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Interview: We must adopt a public health approach in tackling the mental health fallout from Covid-19


By Awil Mohamoud
Reporter
16 June 2020

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Healthcare Leader is speaking with decision makers and those on the ground dealing with the coronavirus pandemic to find out what’s happening nationally, and how best to solve problems.

Today, we speak with Mental Health Foundation director and public health specialist Dr Antonis Kousoulis.

In recent weeks, health organisations have warned of a forthcoming ‘tsunami’ of mental health cases, following almost three months of nationwide lockdown. As routine services resume, doctors have expressed worries around managing that patient demand. While extra investment is needed to support clinical care, funding alone will not be enough to deal with the mental health fallout, says Dr Kousoulis. There must be a fundamental shift in strategy across the board, he suggests.

The lockdown affected peoples’ mental health through disrupting day-to-day lives, work, relationships, connections and causing a loss of identity, Dr Kousoulis explains. 

Just prior to the lockdown in mid-March, 62% of UK adults, and 74% of students, said they felt anxious or worried about the future in a Mental Health Foundation survey. In April, almost a quarter of adults and 44% of young people admitted to feeling loneliness due to coronavirus

Dr Kousoulis says: ‘In many ways, we were experiencing a mental health crisis before the pandemic. We knew there were long waiting lists; universities struggling to support students who were suffering, and teenagers falling between the cracks when transitioning from child to adult services’.

While more investment in services is ‘certainly needed’, the demand for support ‘is so high that, even with this, it will still not be met’, he adds. ‘Doing more of what we know doesn’t work is not going to solve it.’ 

To really get to grips with the mental health crisis, we must adopt a public health and prevention strategy, he says. This means doing more preventative work, supporting people with their mental health (especially those experiencing low level problems) ‘before they reach crisis point’ and turn to clinical services. 

‘Doing this across the country means fewer people will reach that point, and services will be able to cope better with the number of people who will ultimately still need that kind of support.’

For example, ‘there are a number of different socio-economic factors that come together and lead a person to be in a suicidal crisis. If we only manage people who reach the crisis point, we will never be able to meet that need,’ he explains.

This sort of work requires ‘collaboration between the NHS, CCGs, national and local authorities and people who have a nuanced understanding of mental health needs locally’. 

Going forward, Dr Kousoulis believes we will see more community interventions, particularly stemming from the Covid-19 pandemic. This, for instance, includes local peer support and interventions addressing loneliness.

‘If there is another wave, it is likely that some people will be asked to stay at home. Even after the current lockdown is lifted, a lot of people will carry on shielding.’

‘We need those community support interventions, and maybe GPs have a role to play in that, as well as CCGs, in terms of how they allocate resources.’  

More widely, the Government has a responsibility to ensure its policies are proactive in supporting the mental wellbeing of the population.

The furlough scheme is a positive example of this, as it saved many more people from becoming unemployed and facing financial difficulties, which would have had a ‘dramatic effect on mental health across the board’. 

However, some groups are still experiencing deep challenges during the pandemic. 

‘Generally, speaking, we do see high stress levels – especially for people who don’t feel they have a confirmed long-term position at their job, those who struggle with savings or getting through each month and many who are unemployed.’ The Government should consider changes to the benefits system and eviction rules where people cannot afford rent, Dr Kousoulis suggests.  

‘For younger people, aged between 16 and 25, our research showed high level stress and also an increase in self-harm because of a huge disruption to their education and also to connections and their ability to socialise.’ 

There will certainly be a longer-term impact to mental health as well, which will be harder to establish and plan support around initially, but there are some safe assumptions. For instance, we can expect to see an increase in mental health issues if the predicted recession following the pandemic leads to mass job losses, he adds. 

Furthermore, some people have adopted unhealthy coping mechanisms over the last three months, such as taking up or ‘an increase in drinking, drug use and online gambling, which will not easily fade away after lockdown,’ Dr Kousoulis explains.  

Policies at both the national and local level will be needed to help limit the impact, for instance, making alcohol more difficult to buy, imposing minimum unit pricing or restricting advertising for online gambling. 

Also, ‘we need to think about the stress and trauma healthcare and key workers face being on the frontline and exposed to the conditions for an extended period.’ 

Dr Kousoulis points to research that shows that receiving hospital treatment in intensive care units increases the risk of post-traumatic stress disorder. Bereavement also causes a ‘disruption in mood’, which is ‘further complicated when people cannot say goodbye,’ he says. Many people will have experienced these and could require mental support in the future. 

Overall, organisations and policymakers must keep in mind both the short and long-term picture when responding to the mental health fallout of the coronavirus crisis, Dr Kousoulis says. ‘But we have to start planning for it now’.

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