By Richard Carlton-Crabtree
One month from now, a year that most people simply want to see the back of will actually be over. What measure of relief that brings, and how quickly the upcoming Covid-19 vaccine rollout is mobilised to deliver it, remains to be seen.
In recent weeks officials have begun tentatively pointing to the spring as a timeframe by when something like the ‘old normal’ might resume, Easter as a target date by which a good chunk of the most vulnerable, along with our NHS frontline workers, could be inoculated – meeting the first condition for reopening society without unacceptable risks to life.
This prize shines uppermost, but even if achieved on schedule its comforts and easements still lie on the other side of what will surely be a gruelling winter ahead; more long months lived in the shadow of the virus, and navigated under some further combination of national and locally tiered lockdowns.
Lockdown has been the primary policy response to Covid and almost inevitably so. Before vaccination became an option, what else was there?
Since the pandemic broke, governments the world over have been compelled to implement them in one form or another. The simple logic, of course, is to reduce transmission by reducing contact, and while it is possible to argue that the execution has been ham fisted and insufficiently refined, it is hard to claim that the whole lockdown policy per se has been entirely unnecessary or wantonly egregious, not when all alternatives involve risk to life on a cruel and unusual scale.
But if lockdown has been necessary, it has still been a necessary evil; an extreme measure for extreme times, a major deprivation of freedoms and one that inevitably incurs punishing collateral damage.
For this reason, when a lockdown is mandated – be it national, local, or even of a single individual couched under the auspices of Test and Trace – the policy carries serious obligations. For one, and because lockdowns constrain enterprise and earnings, they imply an obligation to provide concurrent financial support.
While keen to point out that they can’t rescue everyone, the government has sought to meet this obligation via the Job Retention (furlough) Scheme and other substantial provisions.
By the same logic, and because of clear evidence that lockdowns adversely affect mental health too, they also imply a corollary obligation to invest more in psychological support than in fair-weather times.
But it is in the mental health arena that far, far less has so far been done to ameliorate the pain.
Humans are social animals, and when forced apart from friends and family and into isolation, against the grain of our nature, the social way of life vital to sustaining our mental equilibrium is sacrificed.
The impacts are particularly acute for those living alone, or in a household scarred by the domestic abuse that can mean the inside of a bubble is sometimes more dangerous than the outside, but everyone’s ability to pursue the lifestyles needed to optimise wellbeing has been constrained to some extent.
And the longer lockdowns endure, the greater the cost to our mental health; this is an indivisible consequence of the lockdown policy just like the economic impacts.
To date, pandemic response measures in the mental health sphere have included October’s announcement of £15 million in extra funding to improve rapid access to psychological support for NHS staff, and a £5 million Coronavirus Mental Health Support Fund for charitable community projects established back in April.
These provisions are positive but piecemeal. Urgently needed now is a more comprehensive, overarching response, with a scope that transcends existing provisions to improve rapid access to mental health support for all sections of the community.
A ‘National Covid Mental Health Response Strategy’ to help with the depression, isolation, loneliness, bereavement and anxieties about health and finances that have accompanied the pandemic.
People are suffering and opportunities to alleviate that suffering are available; taking them is a moral obligation. Particularly as the local measures now superseding the national lockdown have left the vast majority of people in the top two tiers; still under heavy restrictions.
Many have been complaining for some time already that the cure is worse than the disease because for many it is. If we must have further lockdowns then we must, but we must have the proper mitigations too.
A mental health response strategy would be a giant leap forwards towards delivering this. It would require a funding boost for our hard-pressed NHS psychotherapy services so that they are equipped to operate on the greater scale suited to times of exceptional need.
Currently, NHS ‘IAPT’ services typically have capacity to open only in working hours, when people really need them on weekends too, and around the clock.
For those seeking support out of hours, the GOV.UK website presently suggests the Samaritans, an organisation doing valuable work, but one whose volunteers should be augmenting national capacity in a time of crisis, not relied upon as the mainstay of it.
There is no equivalent NHS mental health helpline but, when people are suffering as they are now, there clearly should be. Plugging this gap would help ease the problem of Accident and Emergency departments being forced into acting as a backstop for people whose needs are really psychological, but who have nowhere else to turn.
It would create somewhere for workers in NHS Test and Trace or benefits services to direct the many they encounter whose situations are harming their mental health. And, as an NHS provision, a national helpline could directly facilitate onward referrals into the longer term NHS therapy services, their capacity likewise amplified under the response strategy, when needed.
All this would take money of course, but thankfully the financial arguments for a mental health response strategy stack up just as well as the moral ones. The costs would be tiny next to other Covid provisions, and utterly trivial in comparison with those of abandoning people to spiralling mental ill health, heightened risk of addictions, homelessness, problems worsening to the point of long-term dependency on benefits, or otherwise suffering in ways that ultimately impact the Exchequer.
Indeed, perhaps the strongest argument of all in favour of a mental health response strategy derives from the need to buttress the national psyche for the post-Covid bounce back. The economy is on life support, with a furlough scheme in continuous operation since the start of the pandemic, whole industries underwritten, and thousands of businesses reliant on subsidy to survive.
This financial pain will not dissolve into joy and relief instantly once a vaccine is deployed; somewhere down the line the tap will have to be shut off, and the debt paid for. Many hero key workers and others in food supply chains and vital industries elsewhere have braved the virus throughout, of course, but millions more have been consigned to home working, furlough and unemployment.
Many have become resigned to it, are feeling beaten down by it, and are struggling to hold on to hope. For them, the transition back to the ‘old normal’ may not come easily, and if we are to galvanise our economy tomorrow, we should not neglect their mental health today.
A national mental health response strategy could help prime the coming reorientation from the context of pandemic and lockdown; fortifying those who have suffered through isolation to emerge with vitality to resume the active lifestyles essential to our economy when the time comes.
Achieving this turnaround and finding the positive mentality needed to precipitate a widespread return to the work and social arenas will be critical.
It is the coming frontier in the battle against the pandemic, and the time to be raising our gaze to it is now. That way, when we look back on the age of Covid with broader perspective from the future, we give ourselves the best chance that the coming years won’t end up condemned alongside 2020 – a whole decade we would all just like to forget.
Richard is a Director of the Oakdale Centre Community Interest Company, a not-for-profit provider of psychological therapies for children, families and adults, and the author of ‘Psykhe’ (Amberley Publishing).
The opinions in this article are those of the author and are no reflection of the views of the website or its owners.