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Strengthening public mental health during and after the

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reiterated the substantial impact of the pandemic on addressing disparities in access and quality of services for
mental health and wellbeing globally; in the first year of socioeconomically disadvantaged groups.
the pandemic, there was a 25% increase in anxiety and Efforts to address the wellbeing of different popu­
depression globally and young people are at increased lation groups during and after the acute phase of the
risk of suicide and self-harm injuries.1,2 There are also COVID-19 pandemic will require developing, testing,
uncertainties about the long-term prognosis of people and implementing mental health programmes that use
who recovered from COVID-19,3 its long-term effects on community resources as infrastructure during health
the general population,4 and the pressure of the pandemic emergencies to develop concrete evidence related to
on health-care systems in the future.5 Joint actions from UHC8 and how to address mental health treatment
governments, the global health community, social and gaps. Epidemiological studies that explore the impacts
private sectors, and key stakeholder groups are required of COVID-19 containment measures and mitigation
to address the neuropsychiatric and long-term strength efforts on mental health in the general population will
and asset-building needs associated with the pandemic. inform service development and psychosocial response
The updated WHO Comprehensive Mental Health in current and future humanitarian crises. Information
Action Plan 2013–20306 outlined public health strategies on the effects of SARS-CoV-2 on the brain, cognition,
and achievable goals to promote mental health and and functioning9 in people with lived experience will
prevent mental disorders in the context of universal help design neurological and psychiatric treatment
health coverage (UHC) for mental health services in the plans for affected individuals and provide pointers
coming years, to meet the UN Sustainable Development to more virulent infections that might emerge in the
Goals. However, the ability and resources to implement future.
the action plan remain inadequate.7 The original four There is a need to increase research that identifies
objectives of the action plan include leadership and evidence-based interventions that support psychological
governance, effective coverage through the partnership wellbeing, minimise risks, and promote resilience to
of health and social care, prevention and promotion support children and young people’s mental health
strategies, and strengthening of the research database in and reduce the risks of mental illness in later years.10
mental health. In the updated version,6 four additional Exploratory studies are useful in intervention designs
targets affirm WHO’s commitment to championing the that use community-based resources as partners in
direction of mental health response to the COVID-19 mental health promotion, prevention, and service
pandemic. There are new targets on service expansion delivery. Intervention studies can also evaluate strategies
through community infrastructures, the integration of of partnerships between mental health services and
mental health into public health emergency planning for social organisations, such as schools, workplaces,
population safety, and a pledge to double the global out­ religious groups, and non-governmental organisations,
put of mental health research. These additional strategies to promote mental health help-seeking and suicide
carry an even deeper meaning now with the Russian prevention programmes.11 Cost-effective interventions
invasion of Ukraine, which along with other ongoing and studies that include multilevel cost–benefit analyses
conflicts and humanitarian crises globally is exacerbating are needed to guide decision makers on budgeting, cost
human suffering and forcing people into exodus. savings, and resource allocations for mental health.
We therefore make recommendations to focus on Evaluating the impacts and effectiveness of digital
timely and rapid evidence generation to address the intervention in the COVID-19 pandemic4 is necessary

