The COVID-19 pandemic, initially viewed primarily as a threat to physical health, has significantly impacted psychosocial well-being globally. While the immediate response focused on biomedical aspects, the long-term effects on mental health and the psychosocial care system require thorough investigation. This study, conducted in collaboration with Belgium's Superior Health Council, aimed to assess the impact of the pandemic and associated biomedically-focused policies on psychosocial health professionals, patients, and informal caregivers in Belgium. The study acknowledges the importance of a biopsychosocial approach to pandemic management, highlighting that psychosocial factors directly influence adherence to control measures and the overall outcome of the outbreak. The pandemic's impact on mental health is multifaceted, encompassing the experience of illness and death, as well as the stress caused by implemented protective measures. The research emphasizes the need to understand the pandemic's effects on the psychosocial care system, particularly given its disruption due to resource reallocation and changes in healthcare delivery. By employing a Delphi method, this study aimed to build consensus among experts representing diverse perspectives to improve understanding of this significant issue.

Existing literature highlights the underrepresentation of psychosocial factors in pandemic planning worldwide. Studies show a clear need for a biopsychosocial approach to pandemic management, recognizing the interplay between biomedical and psychosocial aspects. The literature also emphasizes the significant impact of pandemics on the mental health of vulnerable populations, including increased risk of anxiety, stress, and other adverse psychological consequences. Research indicated that the pandemic and preventive measures affected healthcare systems, causing disruptions to services, including those related to mental and psychosocial health. While some studies pointed to the impact of Covid-19 on psychosocial care systems, a detailed understanding of the specific impact and consequences remained lacking in Belgium, forming the basis for this study.

This study used a three-round Delphi method to establish consensus among Belgian psychosocial experts. The first round involved 195 experts (149 professionals, 46 patient/caregiver representatives) answering 30 open-ended questions. Responses were analyzed to create 23 statements and two lists (vulnerable groups, helpful resources) for round two. Round two involved 113 participants rating the statements on a 7-point Likert scale, with consensus defined as >70% agreement and an interquartile range (IQR) ≤2. Round three (50 participants) allowed for score adjustments and comments. The experts included professionals from various backgrounds, patient representatives, and informal caregivers, ensuring a diverse range of perspectives. A non-probability purposive sample was recruited from the Belgian Superior Health Council’s database. The study followed established Delphi methodology guidelines for iterative rounds and consensus determination, accounting for potential attrition rates and ensuring that a sufficient number of experts participated in all rounds. Linguistic differences (French and Flemish) were considered, with no significant impact found on overall consensus.

The study found strong consensus (>80%) on three key statements: (1) the pandemic exacerbated social inequalities, increasing the risk of long-term psychosocial problems; (2) fear of contamination caused pervasive mental strain; and (3) there was a lack of strategic vision for psychosocial care and an underestimation of its importance. Experts consistently identified several vulnerable groups significantly impacted by the pandemic, including the elderly, individuals with lower socioeconomic status, those with pre-existing conditions, and family members of Covid-19 victims. The pandemic increased both the number and severity of psychosocial problems within these groups. The experts also noted that the pandemic's impact on the general population was characterized by significant mental strain and adaptation challenges due to the chronicity of the situation rather than the specific measures themselves. Concerning the psychosocial care system, the experts indicated that preventive measures negatively impacted therapeutic relationships and care continuity, leading to service disruptions. They emphasized inadequate governmental support for the psychosocial care system, leading to resource shortages. The introduction of innovations, such as teleconsultations, while attempted to maintain access to care, faced challenges, and did not always achieve consensus as being consistently successful. Experts identified unmet needs, including the lack of opportunities to recharge, a lack of clear communication, and exacerbated pre-existing systemic challenges within the sector. Helpful resources identified included clear and reliable information, financial security, a healthy lifestyle, and opportunities for social contact.

The findings highlight a critical gap in addressing the psychosocial consequences of Covid-19 in Belgium. The insufficient attention paid to psychosocial aspects reflects a broader issue of systemic underestimation of mental health's importance. The pandemic exacerbated pre-existing vulnerabilities within the psychosocial care system, revealing a lack of preparedness and inadequate support. The study's findings highlight the need for a shift toward a more biopsychosocial approach, emphasizing the interconnectedness of physical and mental health. The limitations of telehealth innovations also suggest that a blended approach is needed to ensure equitable access and quality of care, particularly for vulnerable groups. The study underscores the importance of addressing social inequalities to mitigate the long-term psychosocial consequences of the pandemic.

This Delphi study reveals a significant underestimation of Covid-19's psychosocial impact in Belgium. The lack of strategic vision and support for psychosocial care, coupled with the pandemic's exacerbation of existing inequalities, calls for immediate action. Future research should focus on developing effective strategies for equitable access to psychosocial care, particularly for vulnerable groups. A biopsychosocial approach, incorporating preventive measures and stepped care models, is crucial for addressing the long-term consequences of the pandemic on mental health and social well-being. Further investigation into the effectiveness of telehealth innovations within the context of robust system support is warranted.

The study's reliance on a Delphi method, while providing valuable expert consensus, limits the generalizability of findings to the broader Belgian population. The participants, while diverse, may not fully represent the entire spectrum of experiences within the Belgian psychosocial care system. Future research employing quantitative methodologies to complement these findings is necessary to strengthen the evidence base.