Mental health disorders account for almost a quarter of the total burden of ill health in the UK. Poor mental health is strongly associated with poorer socioeconomic status : living in poverty, low-quality work, unemployment and housing issues. There is a well-documented burden of mental health disorders following disasters, including evidence from previous viral outbreaks. This suggests that COVID-19, and the government's response to the pandemic, could have a significant impact on the nation’s mental health through increased exposure to stressors. Adding to this there has been a loss of coping mechanisms for many and reduced access to mental health treatment. Exerts from recent papers:
“Covid-19 has increased anxiety for many of us, and experts warn a sizeable minority could be left with mental health problems that outlast the pandemic”.
“The mental health impact of the pandemic is likely to last much longer than the physical health impact”.
“If history is any predictor, we should expect a significant ‘tail’ of mental health needs that continue long after the infectious outbreak resolves.”
How has the pandemic affected mental health?
More than two-thirds of adults in the UK (69%) report feeling somewhat or very worried about the effect COVID-19 is having on their life. The most common issues affecting wellbeing are worry about the future (63%), feeling stressed or anxious (56%) and feeling bored (49%).
Groups have not been equally impacted; young adults and women (groups with worse mental health pre-pandemic) – have been the hardest hit.
What are the drivers of worsening mental health in the pandemic?
Quarantines and lockdowns are necessary to minimise viral spread, but they can have a negative psychological impact, such as post-traumatic stress symptoms, depression and insomnia.
The UCL COVID-19 social study of 90,000 UK adults has monitored mental health symptoms throughout the first lockdown. They found levels of anxiety and depression fell in early June as lockdown measures began to lift. But they remained highest among young people, those with lower household income, people with a diagnosed mental illness, people living with children, and people living in urban areas.
Chronic loneliness can be brought on by social isolation, having a chronic illness (such as Long Covid) or “a lack of meaning” in life during the pandemic. Some people have involuntarily found themselves with fewer close connections in the age of social-distancing and working from home and it is challenging to rebuild social networks. Many have deliberately withdrawn from the outside world to feel “a sense of safety” and may in turn become resistant to increasing their social interactions in the future.
“When people experience stress in the outside world, they can detach themselves from that world. Once they experience this detachment, it might be difficult for them to come out into the world and socialise with others.”
Lockdown has brought social isolation to many, particularly people living alone or those who have been shielding. The proportion of people reporting they feel lonely often or always during lockdown has been similar to pre-pandemic, at around 5% during April. But I think new studies will reveal this has increased with further lockdowns and the increasing prevalence of Long Covid. The groups that have been disproportionately affected by loneliness include working-age adults living alone, those in poor health, and people in rented accommodation. I am sure this will rise as we head straight into a third wave.
Social isolation has the potential for other detrimental effects There are concerns about increasing domestic abuse being locked down with perpetrators. A report by MPs found 16 people – 14 women and 2 children – were killed in the first 3 weeks of lockdown, and calls to the national helpline Refuge were 49% higher than usual.
Job loss and financial struggles during a global economic downturn have been associated with a long-lasting decline in mental health. Ongoing unemployment or loss of income may affect long-term wellbeing too. Numerous pre-Covid-19 studies link these factors to depression, stress or suicidal thoughts. Recent polling data from the US found that more than half of those who were jobless or had their income reduced during the pandemic had already reported negative mental health impacts with even higher rates amongst those on lower salaries.
The economic impact of lockdown has hit people unequally, causing immediate impacts on mental health.
The Mental Health Foundation reports over a third of people in full-time work were concerned about losing their job. A quarter reported not coping well with the stress of the pandemic (twice as many as those in employment), almost half were worried about not having enough food to meet basic needs, and one in five had experienced suicidal thoughts.
The advantages of good work are wider than the financial benefits it brings and there is evidence that volunteering also has mental health benefits. The numbers volunteering, however, have halved during the pandemic. This is because volunteers may be in at risk groups, or their activities have been halted, potentially putting five million people – often older or vulnerable – at additional mental health risk.
