Critical Actions for Mental Health Promotion, position statement developed by the IUHPE Global Working Group on Mental Health Promotion

INTRODUCTION The COVID-19 pandemic has had profound impacts on population mental health globally1-4, including rising rates of depression, anxiety, post-traumatic stress symptoms, and increases in suicidal thoughts and behaviours5-7. While the COVID-19 virus itself is associated with a number of mental health consequences, including anxiety disorders8,9, the decline in population mental health is predominantly a product of the `secondary effects of the pandemic. These secondary effects largely operate through the social and structural determinants of mental health leading to widening inequities for sub-populations and groups who already experienced health and social inequities due to racism, exclusion, discrimination, and stigma1,10. These secondary effects include: Far-reaching economic consequences due to rising rates of unemployment, lost wages, and business closures, which have contributed to growing levels of stress, depression, and suicidality11,12. Isolation, a known risk factor for poor mental health, has become pervasive. Indeed, most nations have utilized public health measures such as physical distancing, quarantine, and lockdown mandates, which have been critical to mitigating virus spread, but have also led to feelings of loneliness, social disconnection and decreased sense of belonging, as well as depression and suicidal thoughts13,14. Widespread closures and interruptions to global education settings resulting in job losses, rising student debt, and significant learning disruptions15,16. These disruptions are anticipated to reduce educational outcomes through the pandemic and beyond and to disproportionately impact children from families experiencing socioeconomic deprivation, including through the digital divide17,18. Challenges in accessing mental health care and social services19, food insecurity20,21, and the loss of key mental health promoting resources such as recreation and sports facilities, parks and other public spaces, including arts venues22. Rising gender-based and family violence23-25. Critical Action for Mental Health Promotion IUHPE position statement 4 Even before the COVID-19 pandemic, population mental health was recognised as a chief public health issue for this century. A leading cause of disability worldwide, it accounted for 35% of the global economic burden of non-communicable diseases more than cardiovascular disease, cancer or diabetes26,27. With the makings of a global mental health crisis amid the pandemic, the United Nations and its various offices, including the World Health Organization and the Office for the Coordination of Humanitarian Affairs, have responded with policy briefs, operational guidance documents, and infographics intended to inform needed action on mental health28-30. This important work has provided critical scaffolding toward the aim of mental health becoming front and centre of every countrys response to and recovery from the COVID-19 pandemic 29 (p. 2). Yet the pandemic has also created the conditions to respond to mental health in new ways and to realize the long-overdue need for a comprehensive population approach to mental health. However, achieving this paradigm shift will require urgent investment in the implementation of the most effective evidence-informed strategies. The purpose of this Position Statement is to highlight the most critical actions necessary.