White Paper: Impact of COVID-19 on Mental Health By Jodie Hill, Managing Director, Thrive Law

The severe and unexpected nature of the ongoing global Coronavirus pandemic has caused far-reaching consequences throughout the world, especially among those groups of people who have been identified as especially vulnerable in respect of their mental health challenges.

Particularly in the United Kingdom, where government responses and policies have been widely regarded as reactive and sporadic, resulting in Europe’s worst death toll, they have been criticised on multiple levels, none more so than in their ability to identify and meet headlong the issues of mental health and the associated awareness of how many in society have coped – and are continuing to do so – with the day to day isolation, distancing from loved ones, colleagues and other forms of social interaction.

Allied to this, there have been a multiplicity of issues around how people – including those who hitherto have been regarded as mentally robust – have coped with the financial challenges that the pandemic has placed upon them.

In this regard, while being by no means political, it is worthwhile pointing out that other advanced first world nations have fared better in that their financial support for workers and industries has often been more holistic, as well as their practical and systemic responses more proactive.

Secondary to these core and easily relatable issues has been the well-documented adverse impact upon people’s mental health when they have been diagnosed with cancer or other serious conditions, in particular where treatment has been paused or even not commenced, due to staffing and other resource shortages within the NHS.

This, in many circumstances has also been compounded by loved ones being unable to visit their ill or ailing families and friends, both in care homes and other hospital facilities, as well as, potentially, being unable to attend funerals, should their situations take on a tragic note.

On the other side, new mothers too have not been allowed their partners or other family members to attend the births of their children, and have received limited support after the birth, or even during their weeks of confinement.

One separate and equally important element is that the pandemic and its associated lockdown has seen a significant and measurable rise in suicide and domestic abuse. Allied to the darker nights and inevitable negative thoughts associated with the second lockdown, we have seen domestic incidents spiralling out of control, particularly those involving physical violence and intimidation of women.

Some headline statistics arising from the pandemic:

• Mental distress was 8.1% higher in April 2020 than it was between 2017 and 2019

• Young adults and women are disproportionately affected

• ONS 2020 survey indicated lower levels of subjective well-being and higher anxiety than in last quarter of 2019

• Groups suffering with mental health conditions prior to the pandemic suffered the largest deterioration in mental health: disproportionately affecting young women

• Average GHQ scores among women aged 16-24 rose by 18.2% compared to a counter-factual (non-pandemic) scenario

• Those reporting “severe” problems doubled (17.6% to 35.2%)

• Moreover, it is reported that the percentage of participants classified as experiencing mental health problems increased from 23.3% in 2017-2019 to 36.8% in April 2020.

• The rise in mental health difficulties was 8.6 percentage points (95% CI: 4.1 to 13.2) greater among those aged 18-34 compared to those aged 50 – 64, 6.9 points (95% CI: 4.0 to 9.8) greater in females compared to males and 4 points (95% CI: 1.2, 6.9) greater amongst those with a university degree compared to others.

• A recent study of 230 health care workers (responding to a mental health assessment) found 23.04% had psychosocial problems resulting from the covid-19 outbreak 90.57% of this section were female 81.13% were nurses (compared with 18.9% physicians)

Psychological impact on health care workers included:

23%-44% overall anxiety
2.17% severe anxiety
4.78% moderate anxiety
16.09% mild anxiety
27.4-71% stress disorder
50.4% depression
34% insomnia

“Frontline healthcare workers” in direct contact with Covid-19 patients were at higher risk of depression, insomnia and distress.

Numerous countries have also reported widespread disruption of many kinds of critical mental health services:

• Over 60% reported disruptions to mental health services for vulnerable people, including children and adolescents (72%), older adults (70%), and women requiring antenatal or postnatal services (61%).

• 67% saw disruptions to counselling and psychotherapy; 65% to critical harm reduction services; and 45% to opioid agonist maintenance treatment for opioid dependence.

• More than a third (35%) reported disruptions to emergency interventions, including those for people experiencing prolonged seizures; severe substance use withdrawal syndromes; and delirium, often a sign of a serious underlying medical condition.

• 30% reported disruptions to access for medications for mental, neurological and substance use disorders.

• Around three-quarters reported at least partial disruptions to school and workplace mental health services (78% and 75% respectively).

• More than two-thirds of adults in the UK (69%) report feeling somewhat or very worried about the effect COVID-19 is having on their life. The most common issues affecting wellbeing are worry about the future (63%), feeling stressed or anxious (56%) and feeling bored (49%).

• The UCL COVID-19 social study of 90,000 UK adults has monitored mental health symptoms throughout lockdown, finding levels of anxiety and depression fell in early June as lockdown measures began to lift. But these remained highest among young people, those with lower household income, people with a diagnosed mental illness, people living with children, and people living in urban areas.

• Perhaps surprisingly, the proportion of people reporting they feel lonely often or always during lockdown has been similar to pre-pandemic, at around 5% (2.6 million) during April.

• A report by MPs found 16 people – 14 women and 2 children – were killed in the first 3 weeks of lockdown, and calls to the national helpline “Refuge” were 49% higher than usual.

The Mental Health Foundation reports over a third of people in full-time work surveyed were concerned about losing their job, and mental health impacts on people who were unemployed were widespread and severe.

A quarter reported not coping well with the stress of the pandemic (twice as many as those in employment), almost half were worried about not having enough food to meet basic needs, and one in five had experienced suicidal thoughts.

People’s housing and their ability to afford housing are strong influences on mental health. People who rent have experienced greater financial impacts during the pandemic than those who own their homes, another example of a driver for poor mental health that is socioeconomically patterned.

