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

Hanlon, C; Lempp, H; Alem, A; Alemu, AA; Alvarado, R; Ayinde, OO; Adesola, A; Brohan, E; Davies, T; Fekadu, W; Gureje, O; Jalagania, L; Makhashvili, N; Mihretu, A; Misganaw, E; Milenova, M; Mujirishvili, T; Myshakivska, O; Pinchuk, I; Solis-Araya, C; Sorsdahl, K; Soto-Brandt, G; Susser, E; Toro-Devia, O; Votruba, N

COVID-19 Collection

Journal article

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

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.

Publication status:: Published

Peer review status:: Peer reviewed

Actions

Email

Email this record

Send the bibliographic details of this record to your email address.

Your Email
Please enter the email address that the record information will be sent to.

-
Your message (optional)
Please add any additional information to be included within the email.
Share
Cite

Cite this record

APA Style

Hanlon, C., Lempp, H., Alem, A., Alemu, A. A., Alvarado, R., Ayinde, O. O., Adesola, A., Brohan, E., Davies, T., Fekadu, W., Gureje, O., Jalagania, L., Makhashvili, N., Mihretu, A., Misganaw, E., Milenova, M., Mujirishvili, T., Myshakivska, O., Pinchuk, I., … Votruba, N. (2026). 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. BMJ Open, 16(6), e103813.

MLA Style

Hanlon, C, et al. “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.” BMJ Open, vol. 16, no. 6, 2026, p. e103813.

Chicago Style

Hanlon, C, H Lempp, A Alem, et al. 2026. “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.” BMJ Open 16 (6): e103813.
Print