abstract: 'Background 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. Challenges and lessons learned 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. Conclusions 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.'
affiliation: 'Ryan, GK (Corresponding Author), London Sch Hyg \& Trop Med, Fac Epidemiol
  \& Populat Hlth, Dept Populat Hlth, London, England.

  Mpango, Richard, Butabika Natl Referral Hosp, Res \& Training Sect, Kampala, Uganda.

  Mpango, Richard, MRC UVRI \& LSHTM Uganda Res Unit, Mental Hlth Sect, Entebbe, Uganda.

  Mpango, Richard, Soroti Univ, Sch Hlth Sci, Dept Mental Hlth, Arapai, Uganda.

  Kalha, Jasmine; Kulkarni, Arti; Korde, Palak, Ctr Mental Hlth Law \& Policy, Pune,
  Maharashtra, India.

  Shamba, Donat; Ramesh, Mary; Ngakongwa, Fileuka, Ifakara Hlth Inst, Dept Hlth Syst
  Impact Evaluat \& Policy, Dar Es Salaam, Tanzania.

  Ngakongwa, Fileuka, Muhimbili Univ Hlth \& Allied Sci, Dept Psychiat \& Mental Hlth,
  Dar Es Salaam, Tanzania.

  Nakku, Juliet, Butabika Natl Referral Hosp, Psychiat, Kampala, Uganda.

  Ryan, Grace K., London Sch Hyg \& Trop Med, Fac Epidemiol \& Populat Hlth, Dept
  Populat Hlth, London, England.'
article-number: '90'
author: Mpango, Richard and Kalha, Jasmine and Shamba, Donat and Ramesh, Mary and
  Ngakongwa, Fileuka and Kulkarni, Arti and Korde, Palak and Nakku, Juliet and Ryan,
  Grace K.
author-email: grace.ryan@lshtm.ac.uk
author_list:
- family: Mpango
  given: Richard
- family: Kalha
  given: Jasmine
- family: Shamba
  given: Donat
- family: Ramesh
  given: Mary
- family: Ngakongwa
  given: Fileuka
- family: Kulkarni
  given: Arti
- family: Korde
  given: Palak
- family: Nakku
  given: Juliet
- family: Ryan
  given: Grace K.
da: '2023-09-28'
doi: 10.1186/s12992-020-00622-y
eissn: 1744-8603
files: []
journal: GLOBALIZATION AND HEALTH
keywords: Peer support; Global mental health; Covid-19
keywords-plus: HEALTH
language: English
month: SEP 25
number: '1'
number-of-cited-references: '14'
orcid-numbers: Kalha, Jasmine/0000-0001-7357-2366
papis_id: 01fd3c52b55d34a93c7d8b64e591c94a
ref: Mpango2020challengespeer
researcherid-numbers: 'Wheatley, Dorothy/HGC-9224-2022

  '
times-cited: '11'
title: Challenges to peer support in low- and middle-income countries during COVID-19
type: article
unique-id: WOS:000576290700001
usage-count-last-180-days: '0'
usage-count-since-2013: '1'
volume: '16'
web-of-science-categories: Public, Environmental \& Occupational Health
year: '2020'