Features

Is mental health the new pandemic?

22 July 2020

Covid-19 has put unprecedented pressures on the mental health of millions of people in the UK – including young people, new mothers and healthcare professionals. Journalist Jo Waters looks at the impact, now and moving forward, plus what’s needed to help.

Levels of loneliness, depression, harmful alcohol and drug use, self-harm and suicidal behaviour have been predicted to rise as a result of living through the Covid-19 pandemic, especially from the effect of quarantine on normal life (WHO, 2020). In fact, mental health in the UK was being affected early on into lockdown.

As reported last issue, a survey in the very first week of lockdown saw 83% of young people in the UK with mental health problems saying the pandemic had made their mental health worse (YoungMinds, 2020a). And in the first weeks of the pandemic, one million people downloaded information from mental health charity Mind’s website (Mind, 2020).  

An ongoing study by the Mental Health Foundation (MHF) in late April found that 34% of people in the UK were worried about losing their jobs, while 20% of unemployed people had experienced suicidal thoughts in the previous two weeks (MHF, 2020). The study of more than 4200 people was a collaboration between MHF, the University of Cambridge, Swansea University, the University of Strathclyde and Queen’s University Belfast.

‘Adolescence is challenging ordinarily, but in these unique and unprecedented times, even more so’

Experts are now predicting at least half a million more people in the UK may experience mental health problems as a result of Covid-19, if the pandemic is followed by a recession on the scale of the 2008 financial crash (Durcan et al, 2020). If there is a second wave of Covid-19 and the economy is damaged further, this particular forecast from the charity Centre for Mental Health (CMH) predicts the effects on mental health will be greater – and last longer.

Even with lockdown easing, there are worrying signs of an impending mental health crisis.

A ‘perfect storm’ for problems

The combined stresses of the lockdown that was announced on 23 March – no school or nursery for most children, cancellation of students’ exams, family isolation, loneliness of new mothers, social distancing measures, bereavements, financial worries and the fear of catching Covid-19 – make a perfect storm for anxiety and depressive disorders to develop, warns Professor Rory O’Connor, chair in health psychology at the University of Glasgow’s Institute of Health and Wellbeing.

‘We don’t have all the data yet from representative samples, but evidence from non-representative samples show anxiety levels were really high in the immediate aftermath of the lockdown and depressive symptoms and stress seemed to be much more common,’ says Professor O’Connor.

‘I am particularly concerned that young people’s mental health is prioritised and that supports are in place for them.’

He stresses that not everyone has experienced Covid-19 equally. ‘The literary commentator Damien Barr said recently: “We’re not all in the same boat, we’re all in the same storm. Some of us are on superyachts and some of us just have one oar.” Without a shadow of a doubt, there is huge disparity in how the pandemic is affecting people – the gap between the haves and have-nots is much wider.’

Professor O’Connor says there are concerns about the mental health of particular groups of the population. These include young people, and also new mothers, the unemployed and people with pre-existing mental health problems, as well as healthcare workers.

 

 

Helping our teens

‘Young people who are in a period of adolescent transition, may be particularly vulnerable,’ continues Professor O’Connor. ‘Adolescence is challenging ordinarily, but in these unique and unprecedented times, even more so. They may be feeling very isolated and lonely, and finding it difficult not to see their friends. Most mental health problems emerge by their early twenties, so adolescence is a critical period.’

A recent viewpoint in The Lancet Child & Adolescent Health expressed similar concerns on the impact of reduced face-to-face contact for young people at such critical time in their lives, when they are experiencing hormonal changes and their brains are still developing (Orben et al, 2020).

There are also fears that some of these young people have been falling through the gaps. Tom Madders, director of campaigns at YoungMinds, says the crisis has put added pressure on many young people, and services have been more difficult to access.

‘Despite huge efforts by mental health professionals, some [young people] are finding it difficult to access services either because schools have been closed or some GP surgeries have been harder to access.

‘This means that fewer young people than usual are being referred for support – even though it’s likely that there has been an increase in the number who are struggling to cope.’

 

 

Loneliness among young people is one of the biggest problems to emerge from surveys during the pandemic, reveals Ann John, professor of public health and psychiatry at Swansea University Medical School, and chair of the National Advisory Groups to the Welsh Government on the Prevention of Suicide and Self-harm.

