What have we learned since 2020?
This is an updated version of the paper written in March 2021, which can be accessed here.
Covid-19 restrictions and a relentless media campaign to enhance compliance led to unprecedented levels of loneliness, fear, and anxiety.1 Due to this it was widely reported that a ‘mental health crisis’ swept across the nation.2,3 This paper examines some of the social and psychological impact and potential solutions moving forward.
The Government’s Behavioural Insight Team (BIT) recommend numerous psychological techniques in order to change people’s behaviour.4 The communication style used throughout the covid-19 period, encouraged by BIT and SPI-B employed several covert psychological strategies (‘nudges’) that act upon us subconsciously, below the level of awareness. Psychological manipulation of this kind is not new, but there are serious concerns that this unethical practice has caused significant long-term psychological harm.
Fear is a powerful motivator. The decision to scare us into submission was a strategic one. The SAGE minutes of the 22nd March 20205 state, ‘The perceived level of personal threat needs to be increased …using hard-hitting emotional messaging’. BIT inflicted a prolonged scare campaign upon the British public, the primary aim of which was to inflate levels of fear and thereby achieve compliance.
The Government spent over £184M on advertising covid-19 related messaging during 2020.6 It resulted in many people not daring to leave their house at all for extended periods.7 And even more concerning was the research showing that suicidal thoughts dramatically increased during lockdowns.8, 9 This level of human distress has clearly had a significant societal and psychological impact.
A change in the Government’s communication style moving forward is essential. The approach used was a fear rhetoric, with no balance or compassion and led to increased prevalence of anxiety, depression, and obsessions and compulsions.10,11 The constant communications centred around being tested for covid-19 (even if healthy), staying away from other people, and the need for copious amounts of hand washing and use of hand sanitiser created a deeply unhealthy psychological state across the entire nation. Use of such tactics activates our threat systems leading to distorted risk perception, and aggression and blame towards those that did not rigidly comply to covid-19 rules.12, 13
Moving forward and considering future public health incidents, a communication style which is more balanced and truthful, delivered in a more compassionate way may help contain the public’s anxiety more effectively. It would not only decrease internal stressors, but would also lessen the conflicts witnessed between people,14 which can further exacerbate the public’s level of confusion and distress.15
To meet core human psychological needs, humans need social interactions. To deny them this right for long and undefined periods causes enormous harms. There is a vast body of research demonstrating the wide range of damaging effects.16, 17, 18, 19, 20, 21
● Immune system deficits
● Sleep disturbances
● Cognitive changes e.g., difficulty thinking and speaking
● Problematic mental and physical wellbeing
● Lack of reality and paranoia
Prolonged loneliness is likely to have evoked mental defeat in elderly people with dementia, often resulting in premature death.22 Further evidence of the mental health costs of the restrictions that were put in place emerged frequently, with reports of significantly increased anxiety and depression in postnatal mothers23 and a rise in disabling tic problems in children.24
Restrictions not only created mental health problems in previously healthy people, but exacerbated difficulties in those who were already struggling.25 No comprehensive risk assessments were carried out to measure the harms caused during any of the lockdowns, which was clearly a public health flaw in covid-19 planning. Working on the widely accepted principle of ‘first do no harm’ alongside the clear comparative evidence that emerged from countries and states who did not impose lockdowns,26 it is clear that such measures should not have been repeatedly enforced.27, 28
Stripping away self-care
Observations and anecdotal evidence from clinical practice saw restrictive measures cause devastation for many, and in particular those with pre-existing mental health conditions. To ensure good health and wellbeing, people should have been afforded their own personalised, individual self-care plans, which may not be vital for some, but are absolutely essential in maintaining stable psychological health for the people accessing mental health services.
Such self-care aspects were ruthlessly and suddenly stripped away from people and whilst these impacted upon everyone, those already experiencing mental health issues were at serious risk of falling into crisis and left many people dealing with constant high levels of distress; at an ethical and human level this is highly unacceptable.
As well as a lack of access to vital self-care aspects, the isolation endured seemingly had a significant negative impact upon people’s mental health. A review of 24 quarantines showed that the isolation involved led to debilitating psychological health conditions such as post-traumatic stress and feelings of anger and confusion. 29
Lack of access to psychological care
Throughout lockdowns many mental health services denied people vital face-to-face therapy due to the restrictions. Although other forms of therapeutic care were made available, such as telephone or video-based therapy, some patients found this impractical and stressful, particularly people who have experienced multiple traumas who need that separate safe space away from their place of living. To deny people in extreme distress something which helps soothe them and improve their quality of life, particularly when it could have been carried out safely using basic common sense, is a breach of their human rights.
The World Health Organisation’s (WHO) review of services, reported significant disruptions to mental health care provided; this included out-patient appointments being shortened or cancelled, and within in-patient settings, vital group activities suspended. For people in extreme distress taking away the soothers which help to reduce discomfort is a serious matter and is a human rights issue. 30
With fewer cases and hospitalisations, and bearing in mind covid-19 is a seasonal virus, we need a rapid change in policies around face-to-face psychotherapy because some services are still operating virtually and this lack of access is a serious barrier in psychological services. Additionally, it would be appropriate to see the removal of masks in all therapeutic spaces, with some NHS Trusts still insisting on staff and patients wearing cloth masks. Face coverings are inhibitive to the therapeutic relationship, signal ‘danger’, and are particularly distressing for the 1/6th of the population with hearing impairments and deafness. The therapy environment should be a calm, safe space for each individual and should be the primary available model in NHS mental health services.31
The Significant Impact upon Mental Health
In 2022, the WHO carried out an extensive review of the evidence for the global mental health impact of covid-19 and reported that on a worldwide level there has been an increase of depressive conditions by 28% and a rise of 26% for people experiencing anxiety conditions. 32 A comparison to pre-covid-19 levels of mental health distress saw a significant difference when compared with mental health in mid-2020, indicating that the governmental reaction to the pandemic contributed to the decline in psychological health. It is clear that the government and public health bodies had no thought or foresight to the psychological health of the nation and such lack of care in this area led to the devastation that numerous health professionals communicated would occur. There should be equality of access for mental health compared with physical health and we should be achieving parity of esteem.
