COVID-19 and global mental health

We are inspired by the optimistic tone of comprehensive Review Lola Kola and colleagues1Kola L Kohrt BA Hanlon C et al.COVID-19 mental health impact responses in low-income middle-income countries: reimagining global health.Lancet Psychiatry. 2021; 8: 535-550Summary Full Text PDF PubMed Scopus (277) Google Scholar initiatives countries (LMICs) during COVID-19 pandemic. However, reading paper from point view Latin America Caribbean (LAC), we not as authors, for three reasons. LAC has been deeply affected pandemic,2González Nuevas olas, aumento de contagios, escasez vacunas y elecciones: el panorama la pandemia en Sudamérica.https://actualidad.rt.com/actualidad/387272-contagios-vacunas-elecciones-panorama-pandemia-sudamericaDate: 2021Date accessed: March 23, 2021Google even more than other LMICs; region structural inequities a high prevalence informal work;3CEPALPanorama Social América Latina, 2020. Comisión Económica para Latina Caribe, Santiago2021Google some already faced challenges to implementation care reform before Although remote can be an important booster greater access care, highlighted colleagues,1Kola many people attending community-based programmes, transition might substantially hindered technological access. From our perspective, it is controversial whether increasing amount considered substantial advance reform, or simply mitigation strategy: at probably only available option, but far being optimal option. Remote fill gaps also leaves behind populations that need most. goes against basic tenets care: involvement community settings social participation stated regional agreements (eg, Caracas Declaration, Panamá Consensus), face-to-face contact interaction involved these processes. For with severe conditions who had long term psychiatric hospitalisations, new lockdowns, loss interactions peers health-care staff, disruption rehabilitation services linked pandemic4WHOPulse survey on continuity essential pandemic: interim report, 27 August World Health Organization, Geneva2020Google determined. concerned stagnated, least, first months pandemic risk deteriorating. Community participation, which beyond compromised where live work, seems disabilities have asked about their perspectives how face brings them.5Meresman S Ullmann H las personas con discapacidad Latina: mitigar impacto proteger derechos asegurar inclusión hoy mañana. Serie Políticas Sociales, No 237 (LC/TS.2020/122). Santiago2020Google Is opportunity change care? Probably yes. But really moving forwards, backwards? Declaration see https://www.globalhealthrights.org/wp-content/uploads/2013/10/Caracas-Declaration.pdfFor Consensus https://www.paho.org/hq/dmdocuments/2012/1.PosterEnglishJAN11.pdf https://www.globalhealthrights.org/wp-content/uploads/2013/10/Caracas-Declaration.pdf declare no competing interests. The opinions given this letter personal do reflect institutions authors affiliated with. healthMost population (LMICs), historically received small fraction resources health. spread rapidly countries. This examines implications LMICs four parts. First, review emerging literature health, shows rates psychological distress early warning signs increase disorders. Full-Text healthIn Lancet Psychiatry, my colleagues I describe supports mobilised initial (LMICs).1 In Review, humanitarian organisations expertise began issuing guidelines February, 2020, manage pandemic's effects integrated guidance into national response plans documents widespread innovation illness detection maintain treatment lockdowns. colleagues1 suggested dimensions could way framed achieve equitable coverage worldwide: context, stakeholders, sectors. Here share one interventions example should addressed. Our organisation, Partners Mexico (Compañeros En Salud), working 10 years rural Sierra Fraylesca regions Chiapas, Mexico. Chiapas socioeconomic adversity, 77% living poverty. – Authors' replyWe appreciate insightful position COVID-19. note consensus strengthen globally, particularly emergence value learning experience regularly responding such outbreaks emergencies. examples lessons psychosocial support applied USA very well observed. healthWe welcome Psychiatry (LMICs). gone further call universities high-income (HICs), academics within them, make changes improve equity LMICs. Given HICs hold disproportionate power funding, propose fundamental shift needed. Imbalances privileges seen right across study finding 80% leaders active were citizens HICs, 90% educated 70% men.