Frederick Shepherd is a former Parliamentary researcher.
The Government’s ‘total’ response to the coronavirus and the severity of the measures it has introduced has resulted in the greatest scale of public awareness of a news story since the Second World War.
Severe choices have been foisted upon us which permeate into our homes, our work and our relationships, forcing a response. A knock-on mental health crisis seems certain – likely to be large and already begun.
Building on the Government’s announcement of a £5 million grant to be used by the charity sector to support the general public, the NHS launched its mental health helpline for staff battling on the frontline last week. Both have come in response to a surge in NHS, police and third sector ‘cases’ of what practitioners haved called, “symptoms consistent with clinical diagnoses of mental health conditions”.
Further still, there has been a marked increase in the number of suicides since the pandemic began. Of course one of the difficulties in knowing precisely what is happening on the ground is the lag time in collecting any form of meaningful data. Due to social distancing measures, fewer formal diagnoses can be made and, even were matters otherwise, it would take months to analyse them.
That patients are unable to have face to face consultations and therapy is also a concern. A backlog of patients at GP’s surgeries, Community Mental Health Teams (CMHT) and ‘Improving Access to Psychological Therapies’ (IAPT) services – the NHS’s talking therapies service – will inevitably follow. Apart from adding pressure to the NHS, this backlog will exacerbate the symptoms of individuals and worsen patient outcomes.
The implications for a patient’s mental health often extend beyond their presentation of acute symptoms, too. Mental health conditions such as depression and anxiety, for example, are known for their tendency to resurface, with sufferers relapsing long after going into remission from their their first episode.
A greater problem than the immediate pressures on the NHS and the fear and bereavement associated with the virus itself, however, is the likelihood of a deep and protracted global recession. Job losses, debt, domestic abuse, and the lack of meaningful routines point toward a longer-term mental health pandemic. According to research by the University of Oxford and the London School of Hygiene & Tropical medicine, the 2008 recession was linked with over 10,000 suicides across Europe and North America between 2008 and 2010.
The research team analysed suicide data from the World Health Organisation covering 24 EU countries and two North American countries which observed that the downward trend in suicide rates in the EU reversed when the economic crisis began in 2007, rising by 6.5 per cent by 2009 and remaining at the higher level through to 2011. In Canada, suicides rose by 4.5 per cent between 2007 and 2010, while in the USA, the rate increased by 4.8% over the same period.
As would be expected, the implications extended more widely too. The prescription rates for antidepressants, beta-blockers, benzodiazepines, antipsychotics and mood stabilizers rose markedly too. In the UK, a rise of 11 per cent in antidepressant prescribing between 2003 and 2007 went up to 19 per cent between 2007 and 2010. The above figures were described as ‘conservative’ estimates by the authors.
Yet the Oxford research also showed that there are things the Government can do to prevent this. The study suggests that nations that invest in active labour market programs reduce the risk of suicide, with the authors estimating that for each US$100 spent per capita on programmes offering such assistance for the unemployed, the risk of suicide reduced by 0.4 per cent.
The authors highlight, for example, that Sweden, between 1991 and 1992, and Finland, between 1990 and 1993, both experienced rises in unemployment, yet at the same time as the rate of suicide decreased. In the most recent recession, suicide rates remained stable in Sweden and Finland, while the rate declined in Austria, despite rising unemployment.
A critical question for policy and psychiatric practice is whether mental health and suicide rises are inevitable. The study showed that rising rates have not been observed everywhere so, while recessions will continue to hurt, they don’t always cause self-harm. A range of interventions, from return to work programmes through to antidepressant prescriptions, can reduce risk during future economic downturns.
The Government’s departure from the George Osborne economic model and an increased focus on public spending would indicates a greater appreciation of the role of services to a well-functioning society. Such thinking is likely to indicate a greater willingness to spend in this area of policy. Whether it will be able to commit to doing so on a large scale after the pandemic is another question, but it must do what it can, and fast. A focus on divising programmes is tantamount only to the speed at which something must be implemented. Lives will depend on it.
The Government’s measures to date aren’t short-term precautions for a situation that’s likely to disappear. As with their approach to the virus, their interventions are timed, acting as a first line of defence in an effort to contain the spread of a pandemic they know will grow and develop.
When a drop in the curve of the virus is seen and restrictions are lifted, the concern for the nations public’s health mustn’t be endangered by a blinkered pursuit of economic growth and balancing the books. Investment in mental health and wellness has risen considerably under previous Conservative Governments, and will need to rise more than ever.
The Government has risen to the challenge in response to the public health crisis presented by COVID-19 so far; it must continue to do so if we are to defeat the next invisible enemy.