Policy and public health implications for mental health after the COVID-19 pandemic.

The COVID-19 pandemic revealed essential weaknesses in mental health systems and intensified existing inequities, highlighting the need for a comprehensive assessment of policy responses and strategies for future resilience. Guided by four questions relating to system adaptations, approaches to inequities, financing strategies, and evidence gaps, we synthesised evidence from a structured literature search (2020-24), expert consultation, and lived experience. We found that public health systems embedded infodemic management, expanded digital services, and mobilised community workforces, but responses varied in equity and effectiveness. Although gender, age, socioeconomic, and racial disparities worsened during the COVID-19 pandemic, social protection, gender-sensitive policies, school-based services, and culturally adapted interventions showed promise. High-income countries buffered shocks with welfare measures while low-income and middle-income countries faced sharp fiscal constraints. Few studies evaluated cost-effectiveness or equity impacts of psychosocial interventions. Building resilient, equitable mental health systems requires integrated policies spanning communication, digital and community care, gender-responsive and youth-responsive strategies, and sustainable financing, alongside investment in longitudinal and cross-national research.