COVID-19 and global mental health
Authors: Sara Ardila-Gómez, Alberto Velzi Díaz, Elena Vargas, María Adelaida Arboleda Trujillo, Edison Javier Cárdenas Ortega, Martín Agrest
Journal: The Lancet Psychiatry (2021)

We are inspired by the optimistic tone of the comprehensive Review by Lola Kola and colleagues1Kola L Kohrt BA Hanlon C et al.COVID-19 mental health impact and responses in low-income and middle-income countries: reimagining global mental health.Lancet Psychiatry. 2021; 8: 535-550Summary Full Text Full Text PDF PubMed Scopus (379) Google Scholar of mental health initiatives in low-income and middle-income countries (LMICs) during the COVID-19 pandemic. However, reading the paper from the point of view of Latin America and the Caribbean (LAC), we are not as optimistic as the authors, for three reasons. LAC has been deeply affected by the pandemic,2González C Nuevas olas, aumento de contagios, escasez de vacunas y elecciones: el panorama de la pandemia en Sudamérica.https://actualidad.rt.com/actualidad/387272-contagios-vacunas-elecciones-panorama-pandemia-sudamericaDate: 2021Date accessed: March 23, 2021Google Scholar even more than other LMICs; the region has structural inequities and a high prevalence of informal work;3CEPALPanorama Social de América Latina, 2020. Comisión Económica para América Latina y el Caribe, Santiago2021Google Scholar some countries in LAC already faced challenges to the implementation of mental health care reform before the pandemic. Although remote care can be an important booster for greater access to care, as highlighted by Kola and colleagues,1Kola L Kohrt BA Hanlon C et al.COVID-19 mental health impact and responses in low-income and middle-income countries: reimagining global mental health.Lancet Psychiatry. 2021; 8: 535-550Summary Full Text Full Text PDF PubMed Scopus (379) Google Scholar for many people attending community-based programmes, transition to remote care might be substantially hindered by inequities in technological access. From our perspective, it is controversial whether increasing the amount of remote mental health care in LAC countries can be considered a substantial advance in mental health care reform, or it might simply be a mitigation strategy: at some point probably the only available option, but far from being an optimal option. Remote care might fill some gaps in access to mental health care, but it also leaves behind populations that need care the most. Remote care also goes against some of the basic tenets of mental health care: involvement in community settings and social participation as stated by mental health regional agreements (eg, Caracas Declaration, Panamá Consensus), and face-to-face contact and interaction involved in these processes. For people with severe mental health conditions who had long term psychiatric hospitalisations, the impact of new lockdowns, the loss of face-to-face interactions with peers and health-care staff, and the disruption of rehabilitation services linked to the pandemic4WHOPulse survey on continuity of essential health services during the COVID-19 pandemic: interim report, 27 August 2020. World Health Organization, Geneva2020Google Scholar need to be determined. We are concerned that psychiatric care reform in LAC stagnated, at least, during the first months of the COVID-19 pandemic and it is at risk of deteriorating. Community participation, which goes beyond health care, has been compromised in some LAC countries where we live and work, and it seems that people with disabilities have not been asked about their perspectives of how to face the challenges that the pandemic brings for them.5Meresman S Ullmann H COVID-19 y las personas con discapacidad en América Latina: mitigar el impacto y proteger derechos para asegurar la inclusión hoy y mañana. Serie Políticas Sociales, No 237 (LC/TS.2020/122). Comisión Económica para América Latina y el Caribe, Santiago2020Google Scholar Is the COVID-19 pandemic an opportunity for change in global mental health care? Probably yes. But are we really moving forwards, or backwards? For Caracas Declaration see https://www.globalhealthrights.org/wp-content/uploads/2013/10/Caracas-Declaration.pdfFor Panamá Consensus see https://www.paho.org/hq/dmdocuments/2012/1.PosterEnglishJAN11.pdf For Caracas Declaration see https://www.globalhealthrights.org/wp-content/uploads/2013/10/Caracas-Declaration.pdf For Panamá Consensus see https://www.paho.org/hq/dmdocuments/2012/1.PosterEnglishJAN11.pdf We declare no competing interests. The opinions given in this letter are personal and do not reflect the opinions of the institutions that the authors are affiliated with. COVID-19 mental health impact and responses in low-income and middle-income countries: reimagining global mental healthMost of the global population live in low-income and middle-income countries (LMICs), which have historically received a small fraction of global resources for mental health. The COVID-19 pandemic has spread rapidly in many of these countries. This Review examines the mental health implications of the COVID-19 pandemic in LMICs in four parts. First, we review the emerging literature on the impact of the pandemic on mental health, which shows high rates of psychological distress and early warning signs of an increase in mental health disorders. Full-Text PDF COVID-19 and global mental healthIn The Lancet Psychiatry, my colleagues and I describe the mental health services and supports mobilised in the initial months of the COVID-19 pandemic in low-income and middle-income countries (LMICs).1 In our Review, we describe how humanitarian organisations with expertise in mental health began issuing guidelines in February, 2020, to manage the pandemic's effects on mental health, and many LMICs integrated this guidance into national response plans for mental health. The Review documents widespread innovation in LMICs to increase mental illness detection and maintain treatment during lockdowns. Full-Text PDF COVID-19 and global mental healthIn The Lancet Psychiatry, Lola Kola and colleagues1 suggested three dimensions that could change the way global mental health is framed to achieve equitable mental health coverage worldwide: context, stakeholders, and sectors. Here we share one of our interventions as an example of how these dimensions should be addressed. Our organisation, Partners in Health Mexico (Compañeros En Salud), has been working for 10 years in the rural Sierra and Fraylesca regions of Chiapas, Mexico. Chiapas has severe socioeconomic adversity, with 77% of the population living in poverty. Full-Text PDF COVID-19 and global mental health – Authors' replyWe appreciate the insightful responses to our position paper on global mental health and COVID-19. We note the consensus that the COVID-19 pandemic is an opportunity to strengthen mental health care globally, and particularly that the emergence of a global pandemic has highlighted the value of learning from countries with experience in regularly responding to such outbreaks and other emergencies. The examples given of lessons in mental health and psychosocial support that can be applied in the USA are very well observed. Full-Text PDF COVID-19 and global mental healthWe welcome the review in The Lancet Psychiatry by Lola Kola and colleagues1 on COVID-19 and mental health in low-income and middle-income countries (LMICs). Our view is that this could have gone further to call on universities in high-income countries (HICs), and academics working within them, to make changes to improve equity with universities and academics in LMICs. Given that universities in HICs hold disproportionate power and funding, we propose that a fundamental shift is needed. Imbalances in power and privileges are seen right across global health, with one study finding that 80% of leaders of global organisations active in health were citizens of HICs, 90% were educated in HICs, and 70% were men. Full-Text PDF