People’s housing and their ability to afford housing are strong influences on mental health. People who rent have experienced greater financial impacts during the pandemic than those who own their homes, another example of a driver for poor mental health that is socioeconomically patterned.
During lockdown, people have spent far more time than usual in their homes. Quality of housing and the opportunities it affords – including personal and outdoor space – are highly variable. For example, one in eight households (12%) in Great Britain have no access to a private or shared garden, and black people in England are nearly four times as likely as white people to have no access to outdoor space at home (37% versus 10%).
High levels of unemployment lead to a deterioration in a households' financial status and this has led to increasing food insecurity for many. Unicef have recently launched a campaign in the UK to feed 1800 families in London.
Pre existing Mental health issues:
There are many people who suffer from anxiety already in our society, but because of the serious consequences of a Covid-19 infection, those who tend to feel anxious more easily will continue to feel this and the condition might worsen. Those who have loved ones in hospital, those with Long Covid who are uncertain about their future health.
Those with OCD - Obsessive Compulsive Disorder (contamination obsessions and cleaning compulsions) the stress of Covid-19 is likely to trigger or worsen OCD. Their obsessions will not be helped with the increased need to hand wash and apply hand gel.
Working in a frontline service/ key worker:
From "the plight of essential workers during the Covid-19 pandemic" published in the Lancet:
The COVID-19 pandemic has highlighted how much society depends upon essential workers. Whilst there has been much praise for the heroic work being done by health-care workers to save lives in dangerous, exhausting conditions; those same workers are often left unprotected by governments who have failed to supply them personal protective equipment (PPE), supplies, and resources to do their jobs. There have now been documented deaths.
Essential work extends beyond health care. Some people have been able to shift their jobs to their homes, millions of workers have jobs that cannot be done at home porters in hospitals, teachers and child-care workers, and supermarket workers, delivery people, factory and farm workers, and restaurant staff, often without adequate PPE. These people leave their homes to help maintain a semblance of normality for others, at great risk to themselves and their families.
In the UK, 33% (10·6 million people) of the total workforce are deemed key workers according to the Office for National Statistics. Despite a government plan to pay furloughed workers 80% of their salary, many low-wage workers such as cleaners, migrant and seasonal workers, and student labourers are not be eligible.
Transport staff have been particularly exposed to Covid-19 exposed . At least 28 London bus drivers have died due to COVID-19.
When essential workers are just that—essential—and by protecting their physical and mental health, we protect the health and wellbeing of us all.
Loss of coping mechanisms:
In addition to presenting new or enhanced stressors, the pandemic has diminished many of the mechanisms people typically use to cope with stress. The most popular coping mechanisms during lockdown have been staying in touch with friends and family and taking daily outdoor exercise, which has helped nearly half of the adults surveyed. Work has also been important, with the value for mental wellbeing extending beyond the financial benefits.
Many though have lost jobs or been furloughed, exercise and access to outdoor spaces has been limited, and some people have not been able to meet with friends or family. There are inequalities in these deficits: job loss is socioeconomically patterned, some groups cannot get outdoors, and some are unable to remain digitally connected to friends and family. All of this increases the likelihood that the pandemic will increase mental health inequalities.
Reduced access to mental health services:
While mental health is determined by much broader factors than access to mental health services, these are critical for people experiencing mental illness. Services were already stretched with many providers reporting an inability to meet the demand rising prior to the pandemic, and lockdown is adding pressure that is likely to increase in future.
The Royal College of Psychiatrists reports almost half of psychiatrists have seen increases in urgent and emergency cases during lockdown, but also that a similar proportion have seen falls in routine appointments.
There are fears people are staying away until they reach crisis point, which will result in a flood of exacerbated and untreated mental illness after the pandemic, and mental health providers are already reporting significant increases in demand and severity of new referrals.
The charity Mind has found that almost a quarter of people who tried to access mental health services during a fortnight in April failed to get any help.
