The impact of COVID-19 for people living with a long-term mental health diagnosis

There has been mass media coverage in recent weeks concerning the coronavirus and the implications for the future mental health of the UK population. Researchers are highlighting that indications from recent mental health polls, along with evidence from previous national emergencies, implies that the pandemic and subsequent polices, such as lock-down and social distancing, could have a significant long-term impact on the mental health of the UK population and could even heighten suicide rates (Gunnell et al, 2020).

The consensus from recent publications is that there is a need for more research to monitor the mental health of the UK population and the ability of services to meet the potential mental health care needs of the future. A recent article published in The Lancet highlights an urgent need for data, “Research funders and researchers must deploy resources to understand the psychological, social, and neuroscientific effects of the COVID-19 pandemic. Mobilisation now will allow us to apply the learnings gained to any future periods of increased infection and lockdown, which will be particularly important for front-line workers and for vulnerable groups, and to future pandemics.” (Holmes et al, 2020)

But, what could all this mean for the future of our most vulnerable populations? Specifically, those with long-term and enduring mental health problems? In a recent article with The Guardian, Stephen Buckley, Head of Information at Mind, said, “We know that the coronavirus and its impact are causing stress and worry for many people. If you already have a mental health problem, it’s possible that the worries of coronavirus may be affecting how you’re coping.”

Living with a mental health diagnosis during the Coronavirus pandemic

When we analyse some of the foundations to the recovery for people living with a long-term mental health diagnosis, it is clear to see that social inclusion, structure and a support networks are vital components of recovery.

Situations of uncertainty increase anxiety, loneliness and depressive symptoms, as well as disrupting the routine that so many people with a mental health diagnosis depend on.

People living with existing mental health problems, including those with severe mental illnesses and learning difficulties, could be predominantly affected by disruptions to services such as 1-2-1 therapy, isolation, the possible exacerbation of symptoms in response to pandemic-related media coverage and advice, and changes in mental health law. In this landscape, relapse for some individuals would seem inevitable.

Professor Kevin Gournay,  Non-Executive Chairman at Northern Healthcare comments, “A central concern is that those with long term mental health problems who are already subject of social isolation and deprivation, will be affected by the loss of mental health support from formal and informal carers, because of the social distancing and isolation measures that have been put in place. Therefore, many may relapse into a state of crisis. This will then have a great impact on already stretched crisis response home treatment teams and in-patient services. It is probable that this will lead to problems, for some time to come, with over-burdened services not being able to cope -leaving many without adequate care or treatment.

“It has been suggested that an increase in online treatments and self-help apps may be one solution to dealing, at a population level, with states of depression and anxiety.

“However, what of people with psychotic illness, or the many people in the criminal justice system with mental health problems? These groups need comprehensive programmes of treatment and support where face to face engagement with care and health professionals is essential.”

A recent article published by JAMA Psychiatry further highlights how vulnerable populations, in particular, may be at greater risk, “Disasters disproportionately affect poor and vulnerable populations, and patients with serious mental illness may be among the hardest hit. High rates of smoking in this population may raise the risk of infection and confer a worse prognosis among those who develop the illness. Residential instability and homelessness can raise the risk of infection and make it harder to identify, follow up, and treat those who are infected. Individuals with serious mental illnesses who are employed may have challenges taking time off from work… Small social networks may limit opportunities to obtain support from friends and family members should individuals with serious mental illness become ill. Taken together, these factors may lead to elevated infection rates and worse prognoses in this population.” (Druss, 2020)

A recent survey by Young Minds found that the measures put in place to reduce the spread of the virus are having a profound effect; over 80% of young people with a history of mental illness found their conditions have worsened since the coronavirus crisis began in the UK.

It is clear to see that the coronavirus will have a detrimental effect on many peoples’ physical and mental health. What we do now will have a lasting impact on the future of mental health care.

