What are the obligations of the state? A public mental health ethics perspective on the Covid-19 lockdowns

By Daisy Cheung and Eric C. Ip.

The Covid-19 crisis has led to the unprecedented and widespread use of lockdown measures all over the world. With such drastic measures being imposed so widely and on such short notice, the concern is that the Covid-19 precedent, which has allowed the suspension of a wide range of human rights in a desperate attempt to curb the spread of the pandemic, is a dangerous one. Insufficient thought is being given to the effects of policies being put in place. In particular, the effects of these measures on the right to mental health are being overlooked, next to the harm done to the freedoms of movement, residence, assembly, and association.

What is the right to mental health? Legal obligations aside, it can scarcely be disputed that governments have an obligation to advance the common good and public interest, including to eliminate grave and preventable risks not only to the physical health but also the mental health of their people. There are two important reasons for this. First, without a minimally tolerable level of mental health, citizens will be unable to meaningfully exercise civil and political rights like the freedom of speech and the right to vote. This means that the unwillingness of governments to fulfill basic mental health needs will directly impede democracy-enabling rights. Secondly, neglecting the right to mental health will in one way or another lead to neglecting the right to physical health. There is a broad consensus that mental disorders are risk factors for communicable as well as non-communicable diseases, as well as being contributory factors to accidental as well as non-accidental injuries.

How might this right to mental health be violated by the state? What we are concerned about, in a paper we are currently developing, is the failure to take necessary and appropriate steps to protect public mental health during an emergency. In the context of Covid-19 lockdowns, the primary concern is that in implementing an ill-planned, drastic response to the emergency, the response itself may result in harms to public mental health. While we cannot be sure of the precise psychological effects of the lockdowns, past studies of quarantines provide us with useful insight into the types of effects that lockdowns may have on mental health. For example, in a review of such studies, it was found that most of these reported a series of adverse psychological effects, the impact of which was wide-ranging, substantial and in some cases, long-lasting.

Apart from the increased mental health risk to all citizens subjected to lockdown measures, however, the more troubling aspect is perhaps the disproportionate effect that the violation of the right to mental health will have on vulnerable and disadvantaged populations. Low-income families, for example, are often confined to very small spaces for lengthy periods at a time. The psychological risks of living within tight spaces would likely be gravely exacerbated if one has no choice but to remain in that small space, often with family members, for most of the day, with no end in sight. For these families, school closures may also mean that their children are no longer receiving the school meals that they heavily depend on, likely a source of anxiety for parents and children alike. Those with pre-existing mental disorders are also particularly vulnerable in these circumstances. Fear of hospitals and clinics will likely affect the willingness to access timely mental healthcare. Individuals with mental disorders will not be able to engage in many of the usual recommendations for maintaining good mental health, such as socialisation, which will then detrimentally impact their mental state.

There are many other similarly vulnerable and disadvantaged groups. Lockdowns have kept those with abusive family members confined in the same living space as their abusers. The elderly and the disabled may be more likely to suffer difficulties procuring essential supplies such as groceries and masks, in particular during panic-buying, due to issues with mobility. Single parents are left with very few alternatives when faced with the closure of childcare facilities and schools while continuing to work from home. These predicaments are all likely to leave these groups with a range of adverse psychological reactions: fear, anxiety, anger and frustration.

While the use of drastic lockdown measures in response to Covid-19 may be politically understandable, the justifiability of such extreme measures cannot be taken for granted, even if ultimately shown to have been effective in saving large numbers of lives. Consideration needs to be given to how these measures can be implemented with the least possible limitation to the right to mental health. To address the risks to mental health caused by their emergency measures, governments need to design measures that target identified risks to mental health, beginning with the systematic integration of mental health emergency preparedness into their public health emergency planning and response. Measures targeting disadvantaged groups must also be implemented, such as providing shelters for those who would be at greatest risk if confined to a home setting; providing timely, supportive financial compensation measures and providing outreach support services for both psychiatric care and daily needs.

 

Author(s): Daisy Cheung and Eric C. Ip

Affiliations: Faculty of Law, University of Hong Kong, Hong Kong

Competing interests: None declared.

Social media accounts of post author: @daisytmcheung

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