New research published recently in ‘The Lancet Psychiatry’ warns 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 those from low and middle-income countries, and people with lived experience of mental illness or long COVID. They examined the different responses from governments around the world and reviewed existing evidence to assess what policies were most effective for protecting mental health.

The research was conducted over five years, meaning that the study could review the higher quality, often long-term studies, which have emerged since the pandemic and the initial deluge of small, and less informative studies from the early days of the pandemic.

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 first 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, communities with little access to digital technology missed out.

The second paper 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 implemented around the world and that digital and economic divides often widened inequalities.

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.

Prof Peter B Jones at Cambridge University and the Commission Co-chair, said, “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 were nuanced. We were indeed 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 emergencies. Protecting health services should not be the aim if it is at the expense of the people who need them.”

The commission recommends that policymakers 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.

Prof Etheldreda Nakimuli-Mpungu 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.”