"We must promote physical distancing but not social isolation."

"I think there were two major distinct periods. First, the situation we experienced just over a year ago, at least in Spain, when the strict lockdown was implemented. At that time, it was probably difficult to foresee the needs because it was a very sudden event for all of us. Once that initial period had passed, towards the end of May, we began to see that the lockdown had a significant emotional impact, and it was also foreseeable, given how the pandemic was evolving, that during the end of 2020 and in 2021, a series of specific actions had to be taken to protect the well-being of the population."

"In general, health authorities, and then at a very specific level in each hospital, and even more specifically at the level of family or patient associations, have indeed put forward recommendations or even new actions to try, in some way, to empower citizens, but also to try to respond to these situations. Probably, in some aspects, they are still insufficient, and we need many more resources."

An interesting initiative is the one we launched from the Psychiatry Service of the University Hospital together with CatSalut, the health department of the Generalitat of Catalonia: the Gestió Emocional application.

On the other hand, the number of clinical psychologists at primary care centers has been increased in order to try to be of service to the public in this situation we are experiencing.

The truth is that COVID-19 has also highlighted the shortcomings and limitations we had. At the very beginning of the lockdown, in many centers it was impossible to monitor users because they lacked video cameras and videoconferencing systems; these resources were simply not being used.

In the case of Vall d'Hebron Hospital, for example, we set up a website related to the coronavirus so that people could send us questions and contact us during those first weeks when direct contact was not possible.

We must think of this health crisis as a mass casualty incident, similar to a terrorist attack or a natural disaster. That is, a huge number of people affected and thousands of deaths in a relatively short period of time.

And now, what we see on a daily basis, after the most acute phase of confinement has passed, is that when we want to increase the resources of clinical psychologists or psychiatrists, in short, of people who work in mental health, there is a shortage of people with the qualifications, a shortage of people who can work because during the last few years there has been no forecasting of what the mental health needs were that were required."

"In times of crisis, in times of great war, the best in everyone surely comes to the fore. And this capacity for resilience, which is obviously very individual and specific to each person, is also enhanced by the support they receive from their environment. And this support from their environment is an absolutely key aspect: feeling that you have someone to lean on or a person to whom you can express your discomfort or share the situations that cause you distress."

I think the difference between this health crisis and the 2008 economic crisis is that there is a clear understanding of the need for these social supports and these additional government resources so that citizens do not feel alone and abandoned in such a difficult situation as the one we may be experiencing.

"It's perhaps a paradox. One of the factors known, from a scientific point of view, to have the greatest impact on preventing depression, for example, is having people you can trust and explain your complex situations to. And the other is visiting family, having a social life."

The pandemic, and especially the lockdown, has reduced physical contact. That's why I've always been against the idea of promoting social isolation. No. What we should be promoting is physical distancing.

Technology has allowed people to stay connected with loved ones, even those who might live far away and with whom contact would otherwise be less frequent. I think that's an important aspect to highlight: the fact that today we have a society that can connect more easily in situations where there might be physical limitations and where physical contact is less advisable.

The importance of technology has also become very clear in everything experienced in the hospital setting, with the possibility of contacting family members or in end-of-life processes."

Eat well, sleep well, and exercise.

"First, to convey a message of hope. This is probably the first time in human history that we have developed, in such a short period of time, a vaccine that protects us against a global pandemic. Therefore, there is a glimmer of hope that the situation will change."

Secondly, the importance of adapting to the situation. It's true that some restrictions are not arbitrary or random, as is often thought, but rather necessary adaptations to changing realities. These limitations are to protect us, but there are many other things we can do. Today we can exercise, we can have contact with people while respecting physical distance, wearing masks, and washing our hands frequently. Therefore, for our emotional well-being, it's very important to do everything possible. We must avoid the mindset of staying home out of inertia, as there are many things we can do safely, such as playing sports, going for walks, and enjoying cultural activities. These are the areas we must try to protect, to be able to do what is safe today. And I emphasize the importance of maintaining social contact, whether online, by phone, or by any other means, without feeling isolated.

We also always recommend these three very important points:

• Maintain good sleep hygiene
• Try to have a balanced diet
• Engage in minimal physical activity.

What has come and what is to come

"This is a very important issue because anything that affects children's and adolescents' mental health can lead to long-term chronic problems. The pandemic puts children at particular risk."

The need to prioritize all situations related to COVID-19 and the resulting restrictions may have depleted resources in pediatrics, which is the entry point for detecting mental health disorders. Furthermore, in general, confinement and reduced physical activity have impacted weight changes in many adolescents, for example. The inability to address these issues has put them at risk.

It is crucial to advocate for adequate and appropriate resources for children and adolescents' mental health. And ultimately, in mental health, that means having more professionals, more hands available to carry out this work.

Undoubtedly, there have also been other significant factors, particularly in adult pathology: individuals who already suffered from obsessive-compulsive disorder or depressive disorders. This entire situation is a source of stress that has a very negative effect on mental health, especially in these pre-existing conditions of anxiety and depression.

"I think that ultimately, the crisis we're experiencing has highlighted aspects that we may have already understood. On the one hand, we clearly need to make progress in digital health . If we don't have good digital health, especially in terms of mental health, it will honestly be very difficult to have the minimum resources necessary to meet the needs of the population. Twenty-five percent of the population will experience some form of mental disorder at some point in their lives. Therefore, we need significantly more resources than we currently have. And faced with structural or economic limitations, perhaps the way to reach more people more efficiently will be to have more digital health resources."

The other situation that is tremendously important is having home-based resources, so that citizens don't have to travel to hospitals or community centers for appointments and care. We, as healthcare professionals, increasingly need to move towards this community-based approach. I always say that a community-based approach isn't about having a health center outside the hospital; it's about going where the community is. And the community is in their homes, in a sports hall, and so on.

And perhaps the lesson learned, which is something we've also implemented, is that in a context that won't be uncommon, or, according to experts, where there may be more viruses of this type in the future, it's very important to ensure that people requiring hospitalization for mental health problems are, as much as possible, in single rooms , that they don't have to share rooms. Because this puts us in a very risky situation. And really, while in the public sector, as in other specialties, there has been a trend toward favoring single rooms, this trend probably hasn't been so clear in mental health. And I think it's very important that, in terms of hospital admissions, we increasingly have single rooms for our patients.

"Improvisation. Above all, the failure to listen to health and scientific experts. This improvisation is compounded by the abysmal funding for science and healthcare. It's unacceptable that healthcare has practically the same budget as it did 10 years ago, when the previous crisis began, given all the changes and new needs that have arisen. Investing in health is investing in the economy."

When I talk about investing in health, I'm not just referring to curative care, but to caring for and preparing children and young people to be more resilient. We're talking about emotional management, frustration tolerance, and finding solutions to conflicts and problems. As a knowledge society, if we want a hopeful future for new generations, we must invest in education, science and technology, and health .