The COVID-19 pandemic of 2020 and the social and economic effects of managing the epidemic are likely to significantly affect community mental health (13). These effects will range from short-term fear and anxiety about potential infection during times of high prevalence, long-term depressive and cognitive effects in persons with chronic post-infection health conditions, pathological grieving for deceased family members who could not be visited at the time of death, the psychological effects of large-scale social and economic disruption, and increased severity of pre-existing mental disorders in individuals who cannot access their usual social support or health care networks due to lockdowns or social distancing. The prevalence, severity, demographic distribution, and social and economic effects of COVID-19 vary widely by country, so it is likely that the mental health effects will also vary widely by location and by population cohort within each community. Given that the pandemic is still ongoing, research about its effects on mental health must be considered preliminary (14). For example, a review of the accumulating reports about the effect of COVID-19 on suicidal behavior (15) finds that the quality of such studies is poor; to date, there is no evidence of changes in suicide rates. Monitoring the long-term effects of COVID-19 (and other global or national crises) on mental health will require undertaking annual, high-quality epidemiological surveys of mental health disorders, substance use disorders, and suicidal behaviors in large, nationally representative samples of community residents.
At a time when the need to support the mental health of the community is the greatest due to COVID-19, the resources available to do so in most countries have decreased because the financial needs of other community services (e.g., screening for and treating COVID-19 infections, providing unemployment and welfare support, making schools COVID-19-safe) have increased dramatically while available government funds have been reduced due to decreased tax revenues. In this constrained economic environment, it will be difficult to convince governments and non-governmental organizations (NGOs) to earmark their limited funds and other resources for the sole purpose of increasing the access and quality of mental health services. It should, however, be feasible to include mental health issues as an essential part of governments’ and NGOs’ overall COVID-19 management and recovery plans, so mental health advocates will need to fight to ensure that this happens. Ideally, these challenging times could stimulate the development and promulgation of less-expensive, community-based services — such as the use of telepsychiatry or ‘mental health extenders’ for patients in under-served rural communities — but even if feasible, such innovations are unlikely to substantially change the dire lack of needed mental health services. Once COVID-19 vaccines are widely available, it may be possible to regain lost ground, but long-term financial damages in some LMICs will likely continue to limit the development of mental health services.
In summary, over a decade ago, global mental health advocates promoted the concept of “no health without mental health” (16). This increased awareness of the magnitude of the global mental health problem but had little effect on changing the situation. More recently, the effort to promote global mental health via World Mental Health Day and other initiatives aims to reframe mental health as an integral part of the overall social and economic development using the motto: “No sustainable development without mental health” (7). However, the COVID-19 pandemic is substantially altering the social environment and economic development of many countries, and at this point in time, no one can be certain what the post-pandemic, ‘new normal’ will look like. Thus, the long-term effects of COVID-19 on global mental health also remain uncertain. Ongoing monitoring of the prevalence, severity, and duration of mental health conditions and of the available services for preventing and treating these conditions will be needed to determine whether or not the current strategy of global mental health advocates of linking mental health with development will result in improved global mental health.
In 2019, Dr Tedros Adhanom Ghebreyesus, Director-General of the WHO clarified the central role of mental health to global health as follows: “The world is accepting the concept of universal health coverage(UHC). Mental health must be an integral part of UHC. Nobody should be denied access to mental health care because she or he is poor or lives in a remote place” (17).
Conflicts of interest: The author reports no conflicts of interest related to this manuscript.