As lockdown measures begin to ease, what evidence is there about the impact that COVID-19 has had on our mental health?
The COVID-19 pandemic has impacted on the physical health and safety of populations across the globe. But history tells us that infectious disease outbreaks or pandemics also bring major setbacks in terms of mental health. In addition, the unprecedented scale of the pandemic has also left long-term impacts on the healthcare system, with research indicating that many countries will also face a mental health emergency that could last for years. An independent review commissioned by the UK Government and carried out by the British Academy has termed the long-lasting social impacts of the pandemic (including the impact on mental health) as The COVID Decade.
What types of impact has the pandemic had on people’s mental well-being?
Increased levels of stress, fear and anxiety, anger, denial and sleep disturbance in response to the COVID-19 pandemic have been frequently reported in the literature and are said to be common responses to the changes and uncertainties affecting our daily lives. Despite a reduction in some stressors, people have endured many adjustments with multiple lockdowns, and the effects of the economic downturn. Loneliness and isolation, bereavement, shielding, fears about getting the virus and recovery, loss of income or unemployment are just some of the factors that have impacted on our mental health. Media over-consumption and misinformation surrounding the pandemic have also been linked to increases in anxiety. There have also been reports of increases in domestic abuse, substance abuse, and disordered eating (either over-eating or undereating) as people try to cope with the restrictions and the uncertainty.
Despite these stressors, the broad impacts of COVID‑19 have not affected people equally. The World Health Organization highlights that mental health and many common mental disorders are largely shaped by the social, economic, and physical environments in which we live. Hence people’s experience of the pandemic will be shaped both by their health and existing inequalities. Furthermore, a recent article (June 2021) in The Lancet Psychiatry suggests that the mental health research community has been successful at describing the nature of the impact of COVID-19, but less successful at generating solutions and providing clinical trial data to establish what works in terms of mitigating the negative impacts.
What problems are associated with the data?
Understanding the true implications of COVID-19 on population mental health is complex. Across the world, the scale of the impact remains incomplete as data continues to emerge. In addition, there is no widely published data on the impact of mental health on the population of Northern Ireland at present, therefore the evidence cited in this blog article is drawn from UK-wide research. Research is also limited by the variation in data sources, with many studies unable to provide comparable data from before the pandemic. Various sampling techniques, sizes and the wide variety of research methods used, also make interpretation difficult. Some studies are reporting data over a specific timeframe, whereas others collect data in real time and are more longitudinal in nature. As no single dominant measure or data source on mental health exists, it is difficult to accurately quantify and compare the effects of the pandemic on mental health across studies.
For some, the impact on their mental well-being will be short term or mild, whilst for others, there will have been a more serious deterioration in mental health.
A review of recent research by the Office for National Statistics suggests that self-reported mental health and wellbeing worsened during the first lockdown (March 2020), with signs of recovery between July and September 2020 (coinciding with eases in lockdown during summer and fewer cases of infection), before worsening again between October 2020 and January 2021. The latter comes despite the grounds for some optimism with the roll-out of vaccination programmes announced in December 2020.
According to the Institute of Fiscal Studies, emerging evidence shows that the pandemic has been associated with a substantial rise in symptoms of mental ill-health. Similarly, results from the Mental Health in the Pandemic Study show that, one year on, the pandemic has led to wide and deep emotional impacts on UK adults.
Another UK-wide study on the impact of the virus on mental health conducted by the Mental Health Foundation shows that for the latest reporting period (Wave 10, February 2021) some positive recovery signs are noted, but that overall, there was a mixed picture. Results indicate that anxiety and worry due to the stress of the pandemic declined significantly from 62% in March 2020 to 42% in February 2021 (of 4,251 people sampled). However, in terms of resilience, there was a decrease in the number of people reporting they were coping “very well or fairly well” with the stress related to the pandemic (with 73% reporting that they were coping well in April 2020 compared to 64% in February 2021). Overall, 18% of the sample said they were not coping well.
In February 2021, results of a national YouGov Personality Study involving 2,106 individuals indicated that 53% of respondents felt that the coronavirus pandemic had harmed their mental health, including one in seven (14%) who said it had caused a very negative impact.
In May 2021, the Office for National Statistics also reported that recent rates of depression in the British population had doubled; with the Mental Health Foundation warning of a growing mental health crisis in the UK. Findings from the large scale COVID-19 Social Study (with 70,000 respondents) from May 2021 show that depression and anxiety remain highest in young adults, women, lower income households, ethnic minorities, those with a physical health condition, and those living with children. People with a diagnosed mental illness still report higher levels of depression and anxiety symptoms. Rates of self-harm have remained stable throughout the pandemic (although these rates are usually under-reported). A report by the Samaritans indicates evidence is mixed as to whether rates of suicidal thoughts increased during the pandemic, although the previously noted Mental Health Foundation study reported that thoughts or feelings regarding suicide in the two weeks previous had risen from 8% in April 2020 to 13% in February 2021. According to an article published in The Lancet in April 2021, it is still too soon to examine the effect of the economic downturn and any possible causal impact this may represent in relation to suicide rates.
What groups are most affected?
It is clear that the pandemic and the various measures taken to address it have resulted in differential mental health outcomes. Research indicates that several groups of people have been particularly affected. The findings show:
- Individuals with pre-existing mental health conditions are thought to be some of the most affected.
