My tips for briefing an APPG

The All Party Parliamentary Group (APPG) on Coronavirus seeks to ‘ensure that lessons are learned from the UK’s handling of the coronavirus outbreak so far such that the UK’s response and preparedness may be improved in future’, and it is currently holding an inquiry into the mental health aspects of the pandemic. I was asked to offer oral evidence on this subject at a session in mid-September.

What is an APPG and how do you brief it?

How should you offer evidence to an APPG? As is true for many aspects of work life, preparation is critical, both to know just what you want to convey to the committee, and to marshal the evidence clearly and succinctly.

My approach was first of all to understand the role of APPGs. In essence, they have relatively little formal power within parliament but potentially very considerable influence, depending upon whether their inquiry reports are timely and authoritative. Each APPG is an informal cross-party group of members of the House of Commons and the House of Lords, often balanced to give a broad range of views. There are over 350 APPGs at the moment, and their main activities consist of holding inquiries and writing reports on specific topics.

Second, I decided upon the key points I wanted to convey to the committee, and prepared these carefully, each with strong evidence sources. The committee is more interested in facts from experts than in expert opinions.

Third, I had to understand how APPGs work during such sessions. Each oral evidence session lasts for about an hour (whether in person at the Palace of Westminster or via Zoom). During this time usually three experts are present, and their expertise can be based upon lived experience of the issue at hand, from providing services, or from academic research. The committee staff provide in advance a list of about 10-12 questions on topics that are likely to be raised, but committee members can and do diverge from this, and may raise topics that are hot in the media that day, or topics close to their own heart!

The hidden COVID crisis

Often each expert is asked to give a brief opening statement, and this is the first chance to get across your key points. I started by describing mental health as the ‘hidden COVID crisis’, and then went to discuss four aspects of how COVID-19 influences mental health:

Impacts on the general population

These include, for example, higher levels of ‘health anxiety’, responses to trauma, bereavement and loss, increases in anxiety, depression and sleep disturbance, and probably increases in alcohol consumption.

Impacts on people with pre-existing mental illness

People who had mental health problems before the pandemic are also more vulnerable to coronavirus infection because this group on average has more long-term physical conditions than people without mental illness. There are many other adverse consequences for people treated by mental health services, including, for example, that some mental health services have been downgraded or discontinued because of repurposing to respond to the initial pandemic crisis.

Impacts on people who provide essential services

This category includes the wider range of first responders and people who supply essential goods and services as well as health and care staff. The risks here included post-traumatic stress disorder, a higher risk of COVID-19 infection, and fatigue from working long periods without adequate rest or leave.

Impacts on people who are infected by COVID-19

For example, as there are now several studies showing increasing rates of mental illness in the general population (especially for young people and for women) during the pandemic, I cited these while also mentioning that the gap between mental health needs and services was already huge before the onset of this particular coronavirus. There are also now many reported experiences of stigma and discrimination against people who have or have had the infection.

But the main point that I wanted to get across is that my greatest concern is the risk of rising rates of self harm and suicide from the economic consequences of the pandemic, which we understand well from the economic downturn a decade ago. Suicide specialists Stuckler and Basu have put this starkly when they wrote “recessions can hurt, but austerity kills”.

And as a post-script - do send a post-script! After the evidence session, send a short version of your briefing notes to the committee coordinating staff, with full references, so that they have every chance to include your wise contributions in their final report (Ref 1-3).

For more about this session, I talk about this more in an interview on the NIHR Applied Research Collaboration South London website.

References

1. Vigo D, Patten S, Pajer K, et al. Mental Health of Communities during the COVID-19 Pandemic. Can J Psychiatry 2020: 706743720926676.
2. Maulik PK, Thornicroft G, Saxena S. Roadmap to strengthen global mental health systems to tackle the impact of the COVID-19 pandemic. Int J Ment Health Syst 2020; 14: 57.
3. Vigo D, Thornicroft G, Gureje O. The Differential Outcomes of Coronavirus Disease 2019 in Low- and Middle-Income Countries vs High-Income Countries. JAMA Psychiatry 2020.