Coronavirus: The impact on mental health

Philip Lewis

Introduction

The coronavirus outbreak has affected mental health in a variety of ways. These include:

the impact of lockdown on an individual’s mental health;
the impact on individuals with pre-existing mental health conditions prior to the pandemic; and
loss of funding and operational capacity for mental health services and charities.

Why is mental health affected by the Covid-19 outbreak?

The lockdown, imposed from 23 March, has significantly limited many activities that have been shown to improve mental wellbeing. These include exercise, contact with the natural world, contact with friends and relatives, and a loss of everyday routine. Generalised fear and anxiety around the Covid-19 pandemic itself may also have an impact on an individual’s mental health.

While research on the mental health impact of the current pandemic is limited, studies of previous epidemics have shown that changes in health behaviour can lead to long lasting damage to mental health. These include:

enduring changes in health behaviours, such as insomnia and alcohol abuse;
fragmentation of social engagement, such as continued avoidance of public spaces and contact with others; and
adverse effects on work and working routines, such as isolation caused by remote working, and stress caused by change in working patterns.

Research into previous outbreaks has also shown that health workers and patients are at increased risk of long-term mental health problems.

What has been the impact on the general population?

Research has shown that levels of anxiety have risen since the beginning of the Covid-19 outbreak. The Office for National Statistics (ONS) reported that between 24 April and 3 May 2020, 75% of British adults were “very worried or somewhat worried” about the effect that Covid-19 was having on their lives. Further data released on 15 June showed that the equivalent of 19 million adults in the UK were experiencing high levels of anxiety. Factors that significantly increased the risk of anxiety included how often the respondent felt lonely, their marital status and whether their work had been impacted by Covid-19.

Researchers at University College London are currently running the Covid-19 social study, which provides weekly reports on the experiences of 90,000 individuals. Results from the week proceeding 9 June reported that anxiety and depression levels had fallen in comparison with previous weeks under lockdown, although there was a spike amongst young people during the weekend.

According to the UCL study, anxiety and depression levels remained higher among:

younger adults;
those living alone;
those with lower household income;
people with an existing mental health diagnosis;
people living with children; and
people living in urban areas.

There is also evidence of more positive trends. Data from the ONS has shown a significant increase in people’s expectations for unity. Before the outbreak, 21% of people believed Britain was “very or somewhat united”. In recent data, expectations for unity after the outbreak had risen to 57%. This rise was most pronounced in young people.

What is the impact on those with pre-existing mental health conditions?

Those with pre-existing mental health conditions are facing a reduced level of support during the Covid-19 pandemic.

The National Counselling Society has provided a list of conditions that must be met before face-to-face counselling can go ahead during the lockdown. These include:

a client’s mental health would critically suffer and require medical intervention without the continuation of face to face sessions;
the therapy room provides over two metres of space between counsellor and the client; and
hand sanitiser is provided, and all surfaces are disinfected after the session.

While remote delivery of support services is a lifeline for many during the pandemic, some have highlighted its limitations. Chair of the Royal College of Nursing’s mental health forum, Ed Freshwater, states:

Alongside verbal communication, a large part of what we do is assess someone’s posture and body language. We’re missing out on that, especially for people who are in very vulnerable circumstances. We can’t pick up on those visual cues.

Concerns about not being able to physically access mental health support are worsening existing mental health conditions. Individuals who suffer from mental health conditions are showing significantly less confidence in the Government’s response than those who do not. Those with obsessive compulsive disorders, anxiety and panic disorders, as well as depression, are at particular risk of a worsening of symptoms during the lockdown. A lack of available medication, or a difficulty accessing this medication, is a further complicating factor.

Research published in the Lancet Psychiatry states that the pandemic also “intersects with rising mental health issues in childhood and adolescence”. It calls for a major research initiative to establish how those living with existing mental health conditions are affected by lockdown measures, and Covid-19 in general.

What is the Government doing?

On 29 March, the Government announced £5 million of additional support for mental health charities in England.

The mental health charity Mind, along with a consortium of other charities and organisations, is using the money announced by the Government to run the coronavirus mental health response fund. This allows mental health services across England to apply for grants of either £20,000 or £50,000 for projects lasting up to 12 months. Further details of community groups receiving additional funding were released on 29 May.

In addition, Public Health England (PHE) has updated its Every Mind Matters platform with specific Covid-19 guidance. Yvonne Doyle, medical director at PHE, stated:

We should continue to check up on friends, family and neighbours by phone or online and pursue the activities we are able to do from home and in line with guidance. By adopting a new routine, setting goals, eating healthily and maintaining physical activity, we can stay in good mental health today and tomorrow.

PHE have also published guidance on supporting children and young people’s mental health during the pandemic.

From 15 June, frontline staff and volunteers will be able to access a new Psychological First Aid (PFA) training course, developed by PHE and available via online educational platform FutureLearn. According to the programme overview, PFA is a:

Globally recommended training for supporting people during emergencies, and offers guidance on delivering psychosocial care in the immediate aftermath of the emergency event.

The Scottish Government has announced a £1 million investment in the distress brief intervention programme, which provides early intervention for mental health crises. The Welsh Government has issued new measures under the Mental Health (Wales) Measure 2010. The executive in Northern Ireland has also issued updated guidance.

What next?

On 1 July 2020, Lord Bradley is to ask the Government about the “Impact of the Covid-19 pandemic on mental health”.