Who's paying the price?
Coronavirus and mental health
For many of us, the coronavirus has been a wake-up call, contributing to a rise of consciousness when it comes to our physical health, healthy eating, home workouts, and the rightful classification of flour as a “scarce resource.”
However, with the priority being placed on physical health and the demand on our NHS, these immediate concerns have eclipsed the equally desperate need for mental health care. The scale of this pandemic is like no other the world has seen in our lifetime – the illness itself and policies in place to protect people from the virus are likely to add both short and long-term increases to the mental health pandemic running in the background
As we see lockdowns easing and the number of new cases stabilising, governments who fail to address the growing pressures of mental health will find it significantly more difficult to return to any form of sustainable normality post-pandemic.
“Governments who fail to address the growing pressures of mental health will find it significantly more difficult to return to any form of sustainable normality post-pandemic.”
The impacts on mental health have been grouped into the following but in subsequent articles, we will look more in-depth into each subcategory and the impact the coronavirus has played.
Financial stability, inequality, race, and mental health
The uncertainty in the economy, rising unemployment, financial inequality, and your race adversely impact the likelihood of you developing mental health as a result of the coronavirus
Ordinarily, we feel stressed, anxious, and worried about a host of eventualities that may never happen, but in the wake of the coronavirus, the impact of this uncertainty combined with the climate of fear gives those already prevalent issues a new meaning and a stronger foothold in our day-to-day worries. The fear of catching the virus, schools closing, economic stability, grief, work-life balance, parenting under pressure, no social contact, and the ever-looping news cycle of a growing mortality rate creates a perfect storm for constant stress.
In the early stages of the pandemic, elevated stress and anxiety were the more common contributors to mental health, but as time goes on and new measures and impacts are coming into effect, the scope of those affected is changing as harmful drug use, loneliness, depression and suicidal behaviour are all expected to rise.
As the new economic landscape is still taking shape, the impact on mental health may resemble other periods of economic turmoil. The last sustained period of economic instability was the financial crisis in 2008. If the economy took a similar downturn then we could expect an additional 500,000 people to experience mental health problems but we already see daily reports that the economy will now be worse than that time. In England, British Medical Journal research on the 2008-10 recession evidenced that “10% increase in the number of unemployed men was significantly associated with a 1.4% increase in male suicides.” This translates a ⅖ increase in suicides across this period, many relating to the rise in unemployment.
“10% increase in the number of unemployed men was significantly associated with a 1.4% increase in male suicides.”
From the macro to the micro, once we drill down a little further, the link between a low socioeconomic class, race and mental health is well evidenced. The coronavirus has therefore exposed the following underlying issues:
- Those from lower-income households are more likely to catch the virus and suffer from worsened mental health as a result
- Those from lower-income households are more likely to have pre-existing health conditions, which in turn means they are more likely to develop poor mental health as a result
- Approximately 34% of critical care patients are from Black, Asian and minority ethnic communities (based on demographics on 6,720 patients) and they account for 31% of the deaths and 26% of the survivors (based on the 4,078 patients for whom we have outcome data) (ICNARC, 2020).
- As a result of their overrepresentation as critical care workers, it stands to reason that those from a BAME background will also be overrepresented in those who experience PTSD as a result of the virus. The current proportion of intensive care patients who later suffer from PTSD is 1 in 5.
These statistics have a real human consequence and will only deteriorate if not considered alongside economic reforms.
“Approximately 34% of critical care patients are from Black”
Frontline workers and mental health
“I’m scared and anxious all the time”
“I am doing all I can to protect myself physically but I can’t escape what I have seen at the end of my shift”
We never stop to think – who looks after Superman? The superheroes of the pandemic are our frontline workers. But who do heroes turn to fix their capes or heal their battle scars? Protecting the mental health of our frontline staff who remain calm in the face of panic, composed in the roar of devastation, and battle the virus on the frontlines has been totally overlooked.
Due to the magnitude of the pandemic, our frontline workers are confronted with the reality of extreme suffering every day, placing themselves in harm’s way to protect the needs of the vulnerable. Government restrictions on those allowed to visit loved ones who have fallen sick to the coronavirus often mean that medical staff becomes pseudo-family members, taking on additional strain to their heavy workload. With death toll figures going down, the long-term picture of frontline staff’s mental health is starting to show.
What constitutes an “essential worker”? Frontline staff are often individuals with little or no training in handling the emotional impact of facing suffering, uncertainty, anxiety, and fear all day, every day. Staff who are continually exposed to new or additional trauma are at higher risk of developing anxiety, depression, or PTSD either during or long after the event has passed. Without healthcare professionals receiving the level of care they require, numbers leaving the profession are set to increase, and the pressure on other health services will be exacerbated.
“Frontline staff are often individuals with little or no training in handling the emotional impact of facing suffering, uncertainty, anxiety, and fear all day, every day.”
Mental health hotlines are popping up more and more, but is this enough? Will we be able to recover if a second wave strikes anything like the first?
Grief and mental health
“He died doing the job he loved, serving others not himself”
“She is trying her best to keep it together but she cries every day”
In normal circumstances, grief warrants an alarm to mental health; it is both a full body and mind response where all aspects of our cognitive functioning connect to what we have lost. When we can process our grief it can, at best, lead to mixed thoughts, feelings, and erratic behaviour. However, during the coronavirus, the volume and the circumstance to which deaths have taken place has completely redefined the relationship between grief and mental health.
We are seeing deaths like never before on a global scale – which means grief has become an indiscriminate reality of the pandemic.
“During the coronavirus, the volume and the circumstance to which deaths have taken place has completely redefined the relationship between grief and mental health.”
Due to the policies put in place to protect the public from further outbreaks of the virus, thousands have been unable to visit loved ones whilst they deteriorate, have been denied an adequate funeral, or even missed an opportunity to see their loved ones one last time.
We never truly lose our grief, but we integrate it into our ongoing and productive lives. We are changed, but we resume living. When mourning is derailed, however, we are incapable of moving on.— Katherine Shear The Marion E. Kenworthy Professor of Psychiatry at Columbia University
Many going through the grieving process have been plagued by the regret of letting a loved one go to the supermarket where they caught the virus, or have been unable to grieve due to the immediate demands of caring for children stuck at home.
The rise in mental health, therefore, comes from the inability of those who are left behind to process their grief when, four months ago, we didn’t even know this virus existed. Everything has changed. Where poor mental health becomes a concern is when complicated grief disorder develops – in this case, sufferers are trapped in their pain and unable to function, forced to relive repeated trauma.
“The rise in mental health, therefore, comes from the inability of those who are left behind to process their grief when, four months ago, we didn’t even know this virus existed.”
Traditional ways of mourning have been impacted by the coronavirus, but finding new ways to grieve are important – otherwise, the psychological and emotional impact of the virus will last long after we return to a lower mortality rate.
Where do we go from here?
If you are nervous about the impact of uncertainty, then be assured that you are not alone. As we are living in unprecedented times, the long-term impacts of the coronavirus and the “new normal” are being played out as we speak. It is evident that mental health must be tackled with proactive strategies, not reactionary policies. We need to ensure that existing mental health services are equipped with the resources that they need and adequate investment is made into psychological safety across all sections of society. The UK response to the coronavirus has shed light on many gaps within our mental health system.
“The UK response to the coronavirus has shed light on many gaps within our mental health system.”
The approach across Europe has emphasised the need for a collaborative approach, the sharing of facilities, and the recognition that this will not end when the last positive case has been cleared. Investment in mental health services and training on its prevention will be a basic necessity and a requirement for those inside the public health profession but within the workplace and our schools.