Dr Jonathan Rogers is a psychiatrist and researcher at UCL.
A decade ago, the Coalition Government, as part of its broad-ranging health reforms, pledged “parity of esteem” for mental and physical health, promising that future policy would give equal weight to services.
This was welcome and was underpinned by David Cameron’s ideology of bolstering the country’s wellbeing, not just its pocket. It is also an idea that is still present in healthcare policy with mental health waiting time targets the latest attempt to enshrine parity of esteem.
However, despite the rosy language, the past 16 months have witnessed a staggering deterioration in the nation’s mental health. Although thankfully suicides have not increased, ONS figures suggest that the proportion of adults with symptoms of depression during the first wave of the pandemic rose to almost one in five, twice its pre-pandemic level.
It might have taken years of patient investment to shave 10 per cent off these figures, but they have doubled in the pandemic in one great swipe. Meanwhile, hospital admissions for young people with eating disorders have risen by 50 per cent.
There would likely be an outcry for other areas of health and, indeed, there has been for patient groups such as those suffering from cancer. However, mental health seems to be a disposable asset at crunch points.
This is partly a reflection on the Government’s narrow definition of health during the pandemic: essentially – being alive. The daily death toll has emphasised that what really matters in Whitehall is saving as many lives as possible without very much regard to the quality of those lives.
Early in the outbreak, several psychiatrists examined the potential mental health impact of lockdown policies, concluding from historical examples that lockdown is associated with various poor outcomes, such as post-traumatic stress symptoms, depression and insomnia, some of which can persist beyond the duration of the epidemic.
They recommended that any such policy should be brief and extensions should generally be avoided, due to the risk of compounding mental ill-health through uncertainty.
As a researcher, I have spent a considerable amount of time examining the neurological and psychiatric consequences of being infected with SARS-CoV-2, which are not trivial.
However, I have increasingly become convinced that at the population level the mental health consequences of lockdown substantially outweigh those of actually being infected.
New research looking at the first lockdown in the UK has found that mental health took a massive hit during the first few months of the pandemic and only started to improve as lockdown eased. Moreover, even local lockdowns were associated with poorer mental health in the specific regions where they took place.
This chimes with research from Europe showing that mental health problems eased in tandem with liberalising lockdowns. With this in mind, the broader perspective of Sajid Javid on healthcare beyond Covid-19 is encouraging.
However, the Prime Minister’s refusal to rule out a further lockdown, even after 90 per cent of the adult population has received at least one vaccine dose, is concerning for society and particularly for my patients, as those with pre-existing mental health problems are among those who have suffered the most from this pandemic.
Health means more than just being alive and parity of esteem means giving consideration to mental health even during a pandemic.