- Considerable distress and psychological impact has been experienced by frontline healthcare workers.
- Those who lost jobs or suffered income loss also experienced sharp deteriorations in mental health. Although job retention schemes have helped to support both the incomes and the mental health of some workers, researchers have warned that the complex link between mental health and unemployment requires a joint approach to both issues by policy makers.
- Women were reported to have been more affected than men. Although parents felt the strain on their families, women were more likely to have made larger adjustments to manage housework, childcare and home schooling. Furthermore, lone parents, carers, and families of children with special educational needs were identified as being particularly vulnerable.
- Young people – a study conducted on behalf of Barnardos surveyed over 4,000 16-24 year olds. It showed that 58% of respondents were more stressed, worried (54%), sad (52%) and lonely (56%) now than before the coronavirus pandemic. School closures, isolation, reduced physical activity, uncertainty about the future and the impact on job prospects, as well as increased exposure to family stressors, all constitute risk factors for poor mental health.
- A disproportionate impact on mental health has been felt on Black, Asian, and minority ethnic (BAME) communities, who have also experienced more pronounced infection and mortality rates from COVID-19. Research also indicates that the pandemic has exacerbated widening health inequalities for these communities.
- People from lower socio-economic backgrounds.
Impact on mental health services
Not everyone who experiences symptoms of a mental health condition will need professional treatment and many types of support mechanisms exist, whether formal (such as medication or talking therapies) or informal (like helplines, online services, self-care, or family/friends).
Nevertheless, the World Health Organisation has indicated that the pandemic has disrupted or halted critical mental health services in 93% of countries worldwide. The pandemic also prompted a rapid change and new ways to deliver services (e.g. over the telephone, online). As a result of the disruption, demand has increased, leading to calls for an urgent increase in mental health funding. This has been compounded by years of underfunding of mental health services which has existed in many countries long before the pandemic began.
In May 2021, the Centre for Mental Health in England published a model based on evidence from over 200 research studies to forecast key groups of people who face a high risk of poor mental health as a consequence of the pandemic. The report, entitled COVID-19 and the nation’s mental health, suggests that those who have survived severe Covid-19 illness, healthcare staff, those economically impacted, and the bereaved are at high risk of poor mental health. Worryingly, it predicts that levels of demand for mental health services are to be two to three times that of current NHS mental health capacity over the next three years. The report also warns:
This is not a scenario where services can grow incrementally to meet steadily rising levels of need. Instead, Government and the NHS must take action now to meet a very steep increase in demand for mental health support.
What about Northern Ireland?
Since the COVID-19 pandemic began, there have been over 125,000 positive cases and over 2,155 deaths linked to the virus reported in Northern Ireland. Nevertheless, one year on, we now know much more about the virus. Over 1.1 million first vaccine doses and 780,000 second doses have been administered. As restrictions continue to gradually ease, many people will feel their mental wellbeing improve as they begin to reconnect with others.
However, it is well documented that before the pandemic, mental health problems in Northern Ireland were estimated to be 20-25% higher than in the rest of the UK; yet spend on mental health was significantly less when compared to other parts of the UK.
In May 2020, the Department of Health published a Mental Health Response Plan in the annex of its Mental Health Action Plan to try to mitigate the effects of the pandemic on psychological distress and mental ill health, in addition to a strategic framework for rebuilding services. However, at present, Northern Ireland remains without a mental health strategy. A draft 10-year mental health strategy has been developed and was consulted on in March 2021, with 428 responses received. The Department of Health envisages that the strategy will be published in July 2021, alongside a Mental Health Funding Plan. Yet there have been concerns from some consultation respondents that the ambition of the strategy may not result in adequate levels of funding support.
The lack of funding for the implementation of the strategy was confirmed by the Minister for Health in a briefing for the Northern Ireland Assembly’s Committee for Health in May 2021. The Minister also stated that there had been surge in the number of people presenting with more severe mental health needs:
Our trusts are reporting an increase in referrals as well as heightened acuity for patients. Trusts operate consistently above 100% bed occupancy levels in mental health inpatient units, and patients who are admitted are often much more seriously ill than would usually be expected…It means that there are people whose mental health needs are such that they need to be admitted to hospital, and people who are in crisis and who are seriously ill are being asked to sleep in armchairs and on sofas in hospital… The impact of the past year will have a lasting effect on our communities, on their mental health and on the services that support them.
Further monies (£60 million) have since been allocated to health by the Northern Ireland Executive as part of a COVID-19 recovery fund, but it is not known how much will go towards mental health.
UK-wide evidence indicates there has been a considerable impact on population mental health as a result of the pandemic. Demands on services are increasing. Furthermore, many challenges remain, not least regarding long term funding. Before the onset of the pandemic, Northern Ireland experienced higher levels of mental ill health than the rest of the UK. Despite the challenges, there are grounds for optimism – the rollout of the vaccination programme, the forthcoming mental health strategy, £10 million Mental Health Support Fund announced for charitable/voluntary mental health organisations, the out workings of the review of mental health crisis intervention services, and the introduction of an Elective Care Framework which aims to reduce spiralling waiting lists in Northern Ireland. But experts are warning much more needs to be done. There are also calls for policy and decision makers to utilise the pandemic as an opportunity to revolutionise struggling mental health systems, not only in terms of prevention through to crisis support, but in relation to addressing wider health inequalities.