{
  "abstract": "Objectives The Mental health care: Adverse Sequelae of COVID-19 study aimed to (1) compare the consequences of the COVID-19 pandemic for mental health services and people with pre-existing mental health conditions (MHCs) in six low- and middle-income countries and (2) identify good practice to mitigate these impacts.Design An observational study, using a mixed-methods convergent design triangulating data from (1) semistructured interviews or focus groups and/or a self-completed survey, (2) routine service utilisation data, (3) local grey literature and (4) expert consultation.Setting The study was conducted in Chile, Ethiopia, Georgia, Nigeria, South Africa and Sri Lanka.Participants 121 key informants.Results We found clear evidence in all sites that the pandemic exacerbated pre-existing disadvantages experienced by people with MHCs and led to a deterioration in the availability and quality of care, especially psychosocial care. Alongside increased vulnerability to COVID-19, people with MHCs faced additional barriers to accessing prevention and treatment interventions compared with the general population. To varying extents, sites showed accelerated implementation of digital technologies, but with evidence of worsening inequities in access. In sites where primary care-based mental healthcare was more developed or prioritised, systems seemed more resilient and adaptive.Conclusion Our findings have the following implications. First, these mental health service reductions are clear examples of ‘structural stigma’, namely policy level decisions in healthcare which place a low priority upon services for people with MHCs. Second, integration of mental healthcare into all general healthcare settings is key to ensuring accessibility and parity of physical and mental healthcare. Third, digital innovations should be designed to strengthen and not fragment health systems. We discuss these findings in terms of anticipating such challenges for future pandemics and preparing layers of resilience.",
  "authors": [
    {
      "affiliations": [
        "Division of Psychiatry, Institute for Neuroscience and Cardiovascular Research, University of Edinburgh, Edinburgh, UK",
        "Department of Psychiatry, WHO Collaborating Centre for Mental Health Research and Capacity Strengthening, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia"
      ],
      "name": "Charlotte Hanlon"
    },
    {
      "affiliations": [
        "Inflammation Biology, King’s College London, London, England, UK"
      ],
      "name": "Heidi Lempp"
    },
    {
      "affiliations": [
        "Department of Psychiatry, WHO Collaborating Centre for Mental Health Research and Capacity Strengthening, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia"
      ],
      "name": "Atalay Alem"
    },
    {
      "affiliations": [
        "Department of Psychiatry, WHO Collaborating Centre for Mental Health Research and Capacity Strengthening, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia"
      ],
      "name": "Azeb Asaminew Alemu"
    },
    {
      "affiliations": [
        "Universidad de Valparaiso, Valparaíso, Valparaiso Region, Chile"
      ],
      "name": "Rubén Alvarado"
    },
    {
      "affiliations": [
        "University College Hospital Ibadan, Ibadan, Nigeria"
      ],
      "name": "Olatunde Olayinka Ayinde"
    },
    {
      "affiliations": [
        "Northamptonshire Healthcare NHS Foundation Trust, Kettering, England, UK"
      ],
      "name": "Adekunle Adesola"
    },
    {
      "affiliations": [
        "Health Service and Population Research Department, King’s College London, London, England, UK"
      ],
      "name": "Elaine Brohan"
    },
    {
      "affiliations": [
        "University of Cape Town, Rondebosch, WC, South Africa"
      ],
      "name": "Thandi Davies"
    },
    {
      "affiliations": [
        "Department of Psychiatry, WHO Collaborating Centre for Mental Health Research and Capacity Strengthening, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia"
      ],
      "name": "Wubalem Fekadu"
    },
    {
      "affiliations": [
        "Psychiatry, University of Ibadan College of Medicine, Ibadan, Oyo, Nigeria"
      ],
      "name": "Oye Gureje"
    },
    {
      "affiliations": [
        "Ilia State University, Tbilisi, Tbilisi, Georgia"
      ],
      "name": "Lucy Jalagania"
    },
    {
      "affiliations": [
        "Ilia State University, Tbilisi, Tbilisi, Georgia"
      ],
      "name": "Nino Makhashvili"
    },
    {
      "affiliations": [
        "Department of Psychiatry, WHO Collaborating Centre for Mental Health Research and Capacity Strengthening, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia"
      ],
      "name": "Awoke Mihretu"
    },
    {
      "affiliations": [
        "Mental Health Service User Association, Addis Ababa, Ethiopia"
      ],
      "name": "Eleni Misganaw"
    },
    {
      "affiliations": [
        "Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK"
      ],
      "name": "Maria Milenova"
    },
    {
      "affiliations": [
        "University of Alicante, Sant Vicent del Raspeig, Valencian Community, Spain"
      ],
      "name": "Tamar Mujirishvili"
    },
    {
      "affiliations": [
        "Taras Shevchenko National University of Kyiv, Kyiv, Kyiv City, Ukraine"
      ],
      "name": "Olha Myshakivska"
    },
    {
      "affiliations": [
        "Taras Shevchenko National University of Kyiv, Kyiv, Kyiv City, Ukraine"
      ],
      "name": "Irina Pinchuk"
    },
    {
      "affiliations": [
        "University of Chile, Santiago, Santiago Metropolitan Region, Chile"
      ],
      "name": "Camila Solis-Araya"
    },
    {
      "affiliations": [
        "University of Cape Town Faculty of Health Sciences, Observatory, South Africa"
      ],
      "name": "Katherine Sorsdahl"
    },
    {
      "affiliations": [
        "University of Chile, Santiago, Santiago Metropolitan Region, Chile"
      ],
      "name": "Gonzalo Soto-Brandt"
    },
    {
      "affiliations": [
        "Columbia University, New York, New York, USA"
      ],
      "name": "Ezra Susser"
    },
    {
      "affiliations": [
        "University of Chile, Santiago, Santiago Metropolitan Region, Chile"
      ],
      "name": "Olga Toro-Devia"
    },
    {
      "affiliations": [
        "University of Oxford, Oxford, UK"
      ],
      "name": "Nicole Votruba"
    },
    {
      "affiliations": [
        "University of Colombo, Colombo, WP, Sri Lanka",
        "Rajarata University of Sri Lanka, Mihintale, Sri Lanka"
      ],
      "name": "Anuprabha Wickramasinghe"
    },
    {
      "affiliations": [
        "Faculty of Medicine, University of Kelaniya, Kelaniya, WP, Sri Lanka"
      ],
      "name": "Shehan Williams"
    },
    {
      "affiliations": [
        "Health Service and Population Research, King’s College London, London, England, UK"
      ],
      "name": "Graham Thornicroft"
    }
  ],
  "title": "Adverse sequelae of the COVID-19 pandemic on mental healthcare in six low- and middle-income countries (MASC): a mixed-methods study with lessons for the future",
  "uid": "9f4174d6-b08e-5ebe-ae16-d16bc1ffb6ff"
}