Data so far show mixed results according to their method and research population of interest, but indicate a strong signal that those with a pre-existing mental health condition are likely to have worse outcomes than those who did not. There is also evidence that children and young people have been disproportionately affected by the non-pharmaceutical interventions put in place to reduce transmission of the SARS-CoV-2 viru

Overview of change

Data collection and research to examine the impact of COVID-19 on population mental health began early in 2020. This occurred through both existing and new population-level and cohort surveys (cross-sectional and longitudinal) by national agencies1 (notably the Office for National Statistics2), research bodies and the third sector.3,4 Mental health research was already a strategic focus within UK Research and Innovation (UKRI),5,6 with COVID-19 now a focus for new projects. Similarly, mental health charities that commission and use research have also responded with new projects about the impacts of the pandemic.7

Other research seeks to understand the implications of having had COVID-19 on mental health;8 assessing the psychological impacts of quarantine measures and how these might be mitigated9 and the differential impact of the pandemic on certain groups.10,11,12 These include groups characterised by geography, gender, age, ethnicity and occupation. Data so far show mixed results according to their method and research population of interest, but indicate a strong signal that those with a pre-existing mental health condition are likely to have worse outcomes than those who did not. There is also evidence that children and young people have been disproportionately affected by the non-pharmaceutical interventions put in place to reduce transmission of the SARS-CoV-2 virus.13,14,15

Social isolation and loneliness are ongoing areas of concern affecting vulnerable people and the elderly, with concern that these have been, and continue to be, exacerbated by shielding and other restrictions on daily life. The impact of changing and increased demand on mental health services because of the pandemic is a significant issue, coinciding with a need to deliver services in a different way.16 This is in addition to NHS workforce challenges, with staff absent through illness, self-isolation requirements, caring responsibilities and redeployment. Research on interventions that can promote good mental health and resilience is also in progress, to identify effective approaches.17 These themes highlight the challenges for policy-makers in both the short- and long-term.

Challenges and opportunities

  • Research arising from the pandemic has highlighted the value of high-quality information about the mental health of the population as a whole and the role that powerful longitudinal and qualitative research can play in understanding changes over time, groups affected and the factors that are associated with worsening mental health. In addition to existing population cohorts, several new research projects are strengthening the evidence base so that trends over time before, during and after the pandemic are captured for the population and for specific groups (notably children and young people, people with a pre-existing mental health condition, other vulnerable people, frontline workers and older people).
  • COVID-19 has stimulated focus on the social determinants of mental health, for which it can be argued requires a cross-government ‘mental health in all policies’ approach.18
  • Understanding and measuring short- vs long-term impacts of COVID-19 and its impact on both mental health and its social determinants.
  • Evaluating the success of interventions and policies to prevent the development of mental health problems, and minimise the harms from developing mental health conditions or exacerbating pre-existing ones.
  • The implementation of infection control measures in inpatient settings has highlighted the age and poor quality of the mental health estate. Mental health professionals note that this has had a direct impact on care quality, including that for children and young people.19
  • The resources within specialist mental health services in community and specialised settings to cope with demand and the resilience of professionals working in mental health to deliver care. Mental health charities highlight the need to train and expand the workforce in order to achieve the commitments in the NHS Long Term Plan.

Key unknowns

The long-term impacts of COVID-19 on mental health are unclear but have focused attention on the wider social determinants driving inequalities across physical and mental health. The extent to which the experiences of the pandemic may have created opportunities for, or actually, improved mental health for some are unclear and, if so, whether any positive benefits are also characterised by inequality.

Key questions for Parliament

  • Interrogating the quality of research data on the impacts of the pandemic on mental health at a population level and in vulnerable groups, and whether funding bodies’ approaches to coordinating research on this area, and the research itself, are sufficiently representative.
  • The impact of COVID-19 on existing mental health services in primary and secondary care settings and how this is linked to health outcomes.
  • Understanding who has been affected by the pandemic, what the most effective mental health interventions are, when and how to target them, and how to develop them in culturally appropriate ways in partnership with affected communities and groups.
  • Responding to inequalities and different experiences with mental health services, such as people from Black ethnic groups who have been disproportionately affected by COVID-19 and who already have poorer experience of mental health treatment and care compared with people of White ethnicity.
  • Exploring the UK Government’s strategic plan to respond to the mental health impacts of COVID-19, including action that can be taken to prevent and mitigate the development of mental health problems and worsening of pre-existing conditions.
  • The opportunity to learn from the experience of delivering care remotely and/or with digital technologies and other innovative approaches during the pandemic, and how this can inform provision of mental health care in the long-term with a focus on patient choice. This includes providing services in ways that are acceptable to people and that take account of both their care preferences and their access to the internet and to digital technologies.
  • Understanding the mental health risks arising from an economic downturn resulting from the pandemic.

Likelihood and impact

Research indicates that mental health impacts have already resulted, data on the longer-term picture are less clear.

Research for Parliament 2021

Experts have helped us identify 30 areas of change to help the UK Parliament prepare for the future.

References

  1. Public Health England (18 January 2021). New Every Mind Matters campaign
  2. The Office for National Statistics has published bulletins on a range of mental health conditions during the pandemic: Coronavirus and depression in adults Great Britain: June 2020; Coronavirus and anxiety, Great Britain: 3 April to 10 May 2020; Coronavirus and the social impacts on Great Britain: 29 January 2021
  3. CLOSER. COVID-19 Longitudinal Surveys
  4. Mental Health Foundation. Coronavirus: Mental Health in the Pandemic
  5. UK Research and Innovation. Tackling the impact of COVID-19
  6. UK Research and Innovation. COVID-19, Mental Health and the Medical Research Council
  7. Centre for Mental Health. How mental health charities are responding to Covid-19
  8. Rogers et al. (1 July 2020). Psychiatric and neuropsychiatric presentations associated with severe coronavirus infections: a systematic review and meta-analysis with comparison to the COVID-19 pandemic. The Lancet Psychiatry, Volume 7, Issue 7, P611-627.
  9. Brooks et al. (14 March 2020). The psychological impact of quarantine and how to reduce it: rapid review of the evidence. The Lancet, Volume 395, Issue 10227, P912-920.
  10. Wilson, C. & Bunn, S. Parliamentary Office of Science and Technology, UK Parliament (December 2020). Mental health impacts of COVID-19 on NHS staff, POSTnote 634.
  11. Brooks et al. (14 March 2020). The psychological impact of quarantine and how to reduce it: rapid review of the evidence. The Lancet, Volume 395, Issue 10227, P912-920.
  12. Institute of Fiscal Studies (9 April 2020). Recessions and health: the long-term health consequences of responses to the coronavirus.
  13. Loades et al. (November 2020). Rapid Systematic Review: The Impact of Social Isolation and Loneliness on the Mental Health of Children and Adolescents in the Context of COVID-19. J Am Acad Child Adolescent Psychiatry, 59(11): 1218-1239.
  14. Newlove-Delgado et al. (11 January 2021) Child mental health in England before and during the COVID-19 lockdown. Lancet Psychiatry.
  15. Mental Health Foundation. Coronavirus: The divergence of mental health experiences during the pandemic.
  16. Centre for Mental Health. Covid-19 Forecast Modelling Toolkit.
  17. Mental Health Foundation (September 2020). Resilience across the UK during the coronavirus pandemic.
  18. Allwood L. and Bell A. (June 2020). Understanding inequalities in mental health during the pandemic, Centre for Mental Health.
  19. Royal College of Psychiatrists (22 July 2020). COVID-19 exposed deadly danger of dilapidated mental health wards.

Photo by Avrielle Suleiman on Unsplash

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