Current measures are rightly focused on the physical health of the nation. Lockdowns, school closures, handwashing advice, and increased ventilator production will help ensure as many people as possible survive this pandemic. But the measures necessary to prevent or delay infection will mean another, slower timebomb is ticking away – a lot of people’s mental health will not be the same once this is over. And we need to be prepared.
For even the most mentally robust person, being asked to spend endless weeks alone with nothing but their thoughts for company, or crammed into confined spaces with families or housemates, will take its toll. That’s before you factor in the fear and anxiety over a disease that attacks the most vulnerable, has no cure or treatment, and has swept across the world in a matter of weeks. For those with existing mental health issues, the impact will be significant.
Finding treatment and support for mental ill health has always been a challenge. But now, those who need support, or have ongoing treatment, are struggling even more to access it. Counsellors have jumped on video appointments, which may work for a lot of purposes, but it cannot always fully substitute a face to face conversation. A nationwide handwashing campaign is an essential tool to combat COVID-19 but those with Obsessive-Compulsive Disorder are knocked back when a behaviour they associate with being unwell is now being encouraged for everyone. Recovery from eating disorders can include people limiting the amount of food in their home to restrict binge-eating, but now everyone around them is stocking up and the cupboards are full.
For years, putting mental health on a par with physical health has been a popular refrain. Recent Prime Ministers, Health Secretaries, backbench MPs, and NHS bodies have voiced a commitment to the idea, but there has been criticism this hasn’t been followed up for concrete action.
By 2018/19, NHS England’s budget allocated £12.2bn for mental health support, which accounted for around one in every ten pounds spent by the Department of Health and Social Care. Waiting lists for counselling, therapies, and treatment programmes can run into months. That is assuming you’re lucky enough to see a GP who understands your condition and available treatments, and they are lucky enough to be able to refer you to an applicable service in your area. Many localities are underserved, especially when it comes to very specialist treatment.
“Parity” does not mean 50/50 funding. Treating physical conditions often requires expensive medical equipment and/or medication, while mental health is more often about connecting the right kind of patient with the right kind of specialist. What it means is taking it equally seriously. Mental health is persistently misunderstood, perhaps because the symptoms are often invisible or misread. Yet many physical health conditions the NHS ends up treating have their roots in poor mental health.
In the coming years – when coronavirus, stockpiling, and lockdowns have become a bad memory – the mental health impacts will linger. Anxiety at its most basic form puts the body on a fight or flight footing, with heightened heartrate and rapid breathing. Stay in that state even a relatively short period and you can experience light-headedness and nausea. It can also be a trigger for substance misuse, as people turn to alcohol or drugs to block the negative thoughts.
It’s easy to see that once this is over many people will remain uncomfortable in crowds. Some will suffer agoraphobia. Paranoia about unseen germs and our physical health will linger over us, even when the immediate danger has passed. Time will quell these fears for some, but they may take root in others, with significant consequences.
When the world begins to return to normal, getting people back to work and businesses up and running again will be a priority. Ensuring workers are fit and able to contribute to the economic recovery will be essential and that also means tackling the impact of mental health. According to an OECD estimate, a combination of lower quality of life, sick leave, and the direct cost of services costs the UK economy £94bn per year, while the Department of Health put the figure at just over £105bn. The Institute of Directors puts the economic burden of poor mental health upon the UK’s Gross Domestic Product at 4.5%. Once the Covid-19 crisis has passed, improving mental health provision can be a good investment.
Focusing on survival is imperative in the short term but it is never too early to start planning on how we address the less obvious and less visible aspects of the crisis. Perhaps this catastrophic global event can catalyse a shift from talking about prioritising mental health to actually doing it.