Surviving a Covid -19 infection:
In a recent published paper "Bidirectional associations between COVID-19 and psychiatric disorder: retrospective cohort studies of 62 354 COVID-19 cases in the USA"
Survivors of COVID-19 appear to be at increased risk of psychiatric sequelae, and a psychiatric diagnosis might be an independent risk factor for COVID-19. Although preliminary, our findings have implications for clinical services, and prospective cohort studies are warranted. These were anxiety, insomnia and dementia in those testing positive for Covid-19
What is being down about this potential mental health crisis?
Globally the World Health Organization have published recommendations for safeguarding mental health, and similar guidelines have been issued by government agencies in the US, UK and other countries. The American Psychological Association published a report on the long-term stress-related impacts of the pandemic, and how people can better cope during this period of uncertainty.
Researchers are also gathering data which they hope will provide a better understanding of the long-term mental health side effects of the pandemic, and therefore how to manage it. Major UK studies are looking specifically at the mental health of patients hospitalised with Covid-19 and nurses working on the front line. In Sweden, researchers at the Centre for Psychiatric Research in Stockholm are conducting a year-long project involving more than 3,000 people with pre-existing mental health conditions, including depression, anxiety and OCD. An Australian nationwide survey by the Matilda Centre for Research in Mental Health in Sydney is measuring the impact of the pandemic on the ongoing mental health and wellbeing of the general population.
1. NHS Check (https://www.nhscheck.org) is led by Simon Wessely, professor of psychological medicine at King’s College London. The study started in April in King’s College Hospital NHS Foundation Trust and new funding has meant it has now been expanded to 18 other trusts. Everyone on the payroll at each of the trusts, including doctors, nurses, cleaners, and security guards, are to be contacted.
The study will use a combination of online questionnaires carried out at regular intervals and more detailed interviews with a smaller group of participants. It also hopes to assess the support systems that are in place in different trusts. A sister study will focus particularly on the pandemic’s effects on NHS workers from ethnic minority backgrounds.
2. Another study by Cathy Cresswell from the University of Oxfors will evaluate an online cognitive behavioural therapy programme for children aged 5-12 years who have anxiety. The study will assess whether an online programme is an effective alternative to face-to-face provision by child and adolescent mental health services, which were already struggling to cope with increased demand before the pandemic.
“The pandemic has caused high levels of disruption and uncertainty for young people. Anxiety among primary school age children has increased because they are concerned about friends and family becoming unwell and potentially dying.”
"Secondary school children tended to have more online contact with their peers than younger children, which may mean they feel less isolated"
3. One study will use a cohort of 2000 people aged 14-17 previously recruited for the Resilience, Ethnicity and Adolescent Health (REACH) research project to understand which groups of young people were most likely to experience mental health problems as a result of the pandemic. The other study will work with a cohort of 5000 Londoners aged 15-17 who are taking part in the Study of Cognition, Adolescents and Mobile Phones (SCAMP), which has been collecting data on young people’s mental health and use of digital technology since 2014. It will examine whether changes in use of digital technology during the pandemic have had an impact on adolescents’ mental health.
4. A further study run by the University of Manchester will look at rates of self-harm, GP referrals for mental health treatment, and the risks of suicide and early death before, during, and after the first covid-19 peak. A study from the University of York will look at how people with severe mental ill health experience the social restrictions placed on them by the pandemic
Are there any positives?
Despite the concerns about the long tail of mental health challenges caused by the impact of Covid-19, psychiatrists say it’s important to recognise there are some positives too.
Lockdown for many helped reduce anxiety levels or stop panic attacks among some who had high levels of stress in the outside world before the pandemic.
This is because they felt a greater sense of freedom and safety by spending more hours at home.
Enforced time indoors has encouraged some to strive for a better work-life balance in the future or to socialise on their own terms. Others have used quarantine or lockdowns to declutter their homes, this leads to reflected positively within their mind. Increased time for hobbies have provided a sense of satisfaction, fulfilment and stress-relief for many.
