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Mental health care and resilience during and beyond COVID-19

Sciana members and foundation staff take part in second webinar to discuss COVID-19's effects on mental health and resilience

Sciana members and foundation staff have convened virtually to share cross-country experience and insights on mental health and resilience during and beyond the COVID-19 pandemic.

Ilona Kickbusch, chair of the Sciana programme, and John Lotherington, programme director, moderated the discussion, which took place on May 12. The webinar, which took place under Chatham House rules, began with an overview of mental health issues that have emerged in the UK. 

Webinar participants heard the need for mental health services has risen, but not everyone is accessing the care they require. Calls to mental health helplines in England have increased, and some charities are reporting that existing services have been disrupted

The pandemic is likely to increase need among all age-groups, with one estimate of 500,000 people developing mental ill-health as a result of the crisis. Some of this will be direct: trauma from COVID-19 severe illness, grief, and fear of contracting the virus, and some of it caused by the measures taken to control the virus, including isolation, loss of income, and unemployment. There are worries the steep rise in all-cause mortality may reflect some mental health-related deaths. There is no evidence, so far, that suicides are increasing, but the risk of this happening remains.

This increase in need is happening as action taken to combat the virus disrupts routine mental health services. In the UK, people access many health services by referral from a GP, but referrals have dropped. GPs have switched from face-to-face appointments, and overall appointments dropped by a third in March.

In Wales, evidence suggests that some people are struggling to get help with mental ill health, but others are avoiding contact with health services. Although this trend is starting to reverse, there are concerns the strong government messages at the start of the pandemic to “protect the NHS” may have deterred people from seeking care. For children and young people, the closure of schools has meant the loss of access to mental health support.

For some children, not going to school may have temporarily removed a source of stress, but for others, it has meant they have become invisible to services. In the UK, the voluntary and community sector plays a vital role in mental health services, but many of these organisations are small and are now under significant financial pressure.

On a positive note, services have rapidly switched to online platforms, in contrast to years of slow progress before the pandemic. A challenge for leaders in the mental health sector, which has traditionally received less funding than other kinds of health care, is to move from a “survival mentality” into being proactive. Now, an opportunity exists to influence the government to place good mental health at the centre of a new social contract after the pandemic. Participants felt this movement should include action to enhance those factors which improve mental health, including better support for carers and families, good quality employment, housing, and environments.

Contributions from Germany and Switzerland amplified many of the themes arising from the UK’s experience. In Germany, where social care for older people already felt precarious in many areas, participants heard family members looking after older people at home are reporting high levels of stress during the lockdown. Emergency social care was made available for families of disabled children, but not older people.

Future preparedness needs to fully take on board the evidence about the psychological damage caused by pandemics. The SARS outbreak led to immediate and longer-term trauma in both patients and health workers. Health workers are at risk because many feel professionally obliged to care for patients, even when it brings risks to them and their families. Health systems need to focus as much on mental health protection as they do on physical protection from the virus.

In Switzerland, there is also growing concern about the impact on families. For many weeks, family members were not allowed into care homes and are still officially barred from hospitals. Many people were unable to be with dying family members - a known risk factor for complicated grief, which will need recognition and support from mental health services. The family is also the space in which inequalities have played out: those families with resources may have been able to compensate by buying additional forms of support, or more able to negotiate access to relatives in care.

In all countries, future preparedness needs to rethink the balance between physical and psychological survival, for staff, patients, and families. It is vital to listen and take on board the experience of patients. Even for the best informed, well-resourced people who need to isolate because of existing health conditions, the past two to three months are taking a toll, with the absence of touch and physical contact a significant loss. This impact will reveal itself further as countries open up after lockdowns. There will be two-tier societies as many people return to some sort of normality, while others need to maintain their isolation because of their health conditions.

Several concluding thoughts emerged from the webinar important for future pandemic preparedness and building better societies.

Expert scientific advice for future pandemics must broaden to include public health, psychological, and social perspectives. In the UK, government response drew on behavioural insights at the expense of other disciplines, but participants from different countries noted how virologists, epidemiologists, and economists have also had predominant roles.

Future planning must have a sharper focus on inequalities from the beginning, which can only happen if decision-making bodies have more diverse voices within their ranks. The UK went into the pandemic with ample research evidence that black and minority ethnic groups experienced worse health outcomes, and yet there has been some surprise the virus has led to a difference in mortality between black people and the white community. Addressing this will need a shift in the balance of power. There are similar concerns about the impact of the lockdown on women across Europe, who have an unequal burden of domestic work, including at the expense of professional work. 

Many European governments need to communicate better with the public to address some of the trauma experienced by different groups in society. Governments need to learn how developing countries managed the Ebola crisis, where health workers learned new ways to communicate with diverse communities about sensitive issues, including death and dying.

The COVID crisis presents considerable opportunities to influence and change the direction of European societies. Opportunities include calling for significant investment in public health, renewing the thinking behind public welfare and the role of universal income, and investing in communities so they can flourish. There is also an opportunity to develop an equal footing for social care and health while recognising the importance to human beings of the “social” part of society.