Challenges facing mental health systems arising from the COVID-19 pandemic: evidence from 14 European and North American countries

Janet R. Cummings, Xinyue Zhang, Coralie Gandré, Alisha Morsella, Laura Shields-Zeeman, Juliane Winkelmann, Sara Allin, Gonçalo Figueiredo Augusto, Fidelia Cascini, Zoltán Cserháti, Antonio Giulio de Belvis, Astrid Eriksen, Inês Fronteira, Margaret Jamieson, Liubovė Murauskienė, William L. Palmer, Walter Ricciardi, Hadar Samuel, Silvia Gabriela Scintee, Māris TaubeKarsten Vrangbæk, Ewout van Ginneken

Research output: Contribution to journalReview articlepeer-review

1 Citation (Scopus)
15 Downloads (Pure)


We assessed challenges that the COVID-19 pandemic presented for mental health systems and the responses to these challenges in 14 countries in Europe and North America. Experts from each country filled out a structured questionnaire with closed- and open-ended questions between January and June 2021. We conducted thematic analysis to investigate the qualitative responses to open-ended questions, and we summarized the responses to closed-ended survey items on changes in telemental health policies and regulations. Findings revealed that many countries grappled with the rising demand for mental health services against a backdrop of mental health provider shortages and challenges responding to workforce stress and burnout. All countries in our sample implemented new policies or initiatives to strengthen mental health service delivery – with more than two-thirds investing to bolster their specialized mental health care sector. There was a universal shift to telehealth to deliver a larger portion of mental health services in all 14 countries, which was facilitated by changes in national regulations and policies; 11 of the 14 participating countries relaxed regulations and 10 of 14 countries made changes to reimbursement policies to facilitate telemental health care. These findings provide a first step to assess the long-term challenges and re-organizational effect of the COVID-19 pandemic on mental health systems in Europe and North America.

Original languageEnglish
Article number104878
JournalHealth Policy
Publication statusPublished - Oct 2023


  • Health policy
  • Healthcare reform
  • Healthcare systems
  • Mental health
  • Telehealth


Dive into the research topics of 'Challenges facing mental health systems arising from the COVID-19 pandemic: evidence from 14 European and North American countries'. Together they form a unique fingerprint.

Cite this