As well as the overall impact upon mental health that covid-19 strategy has caused, on a more serious level, adults have reported an increase in distressing suicidal thoughts, which is extremely concerning and something which should be taken into account for any future public health planning. 32
The British Medical Association after investigating the cost to mental health, concluded that the covid-19 pandemic had caused a considerable impact upon the nation’s mental health and could widen the already present societal inequalities, emphasising the catastrophic affect that pandemic handling has led to.33 The report goes onto state that due to the psychological impact of covid-19, more people will need to access mental health services and to cope with the larger capacity needed, the government need to increase funding in this area.
As well as the distressing impact upon the adult population, we have also seen lockdowns have a serious affect upon young people. A study using parental observations of children, reported that 44% of young people were experiencing mental health difficulties. The research report highlighted loneliness as being a marked problem for children. Furthermore, it was concluded that interrupted schooling and social distancing also impacted upon children’s psychological health.34 It is clear from the available evidence that governmental restrictive measures brought in to combat the covid-19 virus, not only brought about mental health problems to the individual, but also at a wider systemic level, which is having a far-reaching societal impact.
The wider mental health impact of lockdowns also had a significant impact upon business owners. A study carried out in Lancashire reported that a third of entrepreneurs reported a decline in their mental health and wellbeing, with a one in four communicating that they were experiencing a mental health condition such as anxiety, depression, or post-traumatic stress. The financial stressors and social loneliness heaped upon business owners because of the restrictive measures placed upon them have clearly led to a deterioration in people’s psychological health with this appearing to be traumatic for some of those affected. If applicable to other geographical areas, this could potentially have seen nearly two million business owners experience a deterioration in their mental health.35
The Government’s communication style and restrictive measures clearly had a significant social and psychological impact upon the public, especially for those who were already experiencing psychological problems. People now need further hope and a degree of certainty about the future. Removal of masks in all settings, an increase in available face-face appointments in psychological therapy services, and compassionate and balanced communications will remind people we are no longer in the middle of an emergency. It is time to allow people to rebuild the delicate fabric of their world to incorporate joy, social interaction, music, travel, and the many other aspects of a healthy social and human life.
- Mental health in the UK during the COVID-19 pandemic: cross-sectional analyses from a community cohort study
- Children are facing a mental health crisis
- Mental Health Emergency: We’re living through a crisis that can’t be ignored
- Mindspace: Influencing behaviour through public policy
- Options for increasing adherence to social distancing measures
- Govt spent more than £184m on Covid comms in 2020 (campaignlive.co.uk)
- Well done, Matt ‘we’re doomed!’ Hancock – Covid fear is now a bigger threat than the virus itself
- Suicide risk and prevention during the COVID-19 pandemic
- COVID-19: Suicidal thoughts increased in young adults during lockdown, UK study finds
- Britons were ‘terrorised’ by the Government’s tough coronavirus message and ‘lost sight’ of the fact most people only have mild illness, says SAGE adviser
- Government has ‘terrorised’ Britons into believing coronavirus will kill them, says adviser
- The Biology of Fear, Adolfs (2014)
- Amygdala Hijack and the Fight or Flight Response
- “A Toxic Trend?”: Generational Conflict and Connectivity in Twitter Discourse Under the #BoomerRemover Hashtag
- Social, Psychological, and Philosophical Reflections on Pandemics and Beyond
- Holt-Lunstad, J., Smith, T. B.,Baker, M., Harris, T., & Stephenson, D. (2015). Loneliness and social isolation as risk factors for mortality: A meta-analytic review. Perspectives on Psychological Science, 10, 227-237
- Social Relationships and Health: The Toxic Effects of Perceived Social Isolation, Cacioppo & Cacioppo, 2014
- Effects of isolation and confinement on humans-implications for manned space explorations
- Psychological Effects of Isolation and Confinement of a Winter-Over Group at McMurdo Station, Antarctica
- Analysis of the stressful effects of hospitalisation and source isolation on coping and psychological constructs
- Relationship Between Loneliness, Psychiatric Disorders and Physical Health ? A Review on the Psychological Aspects of Loneliness, Mushtaq, Shoib, Shah & Mushtaq, 2014
- So Lonely I Could Die
- Psychosocial experiences of postnatal women during the COVID-19 pandemic. A UK-wide study of prevalence rates and risk factors for clinically relevant depression and anxiety
- ‘Explosion’ of children with tics and Tourette’s from lockdown
- Mental health and well-being during the COVID-19 pandemic: longitudinal analyses of adults in the UK COVID-19 Mental Health & Wellbeing study
- Replying to Christopher Snowdon – Again!
- Lockdowns Do Not Control the Coronavirus: The Evidence
- WHO official urges world leaders to stop using lockdowns as primary virus control method
- Mental health after covid-19 | The BMJ
- Mental Health and COVID-19: Early evidence of the pandemic’s impact: Scientific brief, 2 March 2022 (who.int)
- Where is the space? (thecounsellorscafe.co.uk)
- Covid-19 and its impact on global mental health – PMC (nih.gov)
- Parents fear post-Covid mental health epidemic | Evening Standard
- Small business owners battle mental health issues, new Lancashire survey says | Blackpool Gazette