‘We need action on many levels to help them: there is an issue about ensuring young people feel connected to their peers, schools and universities, but also in accessing help,’ says Professor John.

‘It’s so important to make sure they know that primary care is open and helplines are available. Phone helplines can be challenging to use when someone is at home as there is not a lot of privacy in a house – so that’s where web and text messaging services can help.’

‘We need to have really clear pathways on what should happen when a young person is in distress’

Consultant child and adolescent psychotherapist Julia Mikardo, the Association of Child Psychotherapists’ representative on Unite’s Applied Psychology Committee, says the CAMHS service she works at has been accepting new referrals throughout the pandemic, although she concedes it’s not the usual service, and that it has varied around the country.

‘Assessments have been done remotely using video and phone consultations, and after that some can be offered treatment in this way but there may be a wait for others to be seen. It’s not a normal service at the moment,’ she says.

Julia says that while some young people have adapted well to remote video and phone consultations with CAMHS therapists, there were those for whom they would never be enough. ‘Children living in deprived homes, who suffer neglect and abuse, will always need face-to-face consultations, and online is not going to be sufficient for them.

‘We also know that some families have been hunkering down and not seeking help – either because they don’t want to burden doctors at this time, or they are worrying about catching Covid-19. They feel the referral route to CAMHS isn’t open, so once the lockdown is eased I think we’ll see an increase in referrals.’

New parents and young families

Mothers of babies and toddlers isolated from their extended family and network of friends could also be expected to feel particularly vulnerable during the lockdown. Equally, however, some mothers and partners are reported to appreciate a reduction in the pressures of socialising, which has given them time to get to know their babies and have extended time at home with partners who have been furloughed or are working from home.

The Association for Postnatal Illness (APNI) charity says the concerns raised in calls to its helpline include an increased feeling of being disconnected, and not wanting to burden partners with difficulties, given uncertainty regarding work and finances. Fear of ill health (possibly Covid-19) to family – particularly the new baby – and loss of physical contact with other family members and their wider community were other concerns. As were enduring isolation for an uncertain period, and exacerbation of previous mental health difficulties in addition to postnatal illness.

 

 

A spokeswoman for the APNI confirmed there had been a gradual increase in contact with the helpline over recent months. ‘We continue to encourage mums, partners and families to ask for emergency video calls or possible contact as soon as possible if needs indicate this, as well as to access other mental health charity support lines.’

Paul G Murphy, an educational psychologist in Scotland, advises it is crucially important for families to stick to a routine during the lockdown and social distancing period.

‘Having a weekly timetable or a plan of activities for the family every week – even if its putting up a paddling pool or watching a film, will reinstall some predictability.

‘Routines are very important as they take away some of the thought needed in order to understand the world, and they can really help at a time of uncertainty.’

The effect on CPs

Community practitioners (CPs) have themselves been under intense stress during the pandemic, coping with shortages of personal protective equipment (PPE) for home visits (Unite, 2020), or the pressures of making assessments remotely.

Dave Munday, Unite’s lead professional officer on mental health, says that early on in lockdown, health visitors in some areas of England had been told to make home visits without PPE – and asked to phone ahead to check if the household they were visiting had Covid-19 symptoms or not. In other areas, all consultations were being done remotely.

‘Being inappropriately expected by employers to make home visits without suitable PPE relies on families telling the truth about whether they have symptoms or not or being able to recognise them, and CPs have obviously worried about catching the virus and passing it on to their own families, including from clients who are asymptomatic,’ says Dave.

‘CPs carrying out assessments remotely may be hugely anxious about what they might miss by not seeing the family in person, such as cues from women that they are struggling with their mental health and are not coping well.’

It was fears about healthcare professionals’ own mental health that prompted a number of charities including Samaritans, Shout, Mind, Hospice UK, and the Royal Foundation, to set up Our Frontline – a 24-hour helpline for key workers in distress – as highlighted last issue. In the six weeks between 8 April and 25 May, the helpline held more than 1400 conversations with callers – with 55% suffering from anxiety, 19% from depression and 12% from loneliness.

 

 

What will be the long-term impact?