Data from the UK Household Longitudinal Survey (UKHLS) suggests that, among adults:

• Mental distress (measured using GHQ-12) was 8.1% higher in April 2020 than it was between 2017 and 2019.

• Mental distress in April 2020 was 0.5 points higher than expected (on the GHQ-12 scale), after taking into account increases in mental distress since 2013.

• in April 2020 over 30% of adults reported levels of mental distress indicative that treatment may be needed, compared to around 20% between 2017 and 2019.

• Estimated prevalence of common mental disorders was lower in May 2020 than in April 2020, but still higher than between 2017 and 2019.

• Data from other longitudinal studies corroborates this. A study in south west England found evidence of an early increase in anxiety and low wellbeing, but no change in depression.

Another impact of the COVID-19 pandemic is on people suffering from Eating Disorders:

• Eating disorders thrive in isolation. Beat have reported a 30% increase in demand for their helpline services in the wake of the coronavirus crisis and have added a new support group, The Sanctuary, to help with additional demand. They also anticipate a 30% drop in income as a result of COVID-19.

• Beat have also partnered with 30 other organisations to write an open letter to the government, calling for urgent steps to be taken to protect the mental health of young people in light of the virus.

• In Scotland, the rise in Helpline demand was 73% and Beat have been awarded a grant of £42,963 by the Scottish Government as a result.

Northumbria University Study:

• A study of 129 eating disorder sufferers found that the pandemic had had a profound, negative impact on 87% of participants, with 9 out of 10 reporting a deterioration in their symptoms. Over 30% of participants stated that their symptoms were much worse.

• Eight key themes were revealed: (1) disruption to living situation, (2) increased isolation/reduced access to support networks, (3) changes to physical activity rates, (4) reduced healthcare access, (5) disruption to routine and perceived control, (6) changes to relationship with food, (7) increased exposure to triggering messages and (8) positive outcomes.

• Over 20% of the sample reported that they felt less pressure to recover due to the pandemic as they are not seeing the people who would usually notice set-backs and help to challenge the disorder.

• 36.5% reported an increase in physical activity, which qualitative responses indicate were driven by anxieties about weight gain and a desire to counteract the effects of enforced inactivity and/or reduced ability to purge (due to proximity to family) in lockdown.

• Similar results have been seen in non-UK studies – an Australian study funded by the National Health and Medical Research Council of Australia found that 64.5% of eating disorder respondents reported a little or a lot more food restriction, 35.5% reported increased binging behaviours and 18.9% reported increased purging behaviours. 47.3% also reported increased exercising since the pandemic began.

To summarise, the pandemic is having a significant detrimental impact on the mental and physical well-being of people suffering from eating disorders.

The increased isolation and enforced inactivity in particular has led to anxiety around weight gain and perceived loss of control, leading to restriction and potentially dangerous levels of increased exercise.

The lack of social interaction has in some cases lead to the elimination of the challenge required for recovery, increasing the likelihood of relapse.

Conclusion

From looking at the research that has been undertaken since the pandemic and considering pre-pandemic trajectories, it is clear to see the detrimental effect this has had on mental health already and the third lockdown is only going to have a deeper more profound impact as we edge closer to having restrictions in place for 12 months.

Although more so on vulnerable social groups such as single parents, women, unemployed, and people with long term health conditions, the effect has been widespread with 10% of the population having suicidal thoughts at the peak of the lockdown.

Alarmingly, more than 69% of the population report feeling somewhat or very worried about the pandemic.

In April 2020, 30% adults reported mental health issues in need of treatment compared to 20% between 2017-2019.

Loneliness was identified as a main contributing factor as well as economic instability (poverty) and trauma.

It is clear that the negative associated impacts on mental health will continue for many years even after we are able slowly to return to a form of normality, through vaccination and behavioural change.

What can we do to combat this?

We all have a personal responsibility for our own mental health.  Its starts with you. 

Clearly defining a routine which includes exercise and getting outside along with rest breaks throughout the day is important.  It may seem simple but in fact it is an incredibly effective way help manage stress and stay mentally strong.

Many people use exercise to help them manage their mental health, this could be anything from yoga to walking to doing home workouts.  The key is to find something you enjoy doing and make time for this.

It’s helpful to minimise exposure to the media right now due to the subconscious impact this has on our mental health. In the same even, use social media in a positive way, review what accounts you follow, how do they make you feel?  If they don’t add value or make you feel good then it might be helpful to simply unfollow.

Once we have filled our own cup we then should check in on others, being physically isolated does not mean we are socially isolated.  Stay connected and check in on friends, family and colleagues, regularly. Arrange virtual events and phone calls.

Small acts of kindness go along way and can change someone’s whole day. 

If you are an employer, are you checking in on your staff? Have you provided mental health awareness and resilience training?  Invest in your people and it will be repaid in loyalty and output.  Consider doing remote wellbeing/ mental health risk assessments to understand how your staff are coping and what support they will need.  Encourage breaks and self-care and run wellbeing initiatives.  

At Thrive Law we are offering FREE ACCESS to our Thrive Wellbeing platform for the whole of January, make use of free resources if you can’t afford to pay.

About The Author

Jodie Hill, trained as a barrister, cross-qualified as a solicitor.  She is the founder and Managing Partner at multi award winning Thrive Law.  Jodie has specialised in employment law throughout her career and has a keen understanding of this complex and every changing area of law, in particular mental health in the workplace and D&I issues.  She regularly appears in national media as a leading expert.