Reflections by Scott Weich on how we should be thinking about mental health in the light of the pandemic. Scott is Professor of Mental Health at the University of Sheffield, and a Consultant Psychiatrist.
This is a marathon not a sprint, as they say.
The first point that I would make is that the pandemic comes at a time when our national infrastructures and especially social services, local government and health care have been severely undermined by a decade or more of austerity, which was a political choice. We cannot and must not hide from this uncomfortable truth. Investment across the public sector (and in the things that the public sector commissions) has been cut back very drastically, and people have suffered (and died) as a result.
Demand on mental health services has been increasing for many years, and we have struggled to meet this need. Any increase in demand will place further pressure on a system that is already struggling. And this is almost certainly going to happen. My own view is that the greatest increased demand will come not during lockdown but as a consequence of the economic recession that follows. Mental illness is closely linked to unemployment, poverty and others forms of deprivation. This is almost certain to result in a spike in acute episodes of illness and to an increase in rates of suicide.
We live in a time when many people – and especially our young people – lack secure employment and housing. We have a generation who are less well off than their parents – the very generation they have been asked to make sacrifices to shield from the virus. While pre-pandemic employment rates were high, these were not ‘good’ jobs but often low paid and insecure jobs, barely covering the cost of people’s accommodation. The economic shock caused by the pandemic may well prove more severe even than predicted, as many of the service sector jobs will disappear in a socially distanced world. Most of the assets that we need to recover are held by older people (who have been protected by lockdown), but who are no longer economically active.
The most important determinant of mental ill health is inequality. The extent of any ‘epidemic’ of mental illness depends on whether our ‘recovery’ policies address or exacerbate these inequalities – including ethnic inequalities in access to and experience of mental health care, and socio-economic inequalities. It is clear, for example, that extended school closures will increase inequalities in our society. Failure to address these inequalities will drive up rates of mental illness – not just now but over generations. Most mental illness is conditioned by experiences very early in life.
The next 6-12 months will see a proliferation of surveys of mental health (I get bombarded by these daily), in specific populations (such as health care workers) and in the general population. While these are undoubtedly important, we have to beware the twin pitfalls of reading too much into transient states and to inferring too much from results arising from convenience samples.
The true effects of covid-19 will take many months and years to emerge. But this should not prevent us from acting now: we know who the most vulnerable are in our societies, and we know what causes mental illness. And we know how to prevent it. My view is that we should base our actions on what we know (and what we have learned over many decades) and avoid jumping to alarmist conclusions about what is happening at this exact moment, when everyone is uncertain and anxious.
In any endeavour of this nature, there’s a careful line to be tread between contributing to the public good and providing a smokescreen for politicians to hide behind, as our national scientific leaders are experiencing.
If you would like to submit a piece of writing on the theme of ‘Covid and mental health’ please get in touch.