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INTRODUCTION: Mental, neurological and substance use conditions lead to tremendous suffering, yet globally access to effective care is limited. In line with the 13th General Programme of Work (GPW 13), in 2019 the World Health Organization (WHO) launched the WHO Special Initiative for Mental Health: Universal Health Coverage for Mental Health to advance mental health policies, advocacy, and human rights and to scale up access to quality and affordable care for people living with mental health conditions. Six countries were selected as 'early-adopter' countries for the WHO Special Initiative for Mental Health in the initial phase. Our objective was to rapidly and comprehensively assess the strength of mental health systems in each country with the goal of informing national priority-setting at the outset of the Initiative. METHODS: We used a modified version of the Program for Improving Mental Health Care (PRIME) situational analysis tool. We used a participatory process to document national demographic and population health characteristics; environmental, sociopolitical, and health-related threats; the status of mental health policies and plans; the prevalence of mental disorders and treatment coverage; and the availability of resources for mental health. RESULTS: Each country had distinct needs, though several common themes emerged. Most were dealing with crises with serious implications for population mental health. None had sufficient mental health services to meet their needs. All aimed to decentralize and deinstitutionalize mental health services, to integrate mental health care into primary health care, and to devote more financial and human resources to mental health systems. All cited insufficient and inequitably distributed specialist human resources for mental health as a major impediment. CONCLUSIONS: This rapid assessment facilitated priority-setting for mental health system strengthening by national stakeholders. Next steps include convening design workshops in each country and initiating monitoring and evaluation procedures.

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BACKGROUND: Population health and well-being in Latin America, the current epicenter of the COVID-19 pandemic, has been severely affected during the past semester. Despite the growing evidence about the link between the pandemic, its control measures, and mental health worldwide, there is still no regional evidence of the potential mental health impact. We describe the prevalence and distribution of depressive symptoms across demographic and socioeconomic risk factors in the Peruvian population amidst a national lockdown during the COVID-19 pandemic. METHODS: Cross-sectional study conducted during the community transmission phase and national lockdown in Peru (May 4th-16th, 2020). We recorded 64,493 responses from adult Peruvian residents through an opt-in online questionnaire. All analyses were weighted using raking based on proportions of sociodemographic variables from the last Peruvian census in 2017. The prevalence of depressive symptoms was calculated using the Patient Health Questionnaire (PHQ-9) score of 10 or more. We identified associated demographic and socioeconomic factors by prior mental health diagnosis. Sensitivity analysis considered an alternative cut-off point for depressive symptoms of PHQ-9 ≥ 14. RESULTS: A total of 57,446 participants were included in the analytical sample. A third of the participants (n = 23,526, unweighted) showed depressive symptoms in the 2 weeks prior to the study. Participants who reported a previous mental health diagnosis doubled the sample prevalence of depressive symptoms (59, 95%CI 56.7, 61.4%) of those without a prior diagnosis. Psychosocial and functioning reactions were largely more prevalent among females and young adults. A dose-response relationship was found between household income and depressive symptoms across previous mental health diagnosis strata, being as low as 32% less in the wealthiest than the most impoverished group (PR: 0.68, 95%CI 0.58,0.79). Other critical factors associated with a higher burden of depressive symptoms were lower education level, single, unemployed, and chronic comorbidity. CONCLUSIONS: An increased burden of depressive symptoms and psychosocial reactions has emerged during the COVID-19 pandemic in Peru compared to previous years. The mental health burden disproportionately affects women, the younger population, and those with low income and education. As the country eases the social distancing measures, it is crucial to use local evidence to adjust public health policies and mental health services to the renewed population needs.

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[ABSTRACT]. Objective. To identify emerging mental health problems, strategies to address them, and opportunities to reform mental health systems during the COVID-19 pandemic in South America. Methods. An online questionnaire was sent to mental health decision-makers of ministries of health in 10 South American countries in mid-April 2020. The semi-structured questionnaire had 12 questions clustered into three main sections: emerging challenges in mental health, current and potential strategies to face the pandemic, and key elements for mental health reform. We identified keywords and themes for each section through summative content analysis. Results. Increasing mental health burden and needs were reported as direct and indirect consequences of the COVID-19 pandemic. National lockdowns challenge the delivery and access to mental health treatment and care. Strategies to meet mental health needs rely heavily on timely and adequate responses by strengthened mental health governance and systems, availability of services, virtual platforms, and appropriate capacity- building for service providers. Short- and medium-term strategies focused on bolstering community-based mental health networks and telemedicine for high-risk populations. Opportunities for long-term mental health reform entail strengthening legal frameworks, redistribution of financial resources, and collaboration with local and international partners. Conclusions. Mental health and psychosocial support have been identified as a priority area by South American countries in the COVID-19 response. The pandemic has generated specific needs that require appropriate actions, including implementing virtual interventions, orienting capacity-building toward protecting users and health providers, strengthening evidence-driven decision-making, and integrating mental health and psychosocial support in high-level mechanisms guiding the response to COVID-19.

