Since early on in the covid-19 pandemic there have been expressions of concern about its impact on mental health. The mainstream media have reported on these concerns in melodramatic terms, using phrases such as a “tsunami” of referrals to mental health services, or war like analogies. This tone has persisted with the media reporting on the “devastating toll” that the pandemic has had on people’s mental health. 

While there is emerging evidence that the covid-19 pandemic is having a negative impact on people’s mental health, this sort of melodramatic media coverage is unhelpful, with its implication—familiar to those who regret the stigmatisation of mental disorders—that there is something frightening and uncontrollable going on. But melodrama has other more tangible disadvantages.

First is the lost opportunity to conduct, and demonstrate how to conduct, a balanced discussion about the difficulties and uncertainties that attend the interpretation of data. Much of the media coverage consists of anecdotes—the personal interest stories so favoured by journalists—or small-scale interview studies. Data on health service contacts are problematic because of the degree to which disruption caused by the pandemic changes the relation between population prevalence of disorders and attendance rates. So what is, for now, the best evidence probably resides in population surveys. 

However, results from self-reported symptom questionnaires require more cautious interpretation than they are often given. Self-reported symptoms are mainly markers of distress, and although very high scores can be an indication of mental health problem, the likelihood of this depends upon the context. Two studies that have taken repeat measures suggest that most of the distress created by lockdown resolves quite quickly when restrictions are eased. [1,2] 

A bias in thinking about attribution of mental health problems arises with this use of language. A few attempts have been made to link government policy to an increase in mental health problems among the young, but for the most part no explicit suggestions are made. [3] Instead the resort to analogies with war or natural disaster and talk of unprecedented crisis implicitly leads to foregrounding of the pandemic as the main explanation for mental health problems. Undoubtedly, there are big stresses in the current situation, but there are also longer term forces at play. [4-6] Years of government austerity strategy have done great damage, not just to mental health services, but to community assets, employment stability, and family security—the main resources that constitute resilience for the most vulnerable in society.

Mental health is a vague umbrella term that is used to cover everything from the boredom and frustration that so many of us feel for being unable to see friends or go out socially, to severe mental illness. Not all mental health problems require treatment from the mental health services. Even before the pandemic around a third of those identified in the Adult Psychiatric Morbidity Survey as having depression had not been so diagnosed by a professional. [7] A third of adults referred to the Improving Access to Psychological Therapies (IAPT) service do not attend for the first appointment, one possible reason being that many people who are emotionally distressed nonetheless do not want therapy for how they feel. [8]

Of course we need well resourced mental health services, and of course we need to support those whose mental health has been affected by the pandemic. We also need to repair the damage done by years of austerity to schools, community resources, and the quality of life of poorer and more vulnerable communities. Mental health services need to be sufficiently resourced to plan exactly where efforts are best placed. Blanket statements about mental health, may attract media attention, but do not help with thinking about who needs exactly what sort of assistance, either preventive or therapeutic. These are challenging and complex tasks. Dramatic media headlines have a short term impact, but what we really need is reasoned analysis, careful presentation of the facts, and long term planning and resourcing, so that we can support mental health services to look after those whose mental health has been most affected by the pandemic. 

Allan House, emeritus professor of liaison psychiatry at the University of Leeds, I have clinical and research interests in the association between mental disorder and physical illness and its treatment, and in self-harm. Twitter: @allanohouse

Competing interests: none declared. 

References:

1. Fancourt D, Steptoe A, Bu F. Trajectories of anxiety and depressive symptoms during enforced isolation due to COVID-19 in England: a longitudinal observational study. The Lancet Psychiatry. 2020 Dec 9.
2. Shevlin, Mark and Butter, Sarah and McBride, Orla and Murphy, Jamie and Gibson-Miller, Jilly and Hartman, Todd K. and Levita, Liat and Mason, Liam and Martinez, Anton P. and McKay, Ryan and Stocks, Thomas V.A. and Bennett, Kate and Hyland, Philip and Bentall, Richard P., Modelling Changes in Anxiety-Depression and Traumatic Stress During the First Wave of the COVID-19 Pandemic in the UK: Evidence for Population Heterogeneity in Longitudinal Change. Available at SSRN: https://ssrn.com/abstract=3749211 or http://dx.doi.org/10.2139/ssrn.3749211
3. Townsend, E COVID-19 policies in the UK and consequences for mental health, The Lancet Psychiatry, 2020; 7(2): 1014-1015,
4. British Medical Association. Cutting away at our children’s futures: austerity and child health. https://www.bma.org.uk/media/2060/cutting-away-at-our-childrens-futures-austerity-child-health-guuk-2016.pdf
5. Cummins I. The Impact of Austerity on Mental Health Service Provision: A UK Perspective. Int J Environ Res Public Health. 2018 Jun 1;15(6):1145. doi: 10.3390/ijerph15061145.
6. https://blogs.bmj.com/bmj/2020/05/21/young-people-were-reporting-deteriorating-mental-health-even-before-covid-19-struck-we-need-to-take-their-concerns-seriously-going-forward/
7. Adult Psychiatric Morbidity Survey, 2014 https://files.digital.nhs.uk/pdf/t/6/adult_psychiatric_study_ch2_web.pdf
8. Improving Access to Psychological Therapies Annual report 2019-20 https://files.digital.nhs.uk/B8/F973E1/psych-ther-2019-20-ann-rep.pdf accessed 12 February 2021