-19 pandemic.Lancet Psychiatry. 2020; 7: 813-824Google Scholar In our Position Paper, we provide an international perspective, with authors and users and family associations from 14 countries, on how the pandemic offers an opportunity to improve mental health-care provision. Finding commonalities and sharing experiences that can translate to different setting helped us to propose a core set of measures to establish the benefits of such changes once implemented. The views and solutions expressed in our paper do apply to medium-income and high-income countries with advanced health systems where granular mental health monitoring might be possible. We are aware that these approaches might not be relevant to low-income countries with no psychiatrists or with no mental health services in place where, ipso facto, priorities are different, and public health or primary health are the focus. In many of those countries, a greater number of people are dying from causes other than this pandemic, which might be a more immediate focus for health services. We share some concerns with Hailemariam and Pathare. The countries represented in our Position Paper produce more than 80% of all scientific papers in the world,2National Science FoundationPublication Output, by Region, Country, or Economy.https://ncses.nsf.gov/pubs/nsb20206/publication-output-by-region-country-or-economyDate: Dec 17, 2019Date accessed: October 26, 2020Google Scholar, 3Tollefson J China declared largest source of research articles.Nature. 2020; (published online Jan 25.)https://media.nature.com/original/magazine-assets/d41586-018-00927-4/d41586-018-00927-4.pdfDate accessed: October 26, 2020Google Scholar and low-income countries necessarily use drugs developed in high-income countries. We state in our paper that we are deeply concerned about the increasing economic gap and how that will affect mental health of those in low-income countries (and what mental health services could do to reduce the expected widening). The COVID pandemic is global, but its effect on mental health and potential solutions will depend on the setting and on economic, social, and systems variables.4Vieta E Perez V Arango C Psychiatry in the aftermath of COVID-19.Rev Psiquiatr Salud Ment. 2020; 13: 105-110Google Scholar Knowing how difficult it is to change policies in most countries, we adopted a pragmatic approach and focused on one particular side of the problem and our own expertise. But there are some suggestions in our Position Paper that would be useful for all countries, such as the use of digital technologies (which would also benefit rural areas) at the same time as respecting the digital divide. However, we believe mental health experts in low-income countries are the ones entitled to speak up and propose changes tailored to their reality. CM reports personal fees from Janssen, Angelini, Servier, Nuvelution, Otsuka, and Lundbeck. CA reports personal fees from Acadia, Angelini, Gedeon Richter, Janssen Cilag, Lundbeck, Minerva, Otsuka, Roche, Sage, Servier, Shire, Schering Plough, Sumitomo Dainippon, Sunovion, and Takeda. TW declares no competing interests. How mental health care should change as a consequence of the COVID-19 pandemicThe 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. Full-Text PDF The missing global in global mental healthIn 2020, The Lancet Psychiatry published a Position Paper by Moreno and colleagues1 in which the authors claimed "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 authors recommended putting in place service provision that targets health needs and reduces disparities, both globally and within individual countries.1 Although the authors claimed to be an international group of 24, there were no representatives from low-income and middle-income countries (LMICs) of Africa and Asia (except China), which together account for more than half of the world's population. Full-Text PDF