Preparing health systems to reduce mental health problems during public health and economic shocks

Introduction: Public health crises and economic shocks raise profound challenges for population mental health. There is much to learn from different policy approaches to the COVID pandemic across Europe.  We sought to identify strengths and weakness of these responses and make recommendations to aid in health system preparedness for future crises.

Methods: Mixed-methods analysis, including a mental health impact assessment of health and wider system policy responses to the COVID-19 pandemic in eight European countries, informed by findings from observational studies, policy documentation, media reports, literature reviews and semi-structured interviews.

Results: Variation in stringency of pandemic responses is likely to have influenced population mental health. There were some adverse impacts from school closures, social distancing, lockdowns and measures to protect vulnerable people, on mental health, particularly on depression and anxiety. Adverse impacts disproportionately fell on several high-risk population groups. There were also improvements in mental health and wellbeing associated with pandemic policy responses for some population groups. It is likely that additional income/social protection measures, which mitigated immediate economic impacts of the pandemic, may have cushioned some of the mental health impacts of the pandemic.

Discussion: In planning for future crises, additional resources to protect the mental wellbeing and resilience of individuals at high-risk of not being in employment, education or training are likely to be needed. Our analysis highlights the value of real-time measurement of population mental health and wellbeing during the pandemic. It made it easier to identify positive and negative impacts of changes in stringency of policy responses for mental health.

Conclusion: Policy responses need to be multi-sectorial, which implies cross-sectorial planning, which was not always evident during the pandemic. It is also important not only to plan for future pandemics and other public health emergencies, but also plan for continued recovery after these emergencies have ended.