Supporting vulnerable populations during the Coronavirus pandemic

Some key areas of consideration for mental health professionals supporting people living with a long-term mental health diagnosis or learning disability will be:

• Suitability of communications: Every individual should have access to information for mitigating risk and knowing when/how to seek medical treatment for COVID-19. Bespoke materials must be developed which recognise literacy challenges and the capacity of each individual to retain this information.
• Additional support requirements: Self-care is often neglected in vulnerable populations, people with existing mental health conditions may need additional support to ensure they are following personal hygiene advice (e.g. hand washing). Diet, physical activity and self-management strategies for mental and physical health conditions are also of vital importance.
• Relapse indicators: Existing anxiety, loneliness and depressive symptoms may be heightened at this time. Each individual’s, psychological symptoms may develop in a unique context; support plans should be adapted accordingly.
• Training requirements: As a primary contact, mental health professional will need to be trained to recognise the signs and symptoms of COVID-19 and will have to implement new practices when interacting with suspected or confirmed cases. This will involve implementing basic strategies to mitigate the spread of virus and obtaining appropriate PPE whilst maintaining their own safety and wellbeing.
• Vital services: The COVID-19 pandemic is placing a major strain on community mental health services and psychiatric hospitals. Contingency plans must be in placed to maintain vital functions and safe staffing levels.
• Alterations to physical spaces: Shared living spaces need to ensure that they have contingency plans to detect and contain outbreaks should they occur. Additional hand washing facilities may need to be installed, deep cleaning routines implemented and environmental alterations to ventilate shared spaces.
• Sign-posting additional support: Those who become ill may face dual stigma or may feel unable to reach out to their community mental health support team. People need to be aware of the services at their disposable, and any changes from ‘usual’ procedure must be communicated effectively.
• Updated policies: Mental health policies and updates in accordance to local and national response initiatives must be communicated to mental health teams and the people in their care.
• Digital technologies: Many mental health professionals are highlighting the importance of digital psychological interventions to help combat social isolation, anxiety, depression, self-harm and suicide but little is known about the effectiveness of these interventions especially in a time of crisis.

The COVID-19 pandemic will generate unique health and social challenges around the world. People with long-term mental health problems will be uniquely high risk during this period, increasing pressure on an already stretched public mental health care system. Vigilant research, planning and execution at numerous levels will be essential for minimising the adverse outcomes of this pandemic for vulnerable populations and those fundamental to delivering their care.

References

Druss, B.G. (2020). Addressing the COVID-19 Pandemic in Populations With Serious Mental Illness. JAMA Psychiatry.

Gunnell, D., Appleby, L., Arensman, E., Hawton, K., John, A., Kapur, N., Khan, M., O’Connor, R.C., Pirkis, J., Appleby, L., Arensman, E., Caine, E.D., Chan, L.F., Chang, S.-S., Chen, Y.-Y., Christensen, H., Dandona, R., Eddleston, M., Erlangsen, A., Gunnell, D., Harkavy-Friedman, J., Hawton, K., John, A., Kapur, N., Khan, M., Kirtley, O.J., Knipe, D., Konradsen, F., Liu, S., McManus, S., Mehlum, L., Miller, M., Moran, P., Morrissey, J., Moutier, C., Niederkrotenthaler, T., Nordentoft, M., O’Connor, R.C., O’Neill, S., Page, A., Phillips, M.R., Pirkis, J., Platt, S., Pompili, M., Qin, P., Rezaeian, M., Silverman, M., Sinyor, M., Stack, S., Townsend, E., Turecki, G., Vijayakumar, L. and Yip, P.S. (2020). Suicide risk and prevention during the COVID-19 pandemic. The Lancet Psychiatry, [online] 0(0). Available at: https://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(20)30171-1/fulltext [Accessed 24 Apr. 2020].

Holmes, E.A., O’Connor, R.C., Perry, V.H., Tracey, I., Wessely, S., Arseneault, L., Ballard, C., Christensen, H., Cohen Silver, R., Everall, I., Ford, T., John, A., Kabir, T., King, K., Madan, I., Michie, S., Przybylski, A.K., Shafran, R., Sweeney, A., Worthman, C.M., Yardley, L., Cowan, K., Cope, C., Hotopf, M. and Bullmore, E. (2020). Multidisciplinary research priorities for the COVID-19 pandemic: a call for action for mental health science. The Lancet Psychiatry. [online] Available at: https://www.thelancet.com/pdfs/journals/lanpsy/PIIS2215-0366(20)30168-1.pdf [Accessed 16 Apr. 2020].

Murray, J. and Sherwood, H. (2020). Anxiety on rise due to coronavirus, say mental health charities. The Guardian. [online] 13 Mar. Available at: https://www.theguardian.com/world/2020/mar/13/anxiety-on-rise-due-to-coronavirus-say-mental-health-charities.

YoungMinds. (n.d.). Coronavirus Report: Impact on Young People with Mental Health Needs. [online] Available at: https://youngminds.org.uk/about-us/reports/coronavirus-impact-on-young-people-with-mental-health-needs/.

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