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to leverage technology for service delivery for real-time A broader scope of global mental health beyond specific
surveillance and disease trends projections during health disease areas will be crucial to addressing the ongoing
emergencies. Tested capacity-building methods used challenges of COVID-19 and responding to current global
in multipronged approaches12 will help to strengthen unrest and future humanitarian crisis. Learning from the
service delivery by health-care providers and other allied experiences during the COVID-19 pandemic and adapting
workers. the focus of mental health research will be vital to develop
Accelerating research on health disparities, including effective policy in mental health recovery efforts.
barriers to access, will be crucial to improving future We declare no competing interests.
preparedness and the resilience of mental health *Lola Kola, Manasi Kumar, Brandon A Kohrt, Tobi Fatodu,
services. Preparedness strategies of the updated Bisola A Olayemi, Adeyinka O Adefolarin
WHO action plan recognise the disproportionate [email protected]
impacts of crises such as COVID-19 and rising global WHO Collaborating Centre for Research and Training in Mental Health,
Neurosciences and Drug and Alcohol Abuse, Department of Psychiatry, College of
political instability on vulnerable groups. Syndemic Medicine, University of Ibadan, Ibadan 5116, Nigeria (LK, TF, BAO); BRiTE Center,
research approaches will help our understanding of Department of Psychiatry and Behavioral Sciences, University of Washington,
Seattle, WA, USA (LK); Department of Psychiatry, University of Nairobi, Nairobi,
the unequal impacts of the pandemic, for instance, Kenya (MK); Department of Psychology, University College London, London, UK
on people who are homeless, migrants and displaced (MK); Division of Global Mental Health, Department of Psychiatry and Behavioral
Sciences, George Washington University, Washington, DC, USA (BAK); Department
and refugee populations, individuals with disabilities, of Psychiatry and Department of Health Promotion and Education, Faculty of
and people with pre-existing mental or substance use Public Health, College of Medicine, University of Ibadan, Ibadan, Nigeria (AOA)

disorders, particularly the social, economic, and political 1 WHO. COVID-19 pandemic triggers 25% increase in prevalence of anxiety
and depression worldwide. March 2, 2022. https://www.who.int/news/
contexts, and inform necessary interventions for these item/02-03-2022-covid-19-pandemic-triggers-25-increase-in-prevalence-
of-anxiety-and-depression-worldwide (accessed March 18, 2022).
populations.13 Multisectoral and multidisciplinary
2 WHO. Mental health and COVID-19: early evidence of the pandemic’s impact:
research approaches that incorporate partnership within scientific brief, 2 March 2022. https://www.who.int/publications/i/item/
WHO-2019-nCoV-Sci_Brief-Mental_health-2022.1 (accessed
the health sector and collaboration with key government March 17, 2022).
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between COVID-19 and psychiatric disorder: retrospective cohort studies of
services at community levels and the promotion of 62 354 COVID-19 cases in the USA. Lancet Psychiatry 2021; 8: 130–40.
social reconnections and rehabilitation for people with 4 Iacobucci G. England saw record 4·3 million referrals to mental health
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violence, and injuries tested in multidisciplinary studies responses in low-income and middle-income countries: reimagining global
mental health. Lancet Psychiatry 2021; 8: 535–50.
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www.who.int/publications/i/item/9789240031029 (accessed
plans to safeguard human rights in subgroups such March 16, 2022).
as older adults, children, populations with learning 7 Saxena S, Belkin G. Knowledge gaps in implementing global mental health
activities. Glob Ment Health (Camb) 2017; 4: e23.
and intellectual disabilities, and people with severe 8 Eaton J, Ryan G. Making universal health coverage a reality: bridging the gap
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systems. Epidemiol Psychiatr Sci 2017; 26: 245–47.
methods studies will help inform the development of 9 Douaud G, Lee S, Alfaro-Almagro F, et al. SARS-CoV-2 is associated with
programmes to promote healthy coping during and changes in brain structure in UK Biobank. Nature 2022; published online
March 7. https://doi.org/10.1038/s41586-022-04569-5.
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for the COVID-19 pandemic: a call for action for mental health science.
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opportunity. JAMA Psychiatry 2021; 78: 433–38.
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13 Pirrone I, Dieleman M, Reis R, Pell C. Syndemic contexts: findings from a
the mental health workforce is able to deliver equitable review of research on non-communicable diseases and interviews with
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14 Office of the United Nations High Commissioner for Human Rights.
and professional dissatisfaction among front-line COVID-19 and the rights of persons with disabilities: guidance. 2020. https://
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healthcare providers of COVID-19; a systematic review of epidemiology and
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evolving pandemic context for their effectiveness.

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