Mental health care and COVID-19

We would like to thank Hailemariam and Pathare for their letter in which, among other issues, they refer to our recently published Position Paper.¹

In our Position Paper, we provide an international perspective, with authors and users and family associations from 14 countries, on how the pandemic offers an opportunity to improve mental health-care provision. Finding commonalities and sharing experiences that can translate to different setting helped us to propose a core set of measures to establish the benefits of such changes once implemented.

The views and solutions expressed in our paper do apply to medium-income and high-income countries with advanced health systems where granular mental health monitoring might be possible. We are aware that these approaches might not be relevant to low-income countries with no psychiatrists or with no mental health services in place where, ipso facto, priorities are different, and public health or primary health are the focus. In many of those countries, a greater number of people are dying from causes other than this pandemic, which might be a more immediate focus for health services.

We share some concerns with Hailemariam and Pathare. The countries represented in our Position Paper produce more than 80% of all scientific papers in the world,2, 3 and low-income countries necessarily use drugs developed in high-income countries. We state in our paper that we are deeply concerned about the increasing economic gap and how that will affect mental health of those in low-income countries (and what mental health services could do to reduce the expected widening).

The COVID pandemic is global, but its effect on mental health and potential solutions will depend on the setting and on economic, social, and systems variables.⁴ Knowing how difficult it is to change policies in most countries, we adopted a pragmatic approach and focused on one particular side of the problem and our own expertise. But there are some suggestions in our Position Paper that would be useful for all countries, such as the use of digital technologies (which would also benefit rural areas) at the same time as respecting the digital divide. However, we believe mental health experts in low-income countries are the ones entitled to speak up and propose changes tailored to their reality.