26 - TL INIZIO - Mental health post-COVID-19: what are the consequences and lessons learned for healthcare?

The COVID-19 pandemic inflicted a devastating toll on mental health worldwide. Public health measures created an environment that exacerbated risk factors associated with poor mental health – loneliness, fear, grief, stress, financial uncertainty and unemployment – while restricting protective factors – social and educational engagement, daily routine, exercise and access to health services.

The pandemic triggered a ‘mental health tsunami’, with global cases of depression and anxiety rising by 25% in the first year of the pandemic.

Groups disproportionately impacted included those with pre-existing psychological and physical conditions, young people, women, healthcare workers, ethnic minorities and older people who are isolated or digitally excluded.

As with most traumatic events, the increased psychiatric symptoms would be expected to level out as we transition into a post-COVID-19 pandemic era. However, the number of people seeking help for mental health conditions continues to rise and residual waves may threaten society for years to come. Debilitating ‘long COVID’, estimated to affect at least 65 million people worldwide, is associated with neuropsychiatric sequelae such as fatigue, brain fog, memory loss, anxiety and depressive symptoms, and likely contributes to this sustained response. What’s more, since poor mental health is strongly associated with worse physical health, the impact of the pandemic on mental health may have implications on the prognosis and treatment outcomes of other health conditions and widen the pre-existing health inequalities. The unrelenting effects of the pandemic on mental health have also spilled over into other aspects of society, impacting the economy, work performance and healthcare systems.

Despite this, areas of strength, resilience and creativity have revealed new possibilities to transform mental health care.

Despite the collective trauma associated with the pandemic, some people weathered the psychological challenges better than anticipated, demonstrating resilience. The theory of post-traumatic growth (PTG) suggests people can even emerge from trauma mentally stronger.

Many identified unexpected benefits to the removal of stressors, such as offices and the daily commute, including a greater appreciation of life, better work–life balance, healthier lifestyles, improved family dynamics and positive spiritual change. In this way, the pandemic has been a catalyst for many to take greater control of their mental health and build psychological resilience, as well as for society to increase awareness and de-stigmatise mental illness.

The lack of preparedness, depleted workforce, underinvestment and interrupted mental health services during the pandemic posed unique challenges for the access and delivery of mental health services. This led to innovative solutions that have transformed mental health infrastructure, including new crisis phone lines, telepsychiatry to facilitate rapid and flexible communication, biometric monitoring, reassessment of inpatient stays, improvement in mental health education and increased support for mental health staff.

By 2030, mental health conditions are predicted to be the leading cause of mortality and morbidity globally, according to WHO statistics. Therefore, it is vital we continue to optimise mental healthcare systems to keep up with the demand.

The challenge for the global medical community is to convert learnings into strategic solutions. Surveillance to track new variants of the SARS-CoV-2 virus and other pathogens is critical to limit virus transmission and the need for further public health restrictions that may trigger a mental health relapse; funding aimed at understanding the structure, evolution, transmission and treatment of COVID-19 has been allocated.

For effective surveillance, medical systems must ensure the processing of diagnostic tests, a skilled workforce and supplies and equipment to process tests are maintained and sustainable. This may provide opportunities to integrate artificial intelligence, virtual reality and robotics into healthcare further.

The pandemic highlighted the outdated process for vaccine approvals, the need for innovations in information-sharing and the importance of coordinating clinical trials and cohort studies. Opportunities to explore existing medicines in novel indications related to COVID-19, such as the treatment of ‘long COVID’ symptoms or resulting mental health conditions, have also emerged.

Despite the resilience of the population, this does not relieve us of our responsibility to support those most impacted by COVID-19. The benefits of mental health treatment reach far beyond the affected individuals; untreated mental health conditions have high socioeconomic costs that leave society vulnerable to future pandemics. Therefore, mental healthcare should remain a public health priority, with appropriate funding, and policy reform should aim to promote the prevention, holistic treatment and de-stigmatisation of mental health conditions.

While the world cannot protect itself completely from a pandemic, any more than a coastal city can from a tsunami, strategic reprioritisation within global healthcare systems gives us a greater chance of effective preparation and recovery.

References are available on request.

Mental health post-COVID-19: what are the consequences and lessons learned for healthcare?

Beyond the COVID-19 era: positive effects on people living with mental health conditions

Beyond the COVID-19 era: innovations for mental health services

Lessons learned: managing the ongoing implications of COVID-19 and preparing for the next pandemic