Five Years On: What the Pandemic taught us about Mental Health - and what we still have not learned
By Alexandra Schuster, on behalf of The Lancet Psychiatry Commission on COVID-19 and Mental Health
In the early months of the pandemic, public and political discourse was saturated with claims of an impending global “mental health catastrophe.” In this context, the Academy of Medical Sciences, The Lancet Psychiatry, and the charity MQ Mental Health Research convened 24 experts to establish multidisciplinary research priorities for global mental health during the COVID-19 pandemic. This initiative evolved into a larger, more globally inclusive standing commission spanning high-, middle-, and low-income countries, including researchers, clinicians, policy makers, and persons with living and lived experience of mental ill-health, COVID-19, and long-COVID.
On January 22nd, 2026, The Lancet Psychiatry published the first two papers of a three-part global review examining the impacts of the COVID-19 pandemic. Paper 1, The implications of the COVID-19 pandemic for clinical mental health care, examines how clinical services for mental health changed during the pandemic and what those changes mean for future care.1 Paper 2, Policy and public health implications for mental health after the COVID-19 pandemic, analyses how public health systems and social policies responded, and which approaches helped–or failed–to protect population mental health. A third, forthcoming paper will address the neuropsychiatric consequences of SARS-CoV-2 infection and long COVID, including cognitive and neurological outcomes that continue to affect millions.
Collectively, the studies indicate the most detrimental outcomes were primarily attributable to enduring structural deficiencies within mental health systems and broader social inequities, which were both highlighted and exacerbated by the pandemic. Although a singular global "mental health catastrophe" did not occur, there were notable increases in psychological distress during the initial stages of the pandemic, a widening of existing inequalities, and significant interruptions in mental health service delivery.
Strain, Silence, and Sudden Innovation
The first paper, The implications of the COVID-19 pandemic for clinical mental health care, synthesizes global evidence on how mental health symptoms, diagnoses, and services changed during the pandemic. In high-income countries, symptoms of anxiety and depression rose sharply in the early months of the pandemic. The authors found symptoms stabilised or returned close to pre-pandemic levels across general populations; however, persons from vulnerable population—including socioeconomic disadvantaged communities, minoritised ethnic groups, children and young people, and people with pre-existing mental illness—experienced greater and more sustained harms. Apart from rates of eating disorders in young women, this surge did not lead to an increase in the levels of clinical mental illnesses.
Regarding clinical mental healthcare, the first paper highlighted how the pandemic disrupted the delivery of services. Infection-control measures, staff shortages and redeployments, and the sudden loss of in-person care forced service workers to improvise at scale, often with little evidence to guide decision-making. While profoundly challenging, the authors note these disruptions accelerated service innovation. New community-based and task-sharing models emerged, including community-delivered psychological support, task-sharing models, and new ways of involving families and peer support. In parallel was the rapid expansion of remote and digital care. Telepsychiatry, online therapy platforms, and crisis helplines enabled continuity of care and expanded accessibility; however, these gains were not universal. This rapid shift exposed and reinforced digital inequalities, leaving those lacking dependable devices, internet connectivity, or private environments remained unable to benefit from these emerging forms of care. Regardless of the intervention, the authors note that robust trials and economic evaluations were rare, leaving policymakers with little evidence about what should be sustained, adapted, or abandoned.
A central contribution of this paper was its use of candidacy: the dynamic process through which people come to see themselves as eligible for care, and services recognise them as such. During the pandemic, individuals delayed or abandoned help-seeking, while services implicitly raised thresholds for access. Commission Co-Chair Peter Jones observed, “Protecting health services should not be the aim if it is at the expense of the people who need them.”
The COVID-19 pandemic fundamentally altered clinical mental health care worldwide, disrupting routine provision and accelerating new modes of delivery. Most notably, the pandemic intensified longstanding inequities that shape access and outcomes.
Against this backdrop, four key recommendations emerged:
Increasing investment in routine data and longitudinal cohorts to track service use and outcomes;
Prioritising vulnerable groups, and integrating candidacy in service and crisis planning;
Evaluating crisis pathways for future health emergencies; and,
Conducting ambitious, adequately powered trials of new models of clinical care, particularly in under-served settings and for people living with severe mental illness and long-COVID.
Mental Health Is Not a Downstream Outcome
The second paper, Policy and public health implications for mental health after the COVID-19 pandemic, widens the lens to population mental health and the broader policy response.
The authors found the pandemic magnified pre-existing disparities linked to poverty, gender, race and ethnicity, geography, age, disability and prior mental illness. Mental health deteriorated most among people facing job loss, income insecurity, precarious housing, food insecurity and discrimination, and among children and young people whose education and social development were disrupted.
Across countries, policy responses clustered into four broad areas: (1) management of information and “infodemics”; (2) reorganisation of services, including digital care and community mobilisation; (3) targeted efforts to address inequities; and (4) changes in financing and social protection. Governments mostly embedded social listening and rumour-tracking into public health functions, while international agencies such as WHO and UNICEF helped to institutionalise infodemic management as a core task. Others expanded telehealth, set up crisis helplines, or mobilised community health workers, sometimes at impressive scale.
The strongest measures, however, often came from outside the health sector. Wage subsidies, furlough schemes, eviction moratoria, cash transfers, school- and university-based mental health services, gender-sensitive policies such as support for survivors of domestic violence, and culturally adapted community interventions in low-resource settings mitigated the worsening of mental ill-health. The authors notes, however, that these measures were unevenly implemented, often temporary, and rarely evaluated for equity or cost-effectiveness.
The paper’s central argument is simple, but far-reaching. Professor Etheldreda Nakimuli-Mpungu, Professor of Epidemiology at the London School of Hygiene and Tropical Medicine and the Commission Co-chair, states “…mental health must be built into social protection, community services, and crisis planning from the start. If we rely only on specialist services after harm has occurred, we will always be too late.” Key recommendations included:
Embedding mental health in social protection and recovery plans;
Integrating infodemic management and clear, trusted communication into preparedness strategies;
Investing in blended digital and community-based services that are specifically designed to reduce, rather than widen, inequities; and,
Developing financing models that protect mental health budgets during crises.
In addition, the authors also highlight the need for long-term, cross-national research–especially in low-income and middle-income countries–to further understand the enduring mental health effects of the pandemic and of policy choices.
Looking Forward
Reflecting on five years of work, Commission Co-Chair Peter Jones described it as “a privilege to work with Commission members who became so immersed in a rapidly accumulating and ultimately vast evidence base. To have extracted sense and meaningful recommendations is rewarding—but the biggest impact will come from their implementation.”
Together, the series offers not a post-mortem, but a blueprint: for fairer, more resilient mental health systems that are better prepared not just for the next crisis, but for the ongoing, unequal pressures of everyday life.
This challenge now lies with governments, funders, and health systems. The pandemic did not simply test mental health services, but revealed their fragility. The question is no longer whether COVID-19 affected mental health, but whether we are willing to act on what we have learned.
The MQ Mental Health Research and Lancet Psychiatry Standing Commission on the COVID-19 Pandemic and Mental Health: Ziyad Al-Aly, Nisreen Alwan, Chris Bartley, Mariana Bolivar, Michael Erikson Benros, Ed Bullmore, Felicity Callard, Rebecca Cherop, Eric Chen, Rakhi Dandona, Tamsin Ford, Adam Hampshire, Megan von Isenburg, Bronwyn Graham, Simon Gilbody, Paul Harrison, Emily Holmes, Ann John, Edgar Jones, Peter Jones (Co-chair), Ayana Jordan, Martin Knapp, Lola Kola, Emma Kolaru, Carlos López-Jaramillo, Parisa Mansoori, Dmytro Martsenkovskyi, Kate Martin, Benedict Daniel Michael, Fabian Musoro, Vardan Nersejan, Etheldreda Nakimuli-Mpungu (Co-chair), Avi Nath, Timothy Nicholson, Kelvin Opiepie, Rory O’Connor, Soumitra Pathare, Lina Ruiz, Kerry Ressler, Alexandra Schuster, Maxime Taquet, Simon Wessely, Larry White.