The Health Foundation’s COVID-19 impact inquiry is exploring the pandemic’s implications for health and health inequalities in the UK. 

Over the past year, mental health has been in the news continuously – an acknowledgement that the pandemic poses risks beyond our physical health. As someone who has worked in the mental health sector for over 25 years, this increased attention is most welcome. Now is the time to channel this interest and commit to making things better for people who were struggling both before and during the pandemic. By working with these people, we have an opportunity to develop better mental health support for everyone. We must also use greater interest in mental health from the public and from government to strengthen action on inequalities – including racial inequity – so we can tackle the causes of poor mental health.

The emerging picture according to the data

The psychological impact of the pandemic is still emerging. Psychological trauma can take time to reveal itself. Survey data so far tells us that the overall impact is a ‘mixed picture’ for young people and adults. Higher levels of anxiety and depression observed in April 2020 have lessened for some groups, which has been attributed to resilience and coping mechanisms, while other groups have seen sustained distress or deterioration in mental health.

This chimes with lived experience narratives. Some people enjoyed the removal of stressors such as school classrooms or the daily commute. There were unexpected benefits such as enjoying more time in nature or new family routines. Other people have experienced bereavement, furlough and unemployment, as well as lockdown impacts including disruption to schooling, loneliness, digital exclusion and domestic abuse. Front-line health and social care workers have witnessed deaths on an unprecedented scale.

A recent Public Health England review cited evidence from the ‘Understanding Society’ study. The unequal impact of depression includes chronic health conditions, housing conditions and neighbourhood characteristics. This highlights the impact of people’s circumstances going into the pandemic on their mental health.

A divergence of mental health experiences

The mental health effects of the pandemic have not been the same for everyone. Those whose mental health has been particularly impacted by the pandemic include unemployed people, those with existing long-term physical or mental health conditions, women, people from minority ethnic communities, LGBQT people, and older people who are isolated or digitally excluded.

We’ve seen that young people have been disproportionately affected by the pandemic. They’ve faced challenges reaching many areas of life – education and future opportunities, work and unemployment, emotional wellbeing, housing, relationships – with implications for this generation’s future health and wellbeing. For those already marginalised, the pandemic has increased stress and uncertainty. For example, young black people’s employment has fallen 4.5% compared to 1.5% for white young people.

In today’s society racism is a big issue. We should do a lot more research as to why are black people experiencing a decline in employment, why is there more white people in employment – what is the reasoning? … There is so much pressure on us and it is increasing anxiety. And what about our future will we get to the colleges we want to go to, will we get to university?
Young person aged 15, during a McPin Foundation workshop discussion

Race and mental health

McPin worked with Black Thrive and The Social Innovation Partnership (TSIP) using community research methods to explore the initial impact of COVID-19 on black people in Lambeth, London. Many of the recommendations will apply nationally.

Our report focuses on what needs to change for an equitable recovery to occur, and for black people to thrive. It included building trust across a range of organisations and settings with black communities to better meet peoples’ wide ranging needs, focusing on the basics (food, appropriate health care support, access to technology), and addressing inequalities in opportunities for work and education. We know these areas are important for mental health, but without focused efforts to address them, inequalities will widen.

I think there will be some superficial attempts at trying to balance out inequality in the workplace, but I think once the media is not shining so much of a light on these issues, it'll go back to whatever normal was before. Yes, there will be a lot of performative gestures and then no real, like, systemic change, which is what tends to happen in this country.
Lambeth resident, interview study participant

What should our response be?

Mental health is complex. The determinants of mental health are many – most are social, not medical. We know we must address it at different levels – system and society, community and neighbourhood, individual and household. Priorities include:

  • Better access to support: We have some evidence-based treatments and services on offer but they are rarely, if ever, available without extensive waiting lists. There is a cohort of people who are too severely ill for some support but not severe enough for the alternative. And too many of the current approaches do not consider people’s different needs and preferences.
  • Joined-up services: Schools, workplaces and community settings are important for providing mental health support, as much as hospitals and clinics. We need better integration of systems of care – primary care, secondary services and the voluntary sector – which current policy advocates for and is piloting. We require extensive preventive efforts alongside focused delivery of new trauma-informed solutions.
  • Acknowledging distrust: Fundamental problems, including with use of the Mental Health Act, have left many people traumatised and distrustful of the system set up to ‘help’. Another issue is medication, which can be lifechanging for some, but is still too often offered as the only solution and tends to have many problematic side effects.
  • Working with lived experience: Those who are most expert are people living with mental health problems themselves. We must make more of this expertise. It should be central to how services and supports are designed and delivered.

Conclusion

Our response must be to use the pandemic to revolutionise mental health support with lived experience expertise at the heart. Not tinker with it but change things across the spectrum, from prevention to crisis support. And that starts with culture. When you share power, share responsibility, work collectively, and navigate difficult conversations – by using the principles of co-production in research or using peer research methods, you tend to land on better solutions.  This will achieve outcomes that matter most to individuals and families dealing with poor mental health and the aspects of everyday living that exacerbate this. I am not saying this is easy. But it’s important that we use the next few years to drive change and offer real improvements in mental health care and support.

Poor mental health is personal to everyone. It is extremely distressing and can lead to death. We entered the pandemic knowing that too many people were falling through the gaps. Now is the time to focus on the groups we know struggled before and during the pandemic, and work with them to build better systems that will benefit all.

Dr Vanessa Pinfold is the co-founder and research director of the McPin Foundation (@McPinFoundation) and a member of the COVID-19 impact inquiry's expert advisory panel

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