A recent editorial urged those working in global mental health to “change the conversation” on coronavirus disease (Covid-19) by putting more focus on the needs of people with severe mental health conditions. UPSIDES (Using Peer Support In Developing Empowering mental health Services) is a six-country consortium carrying out implementation research on peer support for people with severe mental health conditions in high- (Germany, Israel), lower middle- (India) and low-income (Tanzania, Uganda) settings. This commentary briefly outlines some of the key challenges faced by UPSIDES sites in low- and middle-income countries as a result of Covid-19, sharing early lessons that may also apply to other services seeking to address the needs of people with severe mental health conditions in similar contexts. The key take-away from experiences in India, Tanzania and Uganda is that inequalities in terms of access to mobile technologies, as well as to secure employment and benefits, put peer support workers in particularly vulnerable situations precisely when they and their peers are also at their most isolated. Establishing more resilient peer support services requires attention to the already precarious situation of people with severe mental health conditions in low-resource settings, even before a crisis like Covid-19 occurs. While it is essential to maintain contact with peer support workers and peers to whatever extent is possible remotely, alternatives to face-to-face delivery of psychosocial interventions are not always straightforward to implement and can make it more difficult to observe individuals’ reactions, talk about emotional issues and offer appropriate support. In environments where mental health care was already heavily medicalized and mostly limited to medications issued by psychiatric institutions, Covid-19 threatens burgeoning efforts to pursue a more holistic and person-centered model of care for people with severe mental health conditions. As countries emerge from lockdown, those working in global mental health will need to redouble their efforts not only to make up for lost time and help individuals cope with the added stressors of Covid-19 in their communities, but also to regain lost ground in mental health care reform and in broader conversations about mental health in low-resource settings.

中文翻译：

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COVID-19期间中低收入国家同伴支持的挑战

最近的社论敦促从事全球精神卫生工作的人们通过更加关注严重精神卫生状况患者的需求来“改变关于冠状病毒疾病的对话（Covid-19）”。UPSIDES（在发展赋予精神卫生服务的能力中使用同伴支持）是一个由六国组成的财团，对在高（德国，以色列），中低（印度）和低收入（坦桑尼亚，乌干达）设置。该评论简要概述了Covid-19导致中低收入国家的UPSIDES站点面临的一些主要挑战，分享了早期经验教训，这些经验教训也可能适用于其他寻求解决严重精神健康患者需求的服务类似情况下的条件。从印度经验中获得的主要收获 坦桑尼亚和乌干达的特点是，在获得移动技术以及确保就业和福利方面的不平等，使同伴支持工人处于特别脆弱的境地，正当他们和他们的同龄人也最孤立时。建立更具弹性的同伴支持服务需要注意在资源匮乏地区精神健康状况严重的人早已already可危的状况，即使在发生像Covid-19之类的危机之前也是如此。尽管必须尽可能远程地与同伴支持人员和同伴保持联系，但是面对面提供社会心理干预措施的替代方案并不总是易于实施，并且会使观察个人的反应，谈话更加困难。关于情绪问题，并提供适当的支持。在已经对精神卫生保健进行了大量医疗并且大多仅限于精神病学机构所开具的药物的环境中，Covid-19威胁着为针对患有严重精神卫生状况的人们寻求更全面和以人为本的护理模式而进行的迅速努力。随着国家摆脱封锁，从事全球精神卫生工作的人们将需要加倍努力，不仅要弥补失去的时间，并帮助个人应对社区中Covid-19的压力，还需要重新获得精神上的失地。医疗保健改革以及在资源贫乏地区有关心理健康的广泛讨论中。Covid-19威胁着正在迅速开展的工作，以为患有严重精神健康状况的人们寻求更全面和以人为本的护理模式。随着国家摆脱封锁，从事全球精神卫生工作的人们将需要加倍努力，不仅要弥补失去的时间，并帮助个人应对社区中Covid-19的压力，还需要重新获得精神上的失地。医疗保健改革以及在资源贫乏地区有关心理健康的广泛讨论中。Covid-19威胁着正在迅速开展的工作，以为患有严重精神健康状况的人们寻求更全面和以人为本的护理模式。随着国家摆脱封锁，从事全球精神卫生工作的人们将需要加倍努力，不仅要弥补失去的时间，并帮助个人应对社区中Covid-19的压力，还需要重新获得精神上的失地。医疗保健改革以及在资源贫乏地区有关心理健康的广泛讨论中。