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28 Oct 2020

What aspects of the mental health impact of the Covid-19 pandemic were you invited to submit evidence on?

The brief was to be able to contribute evidence across the whole range of impacts of Covid-19 on the mental health of the general population. I offered information about the impacts on: 1) people in the general population; 2) people with pre-existing mental illness; 3) people who provide essential services and are at increased risk of infection; and 4) people who are infected by Covid-19.

    I am most concerned not about the short-term mental health impacts of the pandemic, as most people are very resilient and will bounce back if given personal and community forms of social support. The greater danger in my view are the longer-term consequences that may well follow economic recession, especially increased rates of suicide.

    Professor Sir Graham Thornicroft

    Professor Sir Graham Thornicroft

    In the early stages of the pandemic, what did you see as the priority areas for mental health research? 

    In my view there are several early and most important priorities in relation to mental health: 

    1) understanding what factors are likely during the early stages of a pandemic to increase the incidence and prevalence of mental illness and to actively mitigate these factors, for example, by providing support to socially isolated people to reduce the onset of depression; 

    2) intervening with social and psychological support to first responders and care staff to reduce the incidence of anxiety, depression, insomnia and post-traumatic stress disorder;

    3) identifying vulnerable groups and ensuring reliable supports are provided to them, for example, those who are in self-isolation, lockdown or quarantine, homeless people, and those with food insecurity; and 

    4) putting in place baseline measures for key metrics to use these to track changes over time, for example, for rates of self-harm.

    The situation is described as “unprecedented”. But in terms of mental health research and knowledge, is it? What existing evidence can you turn to?       

    The specific nature of the virus causing this pandemic is novel, but pandemics per se, and mass trauma and disaster occurrences are in many parts of the world not unusual. We can therefore learn a great deal from how previous pandemics have wreaked havoc on societies, for example, Ebola, HIV/AIDS, SARS and MERS, and from examples of good practice in these pandemics. We can also take lessons from other forms of natural disaster, such as the Indian Ocean tsunami in 2004, both about supporting community resilience, and also on what forms of psycho-social supports are needed and how to adapt services to ‘build back better’.

    What were the key points that you hoped this group of policymakers would take from your evidence?

    I am most concerned not about the short-term mental health impacts of the pandemic, as most people are very resilient and will bounce back if given personal and community forms of social support. The greater danger in my view are the longer-term consequences that may well follow economic recession, especially increased rates of suicide. We know from research in previous periods of economic downturn, that suicide rates usually get worse, especially for people who lose their jobs, but also for those who experience job insecurity. In my view there are clear implications here for the necessity for furlough and job support programmes, both for economic and for mental health reasons.

    What were the APPG most interested in? Did they ask any follow up questions? 

    Yes, they asked all those offering evidence for their views on Covid-19 testing. Unfortunately, I do not have expertise in this area!

    How should applied health and social care research contribute to mitigating the damaging effects of the pandemic?

    The NIHR ARC South London’s work is publicly funded, and we have a responsibility and obligation to do everything we can to support the national effort to minimise the psychological, social and economic damage of the pandemic. Therefore in addition to our usual programmes of about 30 ongoing projects, we have also initiated more than 40 new or adapted projects directly related to Covid-19 across a whole range of health and social care challenges, ranging from social care day centres, support for young people, to the provision of palliative and end of life care during the pandemic.

    From time to time a research finding stands out and in a sense slaps me on the face. Most recently, I was astonished to hear of a study which found that among people who tested positive for Covid-19, only about 20% completed a full period of self-isolation.

    Professor Sir Graham Thornicroft

    Professor Sir Graham Thornicroft

    Is there anything that has surprised you about how the pandemic has progressed?  

    From time to time a research finding stands out and in a sense slaps me on the face. Most recently, I was astonished to hear of a study which found that among people who tested positive for Covid-19, only about 20% completed a full period of self-isolation. It seems to me that the reasons for this need to be urgently understood, whether in terms of lack of food and shopping, or childcare support, or whether if signifies a breakdown in public understanding and trust in the government’s Covid messaging.

    Health and care practice has changed rapidly in the past few months. Can you see any long-term benefits that could come from these changes? 

    Yes. I work part-time as a researcher and part-time as a psychiatric doctor. The change from face-to-face consulting with patients to online / remote consulting took place remarkably quickly and on a very widespread basis. I think that we need to learn soon what are the advantages for patients and for staff to seek a proper balance in the future between in-person and remote consultations – the aim would be to offer people more choice, to minimise travel and waiting times, and to respond well to the needs of individual patients.

    Find out more about the mental health impact of Covid-19 in this selection of published papers co-authored by Professor Sir Graham Thornicroft: