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29 April 2020

How people and policy can protect mental health during the lockdown

Nikolas Rose, Craig Morgan and Benedict Wilkinson

NIKOLAS ROSE, CRAIG MORGAN and BENEDICT WILKINSON: Social interactions and community-level responses are key

Mental health

Efforts to contain and delay the spread of Covid-19 have transformed our social worlds more or less overnight. Governments have introduced severe restrictions that limit physical interactions and our daily routines have been curtailed. We must manage our lives in radically changed spaces and places, invent new routines for ourselves, reframe everyday activities – going for a walk, catching a bus, queueing in a supermarket – as risky and potentially life-threatening.

All of us will feel some effect of these changes, uncertainty and worry about the virus, our loved ones, education, work, and money. This is borne out by recent work. A psychological survey conducted by academics at the University of Sheffield, for instance, reported a spike in symptoms of depression and anxiety the day after the UK Prime Minister announced the lockdown. This is not surprising: it would be unusual not to feel these things under these circumstances. 

Start with social interactions

In crisis situations people need help and support with very practical matters such as obtaining food and medication, keeping in touch with GPs, social workers and care workers, and finding advice on how to cope with everyday difficulties and sudden crises that may not be pandemic-related at all. 

Of course, there is also a temptation to advocate for more individual counselling and therapy. An expert group convened by the mental health charity MQ and the Academy of Medical Sciences, for instance, set out an ambitious range of priorities for research on the mental health consequences and called for new funding to support these kind of activities. 

But before we rush to that, it is worth remembering that the evidence suggests that in times of trouble, it is usually better to unwind with friends than to receive expert mental health intervention. In this regard, the Duke and Duchess of Cambridge were most accurate in pinpointing the need, not for expert intervention, but to be open about these inescapable anxieties and to talk about these with friends and neighbours – as they said, we need to worry most about those who, precisely because of the restrictions and isolation, are denied these friendly and supportive contacts when they most need them. For the cruel irony of our current situation is that the pandemic and subsequent restrictions both generate anxiety and fear and deprive us of the natural supports offered by family and friends.

Disadvantaged communities will be the most affected

While anxiety is a natural and widespread reaction, the impact of the social changes introduced to combat the spread of Covid-19 falls most heavily on those with the fewest social and economic resources to alleviate the effects of social restrictions. Enforced social isolation has its most severe effects on those who are already worse off financially, in precarious employment, dependent on inadequate “conditional” welfare benefits, isolated in old age or dependent on social support, in marginalised black, ethnic minority and refugee communities, and, of course, those already living in abusive relationships. It also acutely affects those with existing mental health problems, whose symptoms may worsen because access to help is limited: for example, during the current “lockdown” contact with care workers, who are often the sole source of social contact for those with enduring mental health problems, can be reduced or lost altogether, leading to a feeling worse than social isolation: abandonment. 

What can we all do?

The emergence of online resources, designed to help maintain good mental health during the current crisis, is essential; for most people, the advice given on “Every Mind Matters” may be common sense but it will help: try to relax, to exercise, to chat with others where possible, and to plan and organise days and weeks. It is important that those with existing mental health problems, those feeling in severe distress whether because of financial problems, family difficulties, or simply the strain of isolation, should be able to access support and treatment from mental health professionals – both now and in the coming months. Even before the current restrictions, those with existing mental health problems found these intensified, even to the point of suicide, by harsh welfare policies, inappropriate assessments of work capability, and inadequate housing.

What can policy do?

However, we need to do more. Because Covid-19 is damaging our social life and the communities in which we live and thrive, we need policy and community-level responses. The most effective responses are likely to be those that mitigate uncertainties around employment and education, provide safety nets for loss of income, and ensure protection for NHS and care workers and those on the front line – the delivery drivers, warehouse packers, and others on whom we now depend for our daily sustenance.

The situation of those dependent on food banks is dire, and actions should be taken immediately to help farmers and others with food that they cannot bring to market to move this to the places of greatest need. These are problems that affect whole groups and communities and need group and community responses: we must harness community resources to support those already experiencing social deprivation, poor mental health, isolation and loneliness. These responses, which should be accompanied by robust research to identify what works best, should aim to reduce uncertainties in people’s lives (including those arising from insecure employment) and restore and build social connections (including online).

We need policy and community-level responses that promote and sustain mental health. Our government has already promised huge resources to support businesses and those plunged into unemployment. But the effects of a decade of austerity have slashed local government services to the bone, and those cuts need to be reversed by pumping funds into cash-starved local authorities and community groups to rebuild the social supports on which individuals depend and to support small local charities and organisations who are not only closest to those in need but also can react quickly, without bureaucratic encumbrances. It is by rapidly enabling those organisations to address these root causes that we will prevent understandable worry, sadness and distress from crystallising into more persistent anxieties, hopelessness, and depression.

Professor Nikolas Rose is Co-Director of the ESRC Centre for Society and Mental Health.

Professor Craig Morgan is Co-Director of the ESRC Centre for Society and Mental Health.

Dr Benedict Wilkinson is Director of Research at the Policy Institute and Policy Lead for the ESRC Centre for Society and Mental Health.