The COVID-19 crisis affects mental health. We use helpline calls to quantify this effect. Helpline calls offer a real-time measure of ‘revealed’ anxiety across a range of topics. We have collected data on 7 million calls from from 19 countries. We find that calls peaked at 35% above pre-pandemic levels, six weeks after the initial outbreak. The increase was mainly driven by fear (including fear of infection), loneliness, and, later in the pandemic, physical-health concerns. Relationship issues, economic problems, violence, and suicidal ideation, however, were less prevalent than before the pandemic. This pattern is apparent both during the first wave and during subsequent waves of the pandemic. Issues directly tied to COVID-19 therefore seem to have substituted rather than exacerbated underlying anxieties. Conditional on infection rates, suicide-related calls increased when containment policies became more stringent and decreased when income support was extended. This implies that financial relief can allay the distress triggered by lockdown measures.