For me personally finding out that I am not alone in my Long Covid journey and that there are many many support groups has been a huge positive in what would was a very lonely time.
How can I help my mental health during the pandemic?
(From the Black dog institute Australia)
Feeling anxious in certain situations can help us avoid danger, it’s how we’ve evolved to keep ourselves safe. Even if you are not typically an anxious person, it’s common to feel some anxiety during periods of change or uncertainty.
If you’re feeling anxious or worried during this time, you’re not alone. Anxiety is normal, and in some cases it can be helpful. For example, research during past pandemics show that people who worry are more likely to do the things that help to keep the virus at bay, like frequent handwashing.
However, sometimes anxiety can be unhelpful. Here are some practical ways that you can keep feelings of anxiety at bay if you are starting to feel overwhelmed.
1. Channel your anxious energy into action: get informed, plan, and prepare
We often feel anxious when events feel out of our control, and when we think we don’t have the capacity, skills or ability to cope. Anxiety tricks us into thinking about the worst-case scenarios in vivid and frightening detail.
Instead of worrying, try your best to focus on what’s under your control. Equip yourself with the facts about COVID-19 from trusted sources. Follow government advice and make a plan about what you and your family will do if you need to be in isolation, or quarantine.
2. Limit or avoid unhelpful media and misinformation
Being exposed to constant, alarming, anxiety-inducing stories convinces us that there is something to panic about, and further perpetuates myths, rumours, misinformation, uncertainty and anxiety. The more we read and hear about it, the more frightening it becomes, and the less chance we have to distract ourselves and do things that can take our minds off it.
Although it might be tempting to keep informed, or difficult to escape, limiting your exposure to media, news, and social media about coronavirus will help quell the panic.
3. Cut down or stop the behaviours that are fuelling your anxiety
There are certain actions, when performed frequently, that can fuel anxiety about health, and germ-phobia. Focusing too much on bodily symptoms, and relying on “Dr Google”, can consume one with anxious thoughts and panic.
Being aware of these behaviours, understanding how they’re making you feel, and replacing them with more helpful coping strategies can alleviate disproportionate feelings of anxiety.
4. Stay focused on the here and now, taking each day step by step
Try to focus on the here and now- not the past and not the future. Live in the moment and take one day at a time.
5. Be aware of negative thoughts and don’t give them too much power
Just because we’re thinking something, doesn’t always mean it’s true. When you notice yourself worrying a lot, take a step back, and try to let worries pass by without focussing on them too much.
6. Look after your body
Get enough sleep, exercise, eat well, avoid smoking, excessive alcohol and drugs. This will help protect your mental health and immune system.
7. Stay connected with others
It can make a huge difference when we share our worries with others, and connect with other people who are supportive. Try to stay connected to supportive people in your life so you feel less isolated and lonely. You might need try new ways of connecting that you haven’t before.
NB - I think this is especially true of Long Covid.
8. Help other people, be kind, and compassionate
When we help other people, it can also make us feel better. We are all in this together so let’s try our best to be kind and compassionate to each other.
9. Take a breath
When you feel overwhelmed take a few slow, deep breaths to help you calm down. If there are other things that help you relax (e.g., a walk or listening to music) you could try these too.
10. If you’re feeling like you’re not coping, get professional advice
It’s ok to ask for help. If you’re feeling overwhelmed by anxiety, seek professional support. Psychological therapies can be done online, or remotely via phone or videoconferencing, and are an excellent option if you’re in self-isolation, or worried about going to a clinic.
Text “SHOUT" to 85258 to contact the Shout Crisis Text Line
Campaign Against Living Miserably (CALM) -a helpline for people in the UK who are down or have hit a wall for any reason, who need to talk or find information and support.
Helpline: 0800 58 58 58
5pm to midnight, every day of the year
https://www.refuge.org.uk/ for victims of domestic abuse
Text "YM" to 85258 to contact the Shout Crisis Text Line
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Phone: 0800 068 4141
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