Exploring the salience of mental health issues in pandemic decision-making: a qualitative analysis

David MCDAID², Wagner SILVA-RIBEIRO², Pablo NICAISE¹, Adelina COMAS-HERRERA², Vincent LORANT¹, A-La PARK²

¹Institute of Health and Society, Université catholique de Louvain, Brussels, Belgium
²Care Policy and Evaluation Centre, Department of Health Policy, London School of Economics and Political Science, London, United Kingdom

Introduction: To examine stakeholder perspectives on the attention given to mental health in the COVID-19 pandemic, particularly trying to understand the role that stakeholders’ ideologies, world views, beliefs and interests played in the decision-making processes.

Methods: In-depth semi-structured interviews were held with a range of stakeholders including selected public health and mental health policymakers in eight European countries. Interviews investigated the salience of mental health issues, stakeholder beliefs and how and when their interactions affected the way mental health and wellbeing issues were addressed during the COVID pandemic. A modified version of a six-step reflexive thematic analysis approach, informed by the Advocacy Coalition Framework approach to the policy making process, was adopted.

Results: The narrow focus on actions to reduce the transmission rate of the virus, particularly at the beginning of the pandemic, meant that wider concerns including mental health only tended to emerge over time, rather than being taken into account in planning. Previous pandemic preparedness plans did not focus on population mental health. Over time financial and other social welfare measures, addressing social isolation, as well as the importance of keeping schools open, were also recognised as being important for mental health.

Discussion: Mental health was not a major consideration for policymakers during the first wave of COVID in Spring 2020. Over time policymakers more actively and explicitly acknowledged the importance of impacts on mental health when formulating policy, including for example, when balancing virus containment with the impacts of reopening schools and the wider economy.

Conclusion: There is a need to put mental health protection plans in place for future pandemics and other public health shocks, including measures to help support the long-term recovery of population groups whose mental health is most affected.