The psychological impact of pandemics, which historically appear in the human species, is described in detail in Steven Taylor’s excellent book “The Psychology of Pandemics”,¹ which was published in 2019, a few months before the outbreak of the Covid-19 pandemic. This pandemic shows similar characteristics in terms of mental health problems to the previous ones described in the book, according to the findings of epidemiological research, both internationally and in Greece.^2-5 The results of these studies show a significant increase of the prevalence of common mental disorders, especially in vulnerable groups, particularly in persons with preexisting mental disorders.

The necessary restrictive measures applied, especially in the first stages of the pandemic, had an impact in the accessibility of psychiatric patients to the mental health services, both in- and outpatient ones.⁶ This led to decreased outpatient appointments and admissions in inpatient wards, depriving a large number of these patients from necessary treatments and interventions, often resulting in worsening their mental state or relapse of acute episodes. The lack of accessibility to mental health services, had a greater impact on persons with social and financial problems, which deteriorated during the pandemic, leading to mental health problems.³ An additional problem is that persons suffering from severe mental disorders, such as chronic psychoses, face a greater risk of infection and death by Covid-19.⁷

These problems, arising during the pandemic (increased prevalence of mental disorders, increase of relapses of serious mental disorders, increased risk of infection and death by Covid-19, increased prevalence in those infected, especially those in the ICUs, problems of accessibility) underline the chronic insufficiencies of the mental health care system, which in many countries, especially in Greece, is fragmented and is not covering adequately the mental health needs of the population. A series of articles in prestigious mental health journals point out the problem and propose solutions, in order to correct insufficiencies and create a new strong mental health system through a series of activities.^8-10

These articles underline the problems known for decades and propose the following solutions for enhancing the existing mental health system, not only to cover additional needs created by the pandemic, but leading to a new mental health system covering adequately the needs of the population: (1) Strengthening leadership and governance, with interventions to politicians and administrators, in order to understand mental health issues, and provide services in terms of inclusivity, equity and accountability. (2) Supporting financially evidence-based services, adopting policies to counteract the social determinants of mental health, as well as the additional needs created by the pandemic. (3) Promoting programmes targeting vulnerable groups, especially those related to social determinants, with the active participation of stakeholders, with emphasis in combating stigma and enhancing mental health literacy. (4) Strengthen mental health services in all three levels, with emphasis in community mental health services, treatment at home, special services for vulnerable groups, services for the Covid-infected and the relatives of the deceased from the infection, the staff of health services dealing with Covid-19, using “telehealth” services, adopting information systems to assist services and close collaboration with the services dealing with Covid-19. (5) Training the staff of primary health care in mental health by using the mhGAP programme of the World Health Organization (WHO) and linking them to the special mental health services. (6) Implementing programmes for mental health promotion and prevention of mental disorders, with the participation of stakeholders, NGOs and the civil society. (7) Improving mental health information systems and connecting them with parallel systems dealing with Covid-19. (8) Strengthen and finance research in mental health, from epidemiology and services research, to neurobiology, as well as research aiming to provide innovative solutions for improving the system of mental health services and the provision of services and interventions through the social media. (9) Protecting rights of mental patients aiming to provide high quality services by use of evaluation instruments such as WHOQualityRights of WHO. 

Venetsanos Mavreas
Emeritus Professor of Psychiatry, University of Ioannina, Ioannina, Greece 

Stelios Stylianidis
Professor of Social Psychiatry, Panteion University, Athens, Greece

References

1. Taylor S. The Psychology of Pandemics: Preparing for the Next Global Outbreak of Infectious Disease. Cambridge Scholars Publishing, Newcastle upon Tyne, 2021
2. Skapinakis P, Bellos S, Oikonomou A, Dimitriadis G, Gkikas P, Perdikari E, Mavreas V. Depression and Its Relationship with Coping Strategies and Illness Perceptions during the COVID-19 Lockdown in Greece: A Cross-Sectional Survey of the Population. Depress Res Treat 2020, 3158954, doi: 10.1155/2020/3158954

• Banks J, Fancourt D, Xiaowei X. Mental Health and the COVID Pandemic. In: Helliwell JF, Layard R, Sachs JD, De Neve J-E, Aknin LB, Wang S. World Happiness Report. 2021. Available from: https://worldhappiness.report

4. Fountoulakis KN, Karakatsoulis G, Abraham S, Adorjan K, Ahmed HU, Alarcón RD, et al. Results of the COVID-19 mental health international for the general population (COMET-G) study. Eur Neuropsychopharmacol 2022, 54:21-40. doi: 10.1016/j.euroneuro.2021.10.004
5. Kessler RC, Chiu WT, Hwang IH, Puac-Polanco V, Sampson NA, Ziobrowski HN, Zaslavsky AM. Changes in Prevalence of Mental Illness Among US Adults During Compared with Before the COVID-19 Pandemic. Psychiatr Clin N Am 2022,45:1–28, doi: 10.1016/j.psc.2021.11.013
6. Murphy L, Markey K, O’ Donnell C, Moloney M, Doody O. The impact of the COVID-19 pandemic and its related restrictions on people with pre-existent mental health conditions: A scoping review. Arch Psychiatr Nurs 2021, 35:375-394, doi: 10.1016/j.apnu.2021.05.002
7. Karaoulanis SE, Christodoulou NG. Do patients with schizophrenia have higher infection and mortality rates due to COVID-19? A systematic review. Psychiatriki 2021, 32:219–223, doi: 10.22365/jpsych.2021.027
8. Moreno C, Wykes T, Galderisi S, Nordentoft M, Crossley N, Jones N, et al. How mental health care should change as a consequence of the COVID-19 pandemic. Lancet Psychiatry 2020, 7:813-824, doi: 10.1016/S2215-0366(20)30307-2
9. Maulik PK, Thornicroft G, Saxena S. Roadmap to strengthen global mental health systems to tackle the impact of the COVID‑19 pandemic. Int J Ment Health Syst 2020, 14:57, doi: 10.1186/s13033-020-00393-4
10. Campion J, Javed A, Lund C, Sartorius N, Saxena S, Marmot M, et al. (2022). Public mental health: required actions to address implementation failure in the context of COVID-19. Lancet Psychiatry 2022, 9:169-182, doi: 10.1016/S2215-0366(21)00199-1

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