[RESUMEN]. Objetivo. Determinar los problemas de salud mental emergentes, las estrategias para abordarlos y las oportunidades para reformar los sistemas de salud durante la pandemia de COVID-19 en América del Sur. Métodos. A mediados de abril del 2020, se envió un cuestionario en línea a los encargados de tomar decisiones en materia de salud mental en los Ministerios de Salud de diez países de América del Sur. El cuestionario semiestructurado consistía en doce preguntas agrupadas en tres secciones principales: desafíos emergentes en materia de salud mental, estrategias actuales y posibles para enfrentar la pandemia, y elementos clave para la reforma de la salud mental. Establecimos palabras clave y temas para cada sección mediante el análisis del contenido sumativo. Resultados. Se informó un aumento de la carga y las necesidades en materia de salud mental como consecuencia directa e indirecta de la pandemia de COVID-19. Los confinamientos a nivel nacional representan un desafío en la prestación y el acceso al tratamiento y la atención de la salud mental. Las estrategias para satisfacer las necesidades de salud mental dependen en gran medida de las respuestas oportunas y adecuadas, que requieren el fortalecimiento de la gobernanza y de los sistemas en el ámbito de la salud mental, la disponibilidad de servicios y plataformas virtuales, y la formación de capacidad apropiada para los prestadores de servicios. Las estrategias a corto y mediano plazo se centran en reforzar las redes comunitarias de salud mental y la telemedicina para los grupos poblacionales de alto riesgo. Las oportunidades para la reforma de la salud mental a largo plazo entrañan fortalecer los marcos jurídicos, la redistribución de los recursos financieros y la colaboración con los asociados a nivel nacional e internacional. Conclusiones. En los países de América del Sur, se ha determinado que la salud mental y el apoyo psicosocial son un área prioritaria en la respuesta a la COVID-19. La pandemia ha generado necesidades específicas que requieren medidas apropiadas, como las intervenciones virtuales, la orientación de la formación de capacidad hacia la protección de los usuarios y prestadores de servicios de salud, el fortalecimiento de la toma de decisiones basadas en la evidencia, y la integración de la salud mental y el apoyo psicosocial en los mecanismos de alto nivel que guían la respuesta a la COVID-19.

[RESUMO]. Objetivo. Identificar problemas emergentes de saúde mental, as estratégias para enfrentá-los e oportunidades para reformar os sistemas de saúde mental durante a pandemia de COVID-19 na América do Sul. Métodos. Em meados de abril de 2020, enviamos um questionário online aos responsáveis pela tomada de decisões em saúde mental dos ministérios da saúde de 10 países da América do Sul. O questionário semiestruturado continha 12 perguntas agrupadas em três seções principais: desafios emergentes em saúde mental, estratégias atuais e potenciais para enfrentar a pandemia e elementos-chave para a reforma da saúde mental. Identificamos palavras-chave e temas para cada seção através da análise de conteúdo sumativa. Resultados. O aumento das necessidades e da carga sobre os serviços de saúde mental foram descritos como consequências diretas e indiretas da pandemia de COVID-19. As medidas de confinamento implementadas pelos governos nacionais dificultam o acesso e a prestação de cuidados e tratamentos de saúde mental. As estratégias para atender às necessidades de saúde mental dependem de respostas rápidas e adequadas através do fortalecimento da governança e dos sistemas de saúde mental, da disponibilidade de serviços, de plataformas virtuais e da capacitação apropriada dos prestadores de serviços. As estratégias de curto e médio prazo se concentraram no reforço das redes comunitárias de saúde mental e da telemedicina para as populações de alto risco. As oportunidades de reforma da saúde mental a longo prazo implicam o fortalecimento dos quadros jurídicos, a redistribuição de recursos financeiros e a colaboração com parceiros locais e internacionais. Conclusões. A saúde mental e o apoio psicossocial foram identificados como uma área prioritária pelos países da América do Sul na resposta à COVID-19. A pandemia criou necessidades específicas que exigem ações apropriadas, incluindo a implementação de intervenções virtuais, a capacitação orientada à proteção dos usuários e prestadores da atenção à saúde, o fortalecimento da tomada de decisões baseada em evidências e a integração da saúde mental e do apoio psicossocial em mecanismos de alto nível que orientem a resposta à COVID-19.

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