Professor John believes society has to prepare for an aftermath of mental health problems after lockdown, particularly among young people and the unemployed.

‘There is a lot of talk about an economic downturn, which will be very worrying for young people in particular, as many won’t have developed the resilience that older, more experienced people have, and the sense that things will pass,’ says Professor John.

‘We need to have really clear pathways about what should happen when a young person is in distress,’ she adds. ‘We also need to think about mitigating the things we know are stresses for young people by ensuring there are active labour markets and opportunities for training and education. More austerity is not the way to respond to this situation.’

Professor John says school nurses (SNs) are ideally placed to look out for young people who are experiencing mental health problems, because they are trusted and familiar faces. ‘Many SNs have already been proactively reaching out to young people previously known to them as having mental health problems. But I think when schools go back they should be looking out for the kids who didn’t have mental health problems before.’

Tom agrees that as we start to emerge from the pandemic, some may find it hard to readjust after being in isolation, or will be coming to terms with much more uncertainty about their future. ‘Schools are an important safe space where young people can talk to adults they trust and a place to be with their friends face to face,’ he says. ‘That’s why we want to see the government commit to helping schools promote and prioritise wellbeing as they manage the phased return for students.’

The viewpoint in The Lancet Child & Adolescent Health concluded there was an ‘urgent need to consider the wellbeing and development of adolescents’, while they suggest the need for further research on how social media might be able to mitigate some of the effects of social deprivation (Orben et al, 2020).

As highlighted last issue, the April Lancet Psychiatry paper co-written by Professor O’Connor saw the authors calling for ‘moment to moment’ monitoring of anxiety, depression, self-harm, suicide and other mental health issues, plus better ways to protect against and treat mental ill health. They also called for the rapid roll-out of evidence-based programmes and treatments that can be accessed remotely.

Similarly, the forecast by the CMH makes four recommendations for actions ‘needed now to protect the nation’s mental health’. These include continued financial support by the government to those whose livelihoods have been affected, and advice and support to organisations – including schools, health and care services and businesses – from the government and Public Health England in trauma-informed approaches (Durcan et al, 2020).

What next?

Moving forward, Professor O’Connor says it’s not inevitable that people will suffer long-term mental health problems as a result of the Covid-19 lockdown, if they get the right support, at the right time.

Dave Munday warns that the HV and SN workforce was hugely depleted before Covid-19, and mental health services under-resourced. As with many areas of healthcare, such as cancer care, unmet needs may now emerge.

‘We may now get the parents who put off getting professional help about their child’s delayed speech coming forward, or children returning to school and their mental health problems becoming apparent – the system could be swamped,’ he says.

‘We have to continue to put the case for more investment in more CP staff to meet these needs – because they are going to be considerable. The impact of Covid-19 isn’t over yet.’

What seems clear is that some kind of action is needed, and fast.

Professor O’Connor concludes: ‘The true mental health impact of Covid-19 won’t be known for some time, but it seems fair to say that while not everyone is going to emerge from lockdown with mental health issues – indeed the majority of people will be fine – there are many people who are particularly vulnerable, and for some people, external factors such as unemployment will make things much worse. So there needs to be support in place to help those people and situations.

He continues: ‘With the right help, it is possible to avert an escalation of long-term mental health issues, but the government needs to act now.’


‘We’ve all dug very deep’

Sally*, a health visitor in London, who is also a single parent, is juggling her job supporting families with babies and young children with shielding her daughter, who 
has an autoimmune condition.

‘So far, the most challenging thing I’ve had to deal with is the right to continue working from home as I’d been put under pressure from management to return to work and visit clients face to face. Fortunately, this pressure has now stopped since I contacted my union and the HR department.

‘Working remotely has its own challenges though – it’s just not the same as being able to see the mum and baby in person and in their home. I worry I’ll miss something and make sure I keep detailed records of all consultations.

‘I phone mothers six to eight weeks after they’ve given birth to see how things are going and it’s a real mixed bag. On the one hand, some mothers with new babies are enjoying the time at home with just their partner – it’s taken the pressure off them to socialise and have people visit, and they are more relaxed and getting some rest. However, others are finding the whole experience a lot more challenging – some really miss the support from being able to see their family 
for instance and are struggling with that.

‘When I chat to them, the issues they’re facing become apparent and some of them break down in tears. The postnatal period can be a stressful time even in normal time, so for some the lockdown has made this worse and I am definitely referring more clients on to support available from online Mind groups and through access to psychological therapies – luckily there does seem to be a lot of help available and parents with children under one are being prioritised. Of course, in more serious cases I will refer them on to their GP for more support.

‘These are unprecedented times, and I think we will look back in years to come and we will wonder how we all coped. I have lots of friends who are nurses in acute care and I’m very proud of how they and all NHS staff have risen to the challenge. We have all dug very deep.’

*Name has been changed


Resources  

  • Coronavirus school toolkits to support children’s mental health during the pandemic, by Mentally Healthy Schools and the Anna Freud National Centre for Children and Families bit.ly/schools_mental_health_Covid-19  
  • Support and advice for young people on their mental health during Covid-19 by charity YoungMinds bit.ly/YM_Covid-19_support Plus advice for parents bit.ly/YM_Covid-19_parents  
  • Support for keyworkers You can call a confidential support line on 0300 131 7000 between 7am and 11pm, seven days a week (England) or 116 123 (rest of the UK). Or text FRONTLINE to 85258. See ourfrontline.org  
  • Reports on mental health and Covid-19 by the charity Centre for Mental Health centreformentalhealth.org.uk

References: 

Durcan G, O'Shea N, Allwood L. (2020). Covid-19 and the nation’s mental health, forecasting needs and risks in the UK: May 2020. See: https://www.centreformentalhealth.org.uk/sites/default/files/2020-05/CentreforMentalHealth_COVID_MH_Forecasting_May20.pdf (accessed 19 June 2020).

Holmes EA, O’Connor RC et al. (2020) Multidisciplinary research priorities for the COVID-19 pandemic: a call for action for mental health science. See: thelancet.com/journals/lanpsy/article/PIIS2215-0366(20)30168-1/fulltext (accessed 19 June 2020).

KCL. (2020) How the UK is sleeping under lockdown. See: https://www.kcl.ac.uk/policy-institute/assets/How-the-UK-is-sleeping-under-lockdown.pdf (accessed 19 June 2020).

Mental Health Foundation. (2020) More than a third of UK adults in full-time work are worried about losing their jobs. See: mentalhealth.org.uk/news/more-third-uk-adults-full-time-work-are-worried-about-losing-their-jobs (accessed 19 June 2020).

Mind. (2020). Mental health charity Mind finds that nearly a quarter of people have not been able to access mental health services in the last two weeks. See: mind.org.uk/news-campaigns/news/mental-health-charity-mind-finds-that-nearly-a-quarter-of-people-have-not-been-able-to-access-mental-health-services-in-the-last-two-weeks/ (accessed 19 June 2020).

Orben A, Tomova L, and Blakemore SJ. (2020)The effects of social deprivation on adolescent development and mental health. See: thelancet.com/journals/lanchi/article/PIIS2352-4642(20)30186-3/fulltext (accessed 19 June 2020).

Unite. (2020) Home-visiting health visitors and community nurses need PPE urgently, says Unite. See: unitetheunion.org/news-events/news/2020/march/home-visiting-health-visitors-and-community-nurses-need-ppe-urgently-says-unite/ (accessed 19 June 2020).

WHO. (2020) Mental Health and COVID-19. See: euro.who.int/en/health-topics/health-emergencies/coronavirus-covid-19/technical-guidance/mental-health-and-covid-19 (accessed 19 June 2020).

YoungMinds. (2020a). Coronavirus having major impact on young people with mental health needs – new survey. See: https://youngminds.org.uk/about-us/media-centre/press-releases/coronavirus-having-major-impact-on-young-people-with-mental-health-needs-new-survey/ (accessed 19 June 2020).

YoungMinds. (2020b). School staff warn of the extensive impact of COVID-19 pandemic on young people’s mental health - new survey. See: youngminds.org.uk/about-us/media-centre/press-releases/school-staff-warn-of-the-extensive-impact-of-covid-19-pandemic-on-young-people-s-mental-health-new-survey/ (accessed 19 June 2020).

 

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