A mental health epidemic caused by coronavirus can be avoided if we act now

Soon after national lockdown was announced in March in response to Covid-19, reports began to appear of a sharp rise in worry and anxiety in the UK. These feelings are understandable. Worry and anxiety are normal reactions to events that create high levels of uncertainty, especially when those events touch on core aspects of our lives: work, income, housing, education, and health – our own and that of our loved ones.

As the pandemic grinds on – and as the negative social and economic consequences deepen – there is growing concern about the long-term effects on mental health. The Centre for Mental Health estimated that around 10 million people will experience enduring mental health problems that require support, as a result of the pandemic.

We need to be cautious with predictions of this kind. People are remarkably resilient and long-lasting emotional distress has not always followed crises, whether war, pandemics, or political upheavals. However, the increases in mental health problems and suicide observed following the 2008 financial crash and subsequent periods of austerity do give cause for concern. The pandemic will have long-lasting economic consequences, and large-scale job losses in the coming months are inevitable. 

There are good reasons to anticipate that mental health problems linked to insecurity, poverty, and social adversity – distressing levels of anxiety and sadness, persistent problems with concentration, sleep, and so on – will increase substantially.

This has important implications for society. Mental health problems encroach on all aspects of life, affecting our ability to learn, to work, to form and sustain relationships – in short, to thrive. A significant increase in demand would put an intolerable strain on an already stretched and underfunded mental health service. The potential costs of increased mental health problems – both direct and indirect – are substantial. Major reinvestment in mental health services and support in schools, workplaces and communities, cannot wait until a crisis has unfolded. We need to act now.

The social and economic consequences of the pandemic are exposing and exacerbating existing inequalities. Plus, all established social risks to mental health are worsening, including unemployment, job insecurity, fuel and food poverty, domestic violence, and fragmented social supports. 

Those who are already disadvantaged, marginalised, and isolated will be the hardest hit. This includes those with existing mental health problems, those who are socially isolated, and those from minority ethnic populations who suffer disproportionate social disadvantage. The latter is linked to structural racism, resulting in many living in poor and overcrowded housing, in poorly paid and insecure frontline jobs, and in areas where community supports have been stripped bare by years of austerity.

We are never all in it together.

This is particularly so for young people. While social restrictions, school closures, and the exams fiasco have impacted on all, for many young people living in disadvantaged households, these impacts are compounded by lack of access to computers and reliable high-speed internet, by cramped housing conditions, and by greater household strains linked to low income, parental job insecurity, and so on. Mental health problems that develop during childhood and adolescence often persist well into adulthood, with profound effects on education, work, and relationships. A sharp rise in mental health problems among young people now will reverberate for years to come, further widening inequalities.

To prevent a mental health crisis developing, as a minimum, government support schemes to protect jobs and protect the most vulnerable must be strengthened. These must address longstanding weakness in policies for employment, housing, and access to critical support services. But more is required – nothing short of a national plan to address the impacts of the pandemic on the root causes of mental health problems, particularly among the most disadvantaged.  

At the core of a National Plan for Mental Health should first be a universal basic income scheme to mitigate the uncertainty and insecurity of rapidly changing economic conditions. There is good evidence that such schemes are cost-effective and do not create disincentives to employment. Second, there should be a package of measures to support young people in disadvantaged households, including the extended provision of free school meals, breakfast clubs, free internet access, and resources for digital education.

Third, there needs to be rapid investment to support local services (like libraries), mutual aid and community groups, and the voluntary sector with an emphasis on women’s refuges, homeless charities, youth groups, and community-based supports for black and minority ethnic populations.

Finally, the government should re-invest in local public health and community mental health teams, in particular child and adolescent mental health teams, to support local strategies to promote mental health and to provide professional support for those most in need.

While these actions will be costly, given the long term costs of mental health problems for society, the savings will probably outweigh these. But this is not the point. The case for a National Plan for Mental Health is not an economic one. It’s a moral one. What kind of society do we want? While the pandemic has demonstrated the great resources of many communities for mutual care and support, the ideology of individualism that has guided much public policy for the past 40 years has left us singularly ill-equipped to respond effectively to the challenge of Covid-19 and other crises that are sure to follow. Rebuilding our infrastructures of social support cannot be left to volunteers, charities and community workers.

Preventing a mental health crisis, and ensuring preparedness for future crises, means reimagining society and it must be done now.

Craig Morgan is a professor of social epidemiology at King’s College London. Nikolas Rose is a professor of sociology at King’s College London. Both work at the ESRC Centre for Society and Mental Health at King’s College London