Because of the limited scientific understanding of the COVID-19 pandemic and mental health thus far, postpandemic preparedness is difficult. The pandemic is an unpredictable, irregular occurrence and its impact could be difficult to measure and explore. Considering this, we recommend using the components of the mental health preparedness and action framework (MHPAF) for postpandemic preparedness. MHPAF consists of five interlinked components, including preparation and coordination, monitoring and assessment, sustainability of mental healthcare services, infodemic management and communications.3 This framework has been used to evaluate pandemic preparedness in some countries like Kenya and the USA.17 However, postpandemic mental health preparedness could be more challenging in countries that are inadequately prepared for pandemics. In addition to preparing for the components of MHPAF, we suggest a few additional interventions for effective and efficient management of postpandemic psychiatric services.
Mental healthcare delivery
COVID-19 has affected mental healthcare delivery because of the redeployment of MHPs. We need to reconsider a few practical approaches or models of care for effective delivery in the postpandemic era.
Telepsychiatry
Telepsychiatry needs to be developed through a government-supported service platform centred on community health service centres to enable easier access to psychiatric care, especially among vulnerable populations (eg, the elderly). However, the digital divide, access to marginalised populations and poverty are major barriers to telepsychiatry services in LMICs. This could affect the feasibility and acceptability of telepsychiatry in many countries. Considering this challenge, it is imperative that healthcare workers reach out to patients and aim at equitable access of telepsychiatric facilities.
Infodemic management
More robust regulation of social media companies by non-partisan, non-corporate, global regulators is needed to clamp down on the spreading of fake news, anti-vaccine movement and polarising content. All countries should take stringent steps towards infodemic management by the formulation of guidelines for responsible media reporting. Additionally, infoveillance (information monitoring), building eHealth literacy and capacity, knowledge refinement and accurate and timely knowledge translation should be encouraged.18
Integrative care
National public health policies should be designed to provide integrated care for mental health in different settings such as hospitals, primary care services, communities, schools, universities, colleges and workplaces.19 Formalising liaison between these settings with mental health services would help to promptly identify and holistically address emerging mental health needs. Developing support groups, screening of at-risk groups, peer counselling services, establishing dedicated crisis helplines, preparation for long-term plans and expanding support services can facilitate early access to mental health needs.
Community mental health services
Community mental health services should be well prepared to screen, identify people at risk, provide psychological first aid and facilitate onward referral services.20 Primary healthcare workers and organisational gatekeepers (eg, pharmacists, geriatric caregivers and school teachers) should be trained to identify individuals at risk and direct them to proper evaluation and treatment.
Human resources, education and training
Current redeployment of, and potential burn-out among, MHPs in the COVID-19 setting is affecting preparations for the delivery of mental health services for the postpandemic era. Policymakers and stakeholders should consider this as a priority. In many countries (like India), grass-roots medical staff (Accredited Social Health Activist-ASHA, teacher) are playing an important role in prescreening and triage, door-to-door visits, follow-up and on-site screening of COVID-19. Therefore, grass-roots workers should be trained in identifying and managing pandemic-associated psychiatric and psychosocial issues.
Formulate guidelines and protocols
Many people have been exposed to similar health risks, isolation, grief and economic uncertainty, individually and with their families. Therefore, certain common themes should be used to formulate guidelines to improve access to care.
Assessment and intervention
The use of a toolkit or stepped care or matched care model through primary care physicians can improve the coverage of mental health services in the postpandemic era by allowing them to manage common mental disorders of mild severity.20
Suicide prevention
In anticipation of an increase in suicide rates, efforts should be made to reduce access to means (eg, more stringent gun control) and for better resourcing with suicide prevention agencies along with global decriminalisation of suicide/attempt(s). In addition, early screening for mental illness and treatment should be encouraged.
Research
Prospective cohort studies should be carried out to identify risk factors and exposure levels, track outcomes and compare outcomes among subgroups. These studies are important to monitor the effect of various interventions and strategies.
Stigma and discrimination
Interventions are needed to reduce stigmatisation and discrimination towards minority or vulnerable groups and to inform policy changes.21 22 General and specific interventions should be directed towards identification of drivers (eg, misinformation), facilitators (eg, lack of regulations) and intersecting factors (eg, occupation such as healthcare workers) towards reducing stigma and discrimination.21
Approach for addressing postpandemic mental health and services
Addressing emergent challenges with appropriate interventions could be challenging in many countries particularly in low-resource settings. Therefore, efforts should be taken for the prevention of mental health issues on a large scale and organisation of services for early identification of mental health issues. These approaches to mental healthcare prevention and treatment after the COVID-19 crisis can be classified as universal, selective or indicated.23 24
Universal approach
This is a population-wide intervention that will help reduce the overall burden of mental health issues (stress, anxiety and fear) through prevention; therefore, it is imperative to have a universal approach for each country (box 2).
Box 2Focus of universal approach in the postpandemic era
Promoting mental health wellness and reducing distress through adequate sleep, healthy diet and exercise, mindfulness‐based programmes (eg, yoga) and awareness about mental health issues.30,31
Using traditional and social media for mental health awareness campaigns and to encourage individuals to seek help with responsible, transparent and timely media reporting.3
Establishing community support for those at risk and encouraging to stay connected and maintain relationships.
Establishing primary screening services for common mental health issues such as anxiety, depression and suicidal thoughts.
Establishing the national suicide prevention helplines or other helplines.32
Integrating basic mental health services into primary care for early identification of COVID-19-related mental health issues.
Developing self-help resources and promoting healthy coping strategies.
Ensuring financial support for people through governmental and non-governmental organisations (eg, loans and credit).
Selective approach
It should be used for an individual having the risk factors for developing mental health issues. For example, a vulnerable population and individuals with risk factors mentioned above. A screening toolkit or guidelines should be developed to identify these groups of people.20
Indicated approach
It should be designed for individuals having signs and symptoms of the mental issues as mentioned above. This approach ought to be guided by well-defined guidelines before the intervention. Some people with mental health issues might not seek help because of fear of COVID-19 infection, stigma and poor motivation. It is therefore important to identify these individuals through a network of hospitals and community health workers.