The COVID-19 pandemic has caused a significant decline in the mental health of the French population, with the most vulnerable groups being hit even harder. This finding is supported by scientific studies and by professionals working on the front lines. Having been actively engaged since the start of the pandemic through enhanced surveillance and prevention efforts targeting all segments of the population, Santé publique France brings together some thirty experts and frontline professionals in this issue. In this report, they provide an overview of current knowledge and analyze the pandemic’s impact on the mental health of the entire population. This special issue specifically examines ethical issues and social and regional health inequalities.

Mental Health: A Major Issue at the Heart of Public Policy

The COVID-19 health crisis has brought mental health to the forefront as a public issue affecting the entire population, and not just “one in five people,” as is generally cited in reference to the number of individuals who may be affected by severe psychological disorders. The crisis has sharply exacerbated existing mental health problems but has also created new ones. Successive lockdowns, the fear of contracting the virus, the economic slowdown, reduced social interaction, job insecurity or loss, and many other key factors have plunged a large portion of the French population into a fragile emotional and psychological state. This marks a turning point: the focus of mental health policies is no longer limited to the organization of psychiatric care but now encompasses prevention and health promotion initiatives: the deployment of suicide prevention programs and helplines, as well as the mobilization of all stakeholders capable of contributing to mental health, including those in the social sector, housing, and education (see the article “Covid-19: The Emergence of Mental Health in Public Debate).

Mobilizing Local Resources

Actions taken during a crisis are all the more effective when connections between stakeholders are already established, such as within local mental health councils or mutual support groups. The pandemic has severely strained the healthcare system and exposed pre-existing vulnerabilities—including those in the psychiatric sector, both in hospitals and in private practice. The priority now is to continue transforming how mental health is promoted and to better understand its determinants, an essential prerequisite for prevention and health promotion.

The Burden of Social and Regional Health Inequalities, Exacerbated by the COVID-19 Crisis

The pandemic and the measures taken to contain it have revealed vulnerabilities and inequalities within the population regarding exposure to the virus, living conditions, and the resulting psychological difficulties. It has affected people differently depending on their housing situation and whether or not they were able to continue working. The impact of the crisis varied greatly depending on individuals’ financial, relational, and social resources, as well as their access to basic necessities, leisure activities, or healthcare. This issue explores the effects of the crisis on the mental health of various populations—including healthcare workers, older adults, students, and people with disabilities—living and working in different settings (such as nursing homes and hospitals, particularly psychiatric wards).

Ethical Issues Raised

Numerous ethical questions have been raised throughout the pandemic. These include potential tensions between protecting health and respecting rights; the priorities and interdependencies between physical and mental health—and even between health and other societal issues (such as the economy or education)—or between individual and collective protection. From an ethical standpoint, as one academic notes, “the crisis has also highlighted the stigmatization of people with mental health conditions.”

The case of children and adolescents

In the face of COVID-19, children demonstrate resilience if they are supported by their families, schools, or professionals. As a child psychiatrist explains, the mental health of children and adolescents has been and continues to be affected by the COVID-19 pandemic. In the fall of 2020, child psychiatry professionals saw children arriving at their clinics in states of acute crisis (generalized anxiety, suicidal crises, etc.). These professionals emphasize that children are particularly sensitive to the anxiety of their loved ones and warn against the effects of family confinement during lockdowns (including an increase in domestic violence); against disrupted school conditions (cancellation of school activities, restricted access to playgrounds, etc.) and against changing health protocols that cause significant stress. These measures have been the subject of ethical and political debates regarding the risk-benefit balance for children.

Definitions and Concepts of Mental Health

This issue reviews the definitions and concepts of mental health and clarifies their scope, particularly to better understand the associated intervention strategies. The High Council for Public Health presents its opinion on the consequences of COVID-19 on mental health, and the World Health Organization issues its recommendations for improving the mental health of populations during a pandemic. A team of researchers summarizes the full range of the pandemic’s impacts on the mental health of the French population. A psychiatrist presents a set of practical measures to help people develop resilience in the face of pandemic-related stress. In this regard, he argues that the lessons learned can be